Document Detail


Effects of TIPS on global end-diastolic volume and cardiac output and renal resistive index in ICU patients with advanced alcoholic cirrhosis.
MedLine Citation:
PMID:  20308721     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The transjugular porto-systemic stent-shunt (TIPS) reduces portal pressure in cirrhotic patients and is used as a nonsurgical treatment for refractory ascites, recurrent variceal hemorrhage or hepatorenal syndrome. There are concerns regarding a negative impact on cirrhotic cardiomyopathy and deterioration of hyperkinetic circulatory dysfunction. We analyzed a prospectively maintained database containing hemodynamic data on cirrhotic ICU patients. Hemodynamic monitoring was performed using transpulmonary thermodilution (PiCCO, Pulsion Medical Systems, Munich, Germany). Renal perfusion was assessed by Doppler ultrasound during studies of portal and TIPS perfusion before and after the procedure. Complete data sets of 8 patients (4 male, 4 female, age 60 years (52-67), Child-Pugh-Turcotte score 10 (8-12)) were available. After TIPS, there was a substantial increase of GEDVI (646 ml/m2 (580-737) to 663 mL/m2 (643-792); p=0.036) that was even more pronounced at 24 hours (716 mL/m2 (663-821); P=0.012). CI increased from 3.3 L/min/m2 (3.1-4.2) to 3.9 L/min/m2 (3.6-5.3) (p=0.012) and 3.9 L/min/m2 (3.7-5.2) (p=0.017), respectively. There was a significant decrease of renal RI from 0.810 (0.781-0.864) to 0.746 (0.710-0.798) (p=0.028) and a transient increase of fractional excretion of sodium. SVRI (1737 dyn*s/cm5/m2 (1088 . 2115) vs. 1917 dyn*s/cm5/m2 (1368-2177) was not significantly altered immediately after TIPS but decreased to 1495 dyn*s/cm5/m2 (833- 1765) at 24 hours (p=0.036). There were no significant changes of mean arterial pressure (MAP). In conclusion, TIPS resulted in a pronounced increase of central blood volume. The observed hemodynamic effects are compatible with a preload driven increase of cardiac output and secondary decreases in SVRI and RI.
Authors:
Andreas Umgelter; Wolfgang Reindl; Fabian Geisler; Bernd Saugel; Wolfgang Huber; Hermann Berger; Roland M Schmid
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of hepatology     Volume:  9     ISSN:  1665-2681     ISO Abbreviation:  Ann Hepatol     Publication Date:    2010 Jan-Mar
Date Detail:
Created Date:  2010-03-23     Completed Date:  2010-07-06     Revised Date:  2013-05-16    
Medline Journal Info:
Nlm Unique ID:  101155885     Medline TA:  Ann Hepatol     Country:  Mexico    
Other Details:
Languages:  eng     Pagination:  40-5     Citation Subset:  IM    
Affiliation:
2nd Medical Department, Klinikum rechts der Isar, Technical University of Munich, Germany. andreas.umgelter@lrz.tu-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / physiology
Blood Volume / physiology*
Cardiac Output / physiology*
Cardiomyopathies / etiology,  physiopathology
Female
Hemodynamics / physiology
Humans
Hypertension, Portal / etiology,  physiopathology
Intensive Care Units*
Kidney / blood supply*
Liver Cirrhosis, Alcoholic / complications,  physiopathology*,  surgery
Male
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic*
Retrospective Studies
Treatment Outcome
Vascular Resistance / physiology*

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