| Effects of TIPS on global end-diastolic volume and cardiac output and renal resistive index in ICU patients with advanced alcoholic cirrhosis. | |
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MedLine Citation:
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PMID: 20308721 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andreas Umgelter; Wolfgang Reindl; Fabian Geisler; Bernd Saugel; Wolfgang Huber; Hermann Berger; Roland M Schmid |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of hepatology Volume: 9 ISSN: 1665-2681 ISO Abbreviation: Ann Hepatol Publication Date: 2010 Jan-Mar |
Date Detail:
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Created Date: 2010-03-23 Completed Date: 2010-07-06 Revised Date: 2012-04-05 |
Medline Journal Info:
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Nlm Unique ID: 101155885 Medline TA: Ann Hepatol Country: Mexico |
Other Details:
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Languages: eng Pagination: 40-5 Citation Subset: IM |
Affiliation:
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2nd Medical Department, Klinikum rechts der Isar, Technical University of Munich, Germany. andreas.umgelter@lrz.tu-muenchen.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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