Single, total paracentesis for tense ascites: sequential hemodynamic changes and right atrial size

Area of Science:

• Cardiology
• Gastroenterology
• Critical Care Medicine

Background:

• Tense ascites significantly impacts intra-abdominal pressure and hemodynamics.
• Paracentesis is a common procedure for managing tense ascites.
• Understanding hemodynamic shifts post-paracentesis is crucial for patient management.

Purpose of the Study:

• To evaluate hemodynamic changes following total paracentesis in patients with tense ascites.
• To assess the timing and potential need for therapeutic plasma expansion.
• To explore the utility of echocardiography in identifying right atrial compression.

Main Methods:

• Hemodynamic parameters (cardiac output, pressures) were monitored before and after paracentesis in 21 patients.
• Fluid drainage ranged from 4 to 16 L over 2 to 8 hours.
• Two-dimensional echocardiography was used in a subset of patients (n=8) to assess atrial dimensions.

Main Results:

• Early post-paracentesis (60 min) showed increased cardiac output and decreased right atrial pressure.
• Later (3-12 hr), significant decreases in right atrial pressure, pulmonary capillary wedge pressure, and cardiac output were observed, indicating relative hypovolemia.
• Echocardiography revealed reduced right to left atrium area ratio in tense ascites patients, suggesting right atrial compression.

Conclusions:

• Total paracentesis induces transient hemodynamic improvements followed by relative hypovolemia, necessitating consideration of plasma expansion.
• Echocardiography can identify right atrial compression in patients with tense ascites.
• These findings guide fluid management strategies post-paracentesis for ascites.