Mean Change in Respiratory Functions With Paracentesis in Chronic Hepatitis C Patients With Cirrhotic Ascites

Faizah  Mukhtar; Moazama Shakeel  Ahmed

doi:10.54112/bcsrj.v6i3.1618

Authors

Faizah Mukhtar Akhtar Saeed Trust Hospital EME Society Lahore, Pakistan
Moazama Shakeel Ahmed King Edward Medical University/Mayo Hospital Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i3.1618

Keywords:

Paracentesis, chronic Hepatitis C, cirrhotic ascites, respiratory function, tidal volume, minute volume, vital capacity

Abstract

Chronic Hepatitis C (CHC) with cirrhotic ascites is associated with significant respiratory dysfunction due to mechanical compression of the diaphragm and lungs. Objective: To evaluate the mean change in respiratory functions following paracentesis in patients with chronic Hepatitis C and cirrhotic ascites. Methods: A cross-sectional study was conducted at the Department of Internal Medicine, Akhtar Saeed Trust Hospital, Lahore. A total of 154 patients aged 25-65 years with chronic Hepatitis C and cirrhotic ascites were enrolled. Patients underwent baseline assessments of respiratory function, including circumferential measurements and ventilometry, 30 minutes before and after paracentesis. Results: Significant improvements in respiratory function were observed following paracentesis. Tidal volume increased by 90 ± 50 mL (p < 0.001), minute volume by 0.8 ± 0.4 L/min (p < 0.001), and vital capacity by 0.6 ± 0.3 L (p < 0.001). Respiratory rate decreased by 2 ± 1 breaths/min (p < 0.001). Circumferential measurements at axillary, xiphoid, and umbilical reference points showed significant reductions, indicating decreased abdominal pressure. These improvements were consistent across gender and age groups. Conclusion: Paracentesis significantly improves respiratory function in patients with chronic Hepatitis C and cirrhotic ascites. The procedure reduces intra-abdominal pressure, enhances lung expansion, and improves ventilatory parameters. Paracentesis should be considered a valuable therapeutic intervention for both ascites and respiratory dysfunction in this patient population.

Downloads

Download data is not yet available.

References

Castellanos MI, Borges SA, Stepanova M, Infante ME, Ruentes C, González SM, et al. Health-related quality of life in Cuban patients with chronic liver disease: A real-world experience. Ann Hepatol. 2021;22(5):100277.

Sarin SK, Choudhury A. Management of acute-on-chronic liver failure: an algorithmic approach. Hepatol Int. 2018;12(5):402-416.

Mustapha SK. Cirrhotic ascites: A review of pathophysiology and management. Niger ET Gastroenterol Hepatol. 2020;12(1):3-12

Biggins SW, Angeli P, Garcia Tsao G, Ginés P, Ling SC, Nadim MK. Et al. Diagnosis evaluation, and management of ascites. Spontaneous bacterial peritonitis and hepatorenal Syndrome: 2021 practice-guidanee by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-48.

Theodorakopoulos T. Kalafateli M. Kalambokis GN. Samonakis DN. Aggelotopoulou I,Tsokias C. Et al. Natural history of grade 1 ascites in patients with liver cirrhosis. Ann Gastroenterol. 2021;34(1):93-103.

Salerno F. Guevara M. Bernard M. Moreau R. Wong F. Angeli P. Et al. Refractory ascites pathogenesis. Definition and therapy of a severe complication in patients with cirrhosis. Liver Int. 2010;30(7):937-47.

Awad NF. Elbalsha AA. Abo Amer MZ. Ibrahim MH. Study of the relationship between Severity of liver cirrhosis and pulmonary function tests. Egypt J Hospital Med. 2019:76(7):4570-6.

Zhao R, Lu J, Shi Y, Zhao H. Xu K. Sheng J. Current management of refractory ascites in patients with cirrhosis. J Int Med Res. 2018;46(3):1138-45.

Wittmer VL. Lima RT. Maia MC, Duarte H, Paro FM. Respiratory and symptomatic impact of ascites relief by paracentesis in patients with hepatic cirrhosis. Arg Gastroenterol. 2020;57(7):64-8.

Gift AG. Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care. 1998:7:200-4.

Angueira CE, Kadakia SC. Effects of large-volume paracentesis on pulmonary function in patients with tense cirrhotic ascites. Hepatology. 1994 Oct;20(4 Pt 1):825-8. doi: 10.1002/hep.1840200409. PMID: 7927222.

Mayr U, Karsten E, Lahmer T, Rasch S, Thies P, Henschel B, Fischer G, Schmid RM, Huber W. Impact of large volume paracentesis on respiratory parameters including transpulmonary pressure and on transpulmonary thermodilution derived hemodynamics: A prospective study. PLoS One. 2018 Mar 14;13(3):e0193654. doi: 10.1371/journal.pone.0193654. PMID: 29538440; PMCID: PMC5851588.

Pereira RA, Esteves AF, Cardoso FS, Perdigoto R, Marcelino P, Saliba F. Abdominal perfusion pressure in critically ill cirrhotic patients: a prospective observational study. Sci Rep. 2023 May 26;13(1):8550. doi: 10.1038/s41598-023-34367-6. PMID: 37237113; PMCID: PMC10214359.

Mayr, U. et al. Impact of large volume paracentesis on respiratory parameters including transpulmonary pressure and on transpulmonary thermodilution derived hemodynamics: A prospective study. PLoS One. 13(3), e0193654 (2018).

Gül F, et al. Abdominal perfusion pressure is superior from intra-abdominal pressure to detect deterioration of renal perfusion in critically Ill patients. Ulus Travma Acil Cerrahi Derg. 2019;25:561–566

Pereira R, et al. Intra-abdominal hypertension and abdominal compartment syndrome in the critically ill liver cirrhotic patient–prevalence and clinical outcomes. A multicentric retrospective cohort study in intensive care. PLoS ONE. 2021;16:e0251498. doi: 10.1371/journal.pone.0251498.

Engelmann C, Clària J, Szabo G, Bosch J, Bernardi M. Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction. J. Hepatol. 2021;75:S49. doi: 10.1016/j.jhep.2021.01.002.

Gaetano JN, et al. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. J. Gastroenterol. Hepatol. 2016;31:1025–1030. doi: 10.1111/jgh.13255.

Montagnese S, et al. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy. J. Hepatol. 2022;77:807–824. doi: 10.1016/j.jhep.2022.06.001

Evans L, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Crit. Care Med. 2021;49:e1063–e1143. doi: 10.1097/CCM.0000000000005337