Prevention of the Paracentesis-Induced Circulatory Dysfunction (PICD) in Cirrhosis: Is the SPA Treatment Worthwhile?

Excerpt

The older leading concept concerning ascites formation postulates an imbalance of oncotic and hydrostatic forces, with portal pressure pushing fluid into the peritoneal cavity opposed by the serum colloid osmotic pressure generated by albumin. When hydrostatic exceed oncotic forces, the abdominal cavity fills with fluid until a counterbalancing increase in abdominal pressure prevents further ascites formation. Furthermore, patients with ascites are almost perfectly separated from those without ascites on the basis of portal pressure (relative to the cardiac pressure) and serum albumin concentration [1] seeming to support this concept. According to this model, decreased intra-abdominal pressure due to fluid removal by paracentesis promotes fluid movement into the peritoneal cavity at the expense of the intravascular compartment, potentially resulting in catastrophic hypotension and renal failure. Since these events were thought to occur soon after paracentesis, the prevailing recommendation was for <2 L to be removed at any one time. Harmful effects from paracentesis were considered likely despite a large global clinical experience that had not identified a high incidence of hypotension or renal failure due to a common and routine clinical procedure. …