Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites

Background-Some cirrhotic patients with tense ascites who undergo paracente sis develop a circulatory dysfunction syndrome, manifested by an increase i n plasma renin activity. Recently, a significant inverse correlation betwee n postparacentesis changes in plasma renin activity and systemic vascular r esistance has been demonstrated in these patients, suggesting that peripher al arterial vasodilatation could be responsible for this circulatory dysfun ction, but the mechanisms by which tense ascites removal induces such chang es are unknown Aim-To investigate the role of a decrease in intra-abdominal pressure (IAP) in the development of early postparacentesis haemodynamic changes Methods- Eleven cirrhotic patients with tense ascites received a large volume parace ntesis. A specially designed pneumatic girdle was used to compress the abdo men to avoid a decrease in IAP during ascites removal. Haemodynamic studies were performed before paracentesis, one hour after ascites flow stopped, a nd 30 minutes after pneumatic girdle deflation Results-When LAP was maintained at its original level, no haemodynamic chan ges were observed, despite large volume paracentesis. However, a significan t decrease in systemic vascular resistance was seen immediately after pneum atic girdle deflation Conclusions-Early haemodynamic changes after paracentesis are avoided if IA P is maintained at its original level. The abrupt decrease in IAP could be the trigger for the development of the initial haemodynamic changes that ev entually produce postparacentesis circulatory dysfunction.