Balancing volume resuscitation and ascites management in cirrhosis

Federico Polli, Luciano Gattinoni

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose of review: Patients with cirrhosis have total extracellular fluid overload but central effective circulating hypovolaemia. The resulting neurohumoral compensatory response favours the accumulation of fluids into the peritoneal cavity (ascites) and may hinder renal perfusion (hepatorenal syndrome). Their deranged systemic haemodynamics (hyperdynamic circulatory syndrome) is characterized by elevated cardiac output with decreased systemic vascular resistance and low blood pressure. Recent findings: Molecular and biological mechanisms determining cirrhosis-induced haemodynamic alterations are progressively being elucidated. The need for a goal-directed assessment of volume resuscitation (especially with volumetric techniques) in patients with cirrhosis is becoming more and more evident. The role of fluid expansion with albumin and the use of splanchnic vasopressors in a variety of cirrhosis-related conditions has recently been investigated. Summary: The response to fluid loading in patients with advanced cirrhosis is abnormal, primarily resulting in expansion of their noncentral blood volume compartment. Colloid solutions, in particular albumin, are best used in these patients. Albumin may be effective in preventing the haemodynamic derangements associated with large-volume paracentesis (paracentesis-induced circulatory dysfunction), in preventing renal failure during spontaneous bacterial peritonitis and, in association with splanchnic vasopressors, in caring for patients with the hepatorenal syndrome.

Original languageEnglish
Pages (from-to)151-158
Number of pages8
JournalCurrent Opinion in Anaesthesiology
Volume23
Issue number2
DOIs
Publication statusPublished - Apr 2010

Keywords

  • Ascites
  • Fluid therapy
  • Haemodynamics
  • Liver cirrhosis
  • Serum albumin

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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