• Journal of critical care · Dec 2014

    The effects of transjugular intrahepatic portosystemic stent shunt on systemic cardiocirculatory parameters.

    • Bernd Saugel, Sebastian Mair, Agnes S Meidert, Veit Phillip, Marlena Messer, Simon Nennstiel, Hermann Berger, Jochen Gaa, Julia Y Wagner, Heike Schneider, Roland M Schmid, and Wolfgang Huber.
    • II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany. Electronic address: bernd.saugel@gmx.de.
    • J Crit Care. 2014 Dec 1;29(6):1001-5.

    PurposeWe aimed to evaluate the effects of transjugular intrahepatic portosystemic stent shunt (TIPS) on systemic cardiocirculatory parameters in patients treated with TIPS for portal hypertension-associated complications.Materials And MethodsThis prospective study was conducted in an intensive care unit of a German university hospital (October 2010-July 2013). We assessed hemodynamic parameters before and after TIPS placement using single-indicator transpulmonary thermodilution and pulse contour analysis. After exclusion of 5 patients treated with vasoactive agents during study measurements, 15 patients were included in the final statistical analysis.ResultsTransjugular intrahepatic portosystemic stent shunt induced a statistically significant decrease in portal pressure (median, 29 [25%-75% percentile range, 23-37] mm Hg before TIPS vs 21 [18-27] mm Hg after TIPS; P<.01) in parallel with a statistically significant increase in central venous pressure (10 [6-15] mm Hg before TIPS vs 13 [9-16] mm Hg after TIPS; P=.01), cardiac index (3.8 [2.9-4.6] L min(-1) m(-2) before TIPS vs 4.5 [3.8-5.4] L min(-1) m(-2) 14 hours after TIPS; P=.01), and stroke volume index (54 [42-60] mL/m2 before TIPS vs 60 [47-63] mL/m2 14 hours after TIPS; P=.03). Arterial blood pressure and systemic vascular resistance index were statistically significantly lower after TIPS.ConclusionsTransjugular intrahepatic portosystemic stent shunt placement is associated with an increase in central venous pressure and an improvement of global blood flow (cardiac index and stroke volume index) in patients with portal hypertension.Copyright © 2014 Elsevier Inc. All rights reserved.

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