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

• Published in: Journal of critical care 2014-12, Vol.29 (6), p.1001-1005
• Main Authors: Saugel, Bernd, MD, Mair, Sebastian, MD, Meidert, Agnes S., MD, Phillip, Veit, MD, Messer, Marlena, MD, Nennstiel, Simon, MD, Berger, Hermann, MD, Gaa, Jochen, MD, Wagner, Julia Y., MD, Schneider, Heike, PhD, Schmid, Roland M., MD, Huber, Wolfgang, MD
• Format: Article
• Language: English
• Subjects: Aged; Blood Circulation - physiology; Blood Pressure - physiology; Cardiac index; Central Venous Pressure - physiology; Critical Care; Electrolytes; Female; Heart rate; Heart Rate - physiology; Hemodynamic monitoring; Hemodynamics - physiology; Humans; Hypertension; Hypertension, Portal - complications; Hypertension, Portal - physiopathology; Hypertension, Portal - therapy; Intensive care; Laboratories; Liver cirrhosis; Male; Middle Aged; Patients; Plasma; Portal hypertension; Portal Pressure - physiology; Portasystemic Shunt, Surgical; Portasystemic Shunt, Transjugular Intrahepatic; Potassium; Prospective Studies; Pulse; Statistical analysis; Stents; Stroke Volume - physiology; Thermodilution - methods; Transpulmonary thermodilution; Variables; Veins & arteries
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.06.028

Abstract Purpose We 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 Methods This 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. Results Transjugular 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. Conclusions Transjugular 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.