Albumin infusion fails to restore circulatory function following paracentesis of tense ascites as assessed by beat-to-beat haemodynamic measurements

Aims: To study whether circulatory changes during large volume paracentesis (LVP) in patients with liver cirrhosis and tense ascites as assessed by novel non‐invasive haemodynamic measuring technology are reversed by subsequent albumin infusion. Materials and methods: Eleven patients with portal hypertensive ascites secondary to liver cirrhosis of Child's class B or C were studied during LVP (10.7 ± 4.4 l) and subsequent infusion of albumin. Digital arterial pulse waves were continuously measured by vascular unloading technique providing data for beat‐to‐beat values of systolic (P_s), diastolic (P_d) and mean arterial pressures (P_m), respectively, as well as for heart rate (F_h), stroke volume (V_s), cardiac output (Q_co) and peripheral resistance (R). Data extrapolated to the end of paracentesis, albumin infusion and follow‐up phases were compared with the end of the equilibration phase. Results: At the end of paracentesis, P_s, P_m and P_d changed by ?14 ± 15% (p < 0.05), ?16 ± 11% (p < 0.01) and ?17 ± 11% (p < 0.001), respectively, whereas Q_co and F_h did not change substantially. There was a highly significant increase in V_s by +21 ± 25% (p < 0.01). The largest change was seen in R which significantly decreased by ?29 ± 24% (p < 0.01). This change was not reversed by infusion of albumin and persisted up to the end of follow‐up. Conclusion: The haemodynamic changes following LVP appear to be first and foremost controlled by changes in peripheral resistance with insufficient cardiac compensation. Further studies combining albumin with vasopressors for prevention of paracentesis‐induced circulatory changes are needed.