Clinical InvestigationPrompt Reduction in Intra-Abdominal Pressure Following Large-Volume Mechanical Fluid Removal Improves Renal Insufficiency in Refractory Decompensated Heart Failure
Section snippets
Patient Population
We prospectively enrolled consecutive subjects (aged ≥ 18 years), with symptomatic heart failure (New York Heart Association class III and IV), who underwent a right-sided heart catheterization for intensive medical therapy of ADHF at the Cleveland Clinic heart failure intensive care unit between March 1, 2007, and June 30, 2007. Subjects who met the following inclusion criteria were enrolled in the study: 1) markedly impaired systolic left ventricular function defined by left ventricular
Baseline Characteristics and Medical Treatment
A total of 9 subjects met eligibility criteria for the study, with 5 of the group receiving paracentesis and 4 of the group receiving ultrafiltration. Baseline characteristics and medical treatment during admission of the subjects are summarized in Table 1. All subjects underwent intensive medical therapy for an average of 12 hours before commencing mechanical fluid removal. As expected, subjects who underwent large-volume paracentesis had extensive abdominal ascites documented by ultrasound.
Discussion
There are several key findings in our hypothesis-generating study. First, we identified the association between the presence of refractory, volume-overloaded ADHF and further increase in IAP. Furthermore, this pathophysiologic link probably is associated with the presence of worsening renal function despite intensive medical therapy. Second, we identified the effectiveness of large-volume mechanical fluid removal (by paracentesis or ultrafiltration, whenever applicable) in achieving effective
Conclusions
Large-volume mechanical fluid removal can achieve a reduction of otherwise persistently elevated IAP with corresponding improvement in renal function in selected volume-overloaded patients admitted with ADHF refractory to intensive medical therapy. Further studies are warranted to determine the clinical utility of IAP measurements in this challenging patient population.
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