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Liver cirrhosis is a major cause of morbidity and mortality in chronic liver disease patients which is multifactorial in nature, leading to several complications including ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis and hepatorenal syndrome.
Also, cirrhotic patients have circulatory changes with high cardiac output and low systemic vascular resistance, rendering them more susceptible to develop circulatory dysfunction and shock due to its complications with end result of multiple organ failure.
Circulatory failure in complicated cirrhotic patients is either distributive as in spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS), or hypovolemic as in variceal bleeding characterized by a greater decrease in arterial pressure associated with signs of impaired tissue perfusion, requiring prompt volume resuscitation to avoid lethal complications of irreversible shock stage.
Fluid management of shocked hepatic patients should be directed to improve circulatory dysfunction and tissue perfusion without overtransfusion causing tissue edema, increased ascites and portal hypertension increase with subsequent risk of variceal bleeding, or under transfusion increasing risk of multiple organ failure development.
This requires a careful assessment of the intravascular volume status and fluid responsiveness targeting fluid therapy, including a variety of static and dynamic parameters used to assess volume status.
Central venous catheter is a static measure being followed widely to assess the volume status and thereby treating the patient accordingly. Insertion of central venous catheter is contraindicated in certain situations as any coagulation disorders, infection over the insertion site etc. There are many reported complications with central venous catheter insertion e.g. infections, accidental arterial puncture, hematoma, hemothorax, pneumothorax, air embolism and dysrhythmias.
Recently the ultrasound guided measurement of the inferior vena cava diameter and its changes with respiration have been used to calculate the fluid status of a patient. It is a safe non invasive technique. It can be used as an alternative to central venous pressure (CVP) to assess the volume status of patients. It is considered a dynamic measure of intravascular volume status, as it reflects the volume changes occurring with respiration.
This study was done on 100 shocked cirrhotic patients to evaluate the correlation between central venous pressure (CVP) measurements and ultrasound measurements of the inferior vena cava diameter, and its collapsibility index, showing a solid negative correlation between the central venous pressure and the inferior vena cava collapsibility index (IVC-CI) in the form of caval index value decline with central venous pressure increase during patient resuscitation with subsequent vital data improvement, denoting that measurement of the inferior vena cava collapsibility index (IVC-CI)is a good non invasive indicator of fluid responsiveness in shocked hepatic patients that can substitute the traditional volume status assessment via central venous pressure catheter.