The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Martin Bjorck - One of the best experts on this subject based on the ideXlab platform.
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response to comment on Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
European Journal of Vascular and Endovascular Surgery, 2012Co-Authors: Martin Bjorck, Djavani K Gidlund, Anders WanhainenAbstract:Response to comment on "Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm"
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intra abdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: Djavani K Gidlund, Anders Wanhainen, Martin BjorckAbstract:Response to comment on "Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm"
Tobias Lahmer - One of the best experts on this subject based on the ideXlab platform.
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large volume paracentesis effects plasma disappearance rate of indo cyanine green in critically ill patients with decompensated liver cirrhosis and Intraabdominal Hypertension
Annals of Intensive Care, 2018Co-Authors: Ulrich Mayr, Leonie Fahrenkrogpetersen, Gonzalo Batresbaires, Alexander Herner, Sebastian Rasch, Roland M Schmid, W Huber, Tobias LahmerAbstract:Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal Hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on Intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function.
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large volume paracentesis effects plasma disappearance rate of indo cyanine green in critically ill patients with decompensated liver cirrhosis and Intraabdominal Hypertension
Annals of Intensive Care, 2018Co-Authors: Ulrich Mayr, Leonie Fahrenkrogpetersen, Gonzalo Batresbaires, Alexander Herner, Sebastian Rasch, Roland M Schmid, W Huber, Tobias LahmerAbstract:Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal Hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on Intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function. We analyzed LVP in 22 patients with decompensated liver cirrhosis. ICG-PDR was assessed by using noninvasive LiMON technology (Pulsion® Medical Systems; Maquet Getinge Group), and hepatic blood flow was analyzed by color-coded duplex sonography. Paracentesis of a median volume of 3450 mL ascites evoked significant increases of ICG-PDR from 3.6 (2.8–4.6) to 5.1 (3.9–6.2)%/min (p < 0.001). Concomitantly, we observed a raise in “ICG-Clearance” from 99 (73.5–124.5) to 104 (91–143.5) mL/min/m2 (p = 0.005), while circulating blood volume index was unchanged [2412 (1983–3025) before paracentesis vs. 2409 (1997–2805) mL/m2, p = 0.734]. Sonography revealed a significant impact of paracentesis on hepatic blood flow: Hepatic artery resistance index dropped from 0.74 (0.68–0.75) to 0.68 (0.65–0.71) (p < 0.001) and maximum flow velocity in hepatic vein increased from 24 (17–30) to 30 (22–36) cm/s (p < 0.001). Consistent with previous studies, paracentesis caused significant decreases in IAP from 19.0 (15.0–20.3) to 11.0 (8.8–12.3) mmHg (p < 0.001) and central venous pressure from 22.5 (17.8–29.0) to 17.5 (12.8–24.0) mmHg (p < 0.001) with inverse increases in APP from 63.0 (56.8–69.5) to 71.0 (65.5–78.5) mmHg (p < 0.001). Changes in ICG-PDR were concomitant with changes in IAP (r = − 0.602) and APP (r = 0.576). Moreover, we found a substantial improvement in respiratory function. By contrast, hemodynamic parameters assessed by transpulmonary thermodilution, serum bilirubin and international normalized ratio did not change after paracentesis. Critically ill patients with decompensated cirrhosis and elevated IAP showed dramatically impaired ICG-PDR. Paracentesis evoked an improvement in ICG-PDR in parallel with a decreased IAP and an increased APP, while conventional parameters of liver function did not change. This effect on ICG-PDR is mainly referable to a relief of Intraabdominal Hypertension and changes in hepatosplanchnic blood flow.
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impact of large volume paracentesis on respiratory parameters including transpulmonary pressure and on transpulmonary thermodilution derived hemodynamics a prospective study
PLOS ONE, 2018Co-Authors: Ulrich Mayr, Sebastian Rasch, Roland M Schmid, Tobias Lahmer, Eugen Karsten, Philipp Thies, Benedikt Henschel, Gerrit Fischer, Wolfgang HuberAbstract:INTRODUCTION Appropriate mechanical ventilation and prevention of alveolar collaps is mainly dependent on transpulmonary pressure TPP. TPP is assessed by measurement of esophageal pressure EP, largely influenced by pleural and Intraabdominal pressure IAP. Consecutively, TPP-guided ventilation might be particularly useful in patients with high IAP. This study investigates the impact of large volume paracentesis LVP on TPP, EP, IAP as well as on hemodynamic and respiratory function in patients with liver cirrhosis and tense ascites. MATERIAL AND METHODS We analysed 23 LVP-procedures in 11 cirrhotic patients ventilated with the AVEA Viasys respirator (CareFusion, USA) which is capable to measure EP via an esophageal tube. RESULTS LVP of a mean volume of 4826±1276 mL of ascites resulted in marked increases in inspiratory (17.9±8.9 vs. 5.4±13.3 cmH2O; p<0.001) as well as expiratory TPP (-3.0±4.7 vs. -15.9±10.9 cmH2O; p<0.001; primary endpoint). In parallel, the inspiratory (2.4±8.7 vs. 14.1±14.5 cmH2O; p<0.001) and expiratory EP (12.4±6.0 vs. 24.9±11.3 cmH2O; p<0.001) significantly decreased. The effects were most pronounced for the release of the first 500 mL of ascites. LVP evoked substantial decreases in IAP and central venous pressure CVP. By contrast, mean arterial pressure, cardiac index, global end-diastolic volume index, extravascular lung water index and systemic vascular resistance index did not change. Among the respiratory parameters we observed an increase in paO2/FiO2 (247.7±60.9 vs. 208.3±46.8 mmHg; p<0.001) and a decrease in Oxygenation Index OI (4.8±2.0 vs. 5.8±3.1 cmH2O/mmHg; p = 0.002). Tidal volume (510±100 vs. 452±113 mL; p = 0.008) and dynamic respiratory system compliance Cdyn (46.8±15.9 vs. 35.1±14.6 mL/cmH20; p<0.001) increased, whereas paCO2 (47.3±10.7 vs. 51.2±12.3mmHg; p = 0.046) and the respiratory rate decreased (17.1±7.3 vs. 19.6±7.8 min-1; p = 0.010). CONCLUSIONS In mechanically ventilated patients with decompensated cirrhosis, Intraabdominal Hypertension resulted in a substantially decreased TPP despite PEEP-setting according to the ARDSNet. In these patients LVP markedly increased TPP and improved respiratory function in parallel with a decline of EP. Furthermore, LVP induced a decrease in IAP and CVP, while other hemodynamic parameters did not change.
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Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and Intraabdominal Hypertension
SpringerOpen, 2018Co-Authors: Ulrich Mayr, Alexander Herner, Sebastian Rasch, Roland M Schmid, Wolfgang Huber, Leonie Fahrenkrog-petersen, Gonzalo Batres-baires, Tobias LahmerAbstract:Abstract Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal Hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on Intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function. Methods We analyzed LVP in 22 patients with decompensated liver cirrhosis. ICG-PDR was assessed by using noninvasive LiMON technology (Pulsion® Medical Systems; Maquet Getinge Group), and hepatic blood flow was analyzed by color-coded duplex sonography. Results Paracentesis of a median volume of 3450 mL ascites evoked significant increases of ICG-PDR from 3.6 (2.8–4.6) to 5.1 (3.9–6.2)%/min (p
Anders Wanhainen - One of the best experts on this subject based on the ideXlab platform.
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response to comment on Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
European Journal of Vascular and Endovascular Surgery, 2012Co-Authors: Martin Bjorck, Djavani K Gidlund, Anders WanhainenAbstract:Response to comment on "Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm"
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intra abdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: Djavani K Gidlund, Anders Wanhainen, Martin BjorckAbstract:Response to comment on "Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm"
Ulrich Mayr - One of the best experts on this subject based on the ideXlab platform.
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large volume paracentesis effects plasma disappearance rate of indo cyanine green in critically ill patients with decompensated liver cirrhosis and Intraabdominal Hypertension
Annals of Intensive Care, 2018Co-Authors: Ulrich Mayr, Leonie Fahrenkrogpetersen, Gonzalo Batresbaires, Alexander Herner, Sebastian Rasch, Roland M Schmid, W Huber, Tobias LahmerAbstract:Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal Hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on Intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function.
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large volume paracentesis effects plasma disappearance rate of indo cyanine green in critically ill patients with decompensated liver cirrhosis and Intraabdominal Hypertension
Annals of Intensive Care, 2018Co-Authors: Ulrich Mayr, Leonie Fahrenkrogpetersen, Gonzalo Batresbaires, Alexander Herner, Sebastian Rasch, Roland M Schmid, W Huber, Tobias LahmerAbstract:Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal Hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on Intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function. We analyzed LVP in 22 patients with decompensated liver cirrhosis. ICG-PDR was assessed by using noninvasive LiMON technology (Pulsion® Medical Systems; Maquet Getinge Group), and hepatic blood flow was analyzed by color-coded duplex sonography. Paracentesis of a median volume of 3450 mL ascites evoked significant increases of ICG-PDR from 3.6 (2.8–4.6) to 5.1 (3.9–6.2)%/min (p < 0.001). Concomitantly, we observed a raise in “ICG-Clearance” from 99 (73.5–124.5) to 104 (91–143.5) mL/min/m2 (p = 0.005), while circulating blood volume index was unchanged [2412 (1983–3025) before paracentesis vs. 2409 (1997–2805) mL/m2, p = 0.734]. Sonography revealed a significant impact of paracentesis on hepatic blood flow: Hepatic artery resistance index dropped from 0.74 (0.68–0.75) to 0.68 (0.65–0.71) (p < 0.001) and maximum flow velocity in hepatic vein increased from 24 (17–30) to 30 (22–36) cm/s (p < 0.001). Consistent with previous studies, paracentesis caused significant decreases in IAP from 19.0 (15.0–20.3) to 11.0 (8.8–12.3) mmHg (p < 0.001) and central venous pressure from 22.5 (17.8–29.0) to 17.5 (12.8–24.0) mmHg (p < 0.001) with inverse increases in APP from 63.0 (56.8–69.5) to 71.0 (65.5–78.5) mmHg (p < 0.001). Changes in ICG-PDR were concomitant with changes in IAP (r = − 0.602) and APP (r = 0.576). Moreover, we found a substantial improvement in respiratory function. By contrast, hemodynamic parameters assessed by transpulmonary thermodilution, serum bilirubin and international normalized ratio did not change after paracentesis. Critically ill patients with decompensated cirrhosis and elevated IAP showed dramatically impaired ICG-PDR. Paracentesis evoked an improvement in ICG-PDR in parallel with a decreased IAP and an increased APP, while conventional parameters of liver function did not change. This effect on ICG-PDR is mainly referable to a relief of Intraabdominal Hypertension and changes in hepatosplanchnic blood flow.
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impact of large volume paracentesis on respiratory parameters including transpulmonary pressure and on transpulmonary thermodilution derived hemodynamics a prospective study
PLOS ONE, 2018Co-Authors: Ulrich Mayr, Sebastian Rasch, Roland M Schmid, Tobias Lahmer, Eugen Karsten, Philipp Thies, Benedikt Henschel, Gerrit Fischer, Wolfgang HuberAbstract:INTRODUCTION Appropriate mechanical ventilation and prevention of alveolar collaps is mainly dependent on transpulmonary pressure TPP. TPP is assessed by measurement of esophageal pressure EP, largely influenced by pleural and Intraabdominal pressure IAP. Consecutively, TPP-guided ventilation might be particularly useful in patients with high IAP. This study investigates the impact of large volume paracentesis LVP on TPP, EP, IAP as well as on hemodynamic and respiratory function in patients with liver cirrhosis and tense ascites. MATERIAL AND METHODS We analysed 23 LVP-procedures in 11 cirrhotic patients ventilated with the AVEA Viasys respirator (CareFusion, USA) which is capable to measure EP via an esophageal tube. RESULTS LVP of a mean volume of 4826±1276 mL of ascites resulted in marked increases in inspiratory (17.9±8.9 vs. 5.4±13.3 cmH2O; p<0.001) as well as expiratory TPP (-3.0±4.7 vs. -15.9±10.9 cmH2O; p<0.001; primary endpoint). In parallel, the inspiratory (2.4±8.7 vs. 14.1±14.5 cmH2O; p<0.001) and expiratory EP (12.4±6.0 vs. 24.9±11.3 cmH2O; p<0.001) significantly decreased. The effects were most pronounced for the release of the first 500 mL of ascites. LVP evoked substantial decreases in IAP and central venous pressure CVP. By contrast, mean arterial pressure, cardiac index, global end-diastolic volume index, extravascular lung water index and systemic vascular resistance index did not change. Among the respiratory parameters we observed an increase in paO2/FiO2 (247.7±60.9 vs. 208.3±46.8 mmHg; p<0.001) and a decrease in Oxygenation Index OI (4.8±2.0 vs. 5.8±3.1 cmH2O/mmHg; p = 0.002). Tidal volume (510±100 vs. 452±113 mL; p = 0.008) and dynamic respiratory system compliance Cdyn (46.8±15.9 vs. 35.1±14.6 mL/cmH20; p<0.001) increased, whereas paCO2 (47.3±10.7 vs. 51.2±12.3mmHg; p = 0.046) and the respiratory rate decreased (17.1±7.3 vs. 19.6±7.8 min-1; p = 0.010). CONCLUSIONS In mechanically ventilated patients with decompensated cirrhosis, Intraabdominal Hypertension resulted in a substantially decreased TPP despite PEEP-setting according to the ARDSNet. In these patients LVP markedly increased TPP and improved respiratory function in parallel with a decline of EP. Furthermore, LVP induced a decrease in IAP and CVP, while other hemodynamic parameters did not change.
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Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and Intraabdominal Hypertension
SpringerOpen, 2018Co-Authors: Ulrich Mayr, Alexander Herner, Sebastian Rasch, Roland M Schmid, Wolfgang Huber, Leonie Fahrenkrog-petersen, Gonzalo Batres-baires, Tobias LahmerAbstract:Abstract Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal Hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on Intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function. Methods We analyzed LVP in 22 patients with decompensated liver cirrhosis. ICG-PDR was assessed by using noninvasive LiMON technology (Pulsion® Medical Systems; Maquet Getinge Group), and hepatic blood flow was analyzed by color-coded duplex sonography. Results Paracentesis of a median volume of 3450 mL ascites evoked significant increases of ICG-PDR from 3.6 (2.8–4.6) to 5.1 (3.9–6.2)%/min (p
Djavani K Gidlund - One of the best experts on this subject based on the ideXlab platform.
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response to comment on Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
European Journal of Vascular and Endovascular Surgery, 2012Co-Authors: Martin Bjorck, Djavani K Gidlund, Anders WanhainenAbstract:Response to comment on "Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm"
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intra abdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: Djavani K Gidlund, Anders Wanhainen, Martin BjorckAbstract:Response to comment on "Intraabdominal Hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm"
