Reviewer's report
Title:Effects of paracentesis on hemodynamic parameters and respiratory
function in critically ill patients
Version:1Date:10 December 2013
Reviewer: Erwin Gäbele
Reviewer's report:
In the manuscript „Effects of paracentesis on hemodynamic parameters and
respiratory function in critically ill patients“ Philipp and coworkers demonstrated
that paracentesis in patients with advanced liver cirrhosis was safe regarding
cardiocirculatory parameters and significantly improved respiratory function in
mechanically ventilated patients.
Specifically, mean arterial pressure and systemic vascular resistance index,
using standard monitoring procedures, initially showed a slight decrease but
stable parameters 6 hours after paracentesis. On the other hand lung injury
score and PaO2/FIO2 improved at all timepoints after paracentesis.
Univariate analysis found an association between the amount of ascites, lung
injury score and PaO2/FIO2. In addition multivariate regression analysis
confirmed lung-injury score used and the amount of ascites removed as
independent parameters for improvement of the respiratory function. In addition
an improvement of the renal function was observed.
In summary this is nice prospective study which demonstrated hemodynamic
stability on the one hand and improvement of the respiratory function on the
other hand, probably due to optimized volume monitoring and therapy after
paracentesis. The effects were most likely due to a reduction of intraabdominal
pressure thereby limiting respiratory complications. Although this study was only
performed in a small cohort, large volume paracentesis should be performed in
advanced liver cirrhosis combining adequate hemodynamic monitoring and fluid
substitution.
Methods and presentation of the manuscript are excellent. If the authors could
give a more detailed explanation for the improvement of renal function despite
changes of the mean arterial pressure after 6 hours the manuscript should be
accepted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Reviewer's report
Title:Effects of paracentesis on hemodynamic parameters and respiratory
function in critically ill patients
Version:1Date:10 December 2013
Reviewer: Erwin Gäbele
Reviewer's report:
In the manuscript „Effects of paracentesis on hemodynamic parameters and
respiratory function in critically ill patients“ Philipp and coworkers demonstrated
that paracentesis in patients with advanced liver cirrhosis was safe regarding
cardiocirculatory parameters and significantly improved respiratory function in
mechanically ventilated patients.
Specifically, mean arterial pressure and systemic vascular resistance index,
using standard monitoring procedures, initially showed a slight decrease but
stable parameters 6 hours after paracentesis. On the other hand lung injury
score and PaO2/FIO2 improved at all timepoints after paracentesis.
Univariate analysis found an association between the amount of ascites, lung
injury score and PaO2/FIO2. In addition multivariate regression analysis
confirmed lung-injury score used and the amount of ascites removed as
independent parameters for improvement of the respiratory function. In addition
an improvement of the renal function was observed.
In summary this is nice prospective study which demonstrated hemodynamic
stability on the one hand and improvement of the respiratory function on the
other hand, probably due to optimized volume monitoring and therapy after
paracentesis. The effects were most likely due to a reduction of intraabdominal
pressure thereby limiting respiratory complications. Although this study was only
performed in a small cohort, large volume paracentesis should be performed in
advanced liver cirrhosis combining adequate hemodynamic monitoring and fluid
substitution.
Methods and presentation of the manuscript are excellent. If the authors could
give a more detailed explanation for the improvement of renal function despite
changes of the mean arterial pressure after 6 hours the manuscript should be
accepted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Please review this paper.
user
Reviewer's report
Title:Effects of paracentesis on hemodynamic parameters and respiratory
function in critically ill patients
Version:1Date:10 December 2013
Reviewer: Erwin Gäbele
Reviewer's report:
In the manuscript „Effects of paracentesis on hemodynamic parameters and
respiratory function in critically ill patients“ Philipp and coworkers demonstrated
that paracentesis in patients with advanced liver cirrhosis was safe regarding
cardiocirculatory parameters and significantly improved respiratory function in
mechanically ventilated patients.
Specifically, mean arterial pressure and systemic vascular resistance index,
using standard monitoring procedures, initially showed a slight decrease but
stable parameters 6 hours after paracentesis. On the other hand lung injury
score and PaO2/FIO2 improved at all timepoints after paracentesis.
Univariate analysis found an association between the amount of ascites, lung
injury score and PaO2/FIO2. In addition multivariate regression analysis
confirmed lung-injury score used and the amount of ascites removed as
independent parameters for improvement of the respiratory function. In addition
an improvement of the renal function was observed.
In summary this is nice prospective study which demonstrated hemodynamic
stability on the one hand and improvement of the respiratory function on the
other hand, probably due to optimized volume monitoring and therapy after
paracentesis. The effects were most likely due to a reduction of intraabdominal
pressure thereby limiting respiratory complications. Although this study was only
performed in a small cohort, large volume paracentesis should be performed in
advanced liver cirrhosis combining adequate hemodynamic monitoring and fluid
substitution.
Methods and presentation of the manuscript are excellent. If the authors could
give a more detailed explanation for the improvement of renal function despite
changes of the mean arterial pressure after 6 hours the manuscript should be
accepted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
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