Towards goal-directed therapy of hepatorenal syndrome we have the tools but we need the trials 英文参考文献.docVIP

Available online /content/12/2/119 Commentary Towards goal-directed therapy of hepatorenal syndrome: we have the tools but we need the trials Rajeshwar P Mookerjee and Rajiv Jalan Liver Failure Group, Institute of Hepatology, 69–75 Chenies Mews, London WC1E 6HX, UK Corresponding author: Rajiv Jalan, r.jalan@ucl.ac.uk Published: 19 March 2008 Critical Care 2008, 12:119 (doi:10.1186/cc6804) This article is online at /content/12/2/119 ? 2008 BioMed Central Ltd See related research by Umgelter et al., /content/12/1/R4 Abstract the central volume. The study’s key findings were a demonstration that the cardiac index in HRS patients was fluid responsive despite a normal central venous pressure, and that the reduction in intra-abdominal pressure following paracentesis was associated with an improvement in renal function in the context of fluid substitution guided by assess- ment of the global end-diastolic volume. In their uncontrolled study, a transpulmonary thermodilution technique (the PiCCO system, Pulsion Medical Systems, AG) facilitated measure- ment of both cardiac output as well as intrathoracic and pulmonary blood volumes. A subtraction of the pulmonary blood volume from the intrathoracic blood volume enabled an estimate of the ‘central’ blood volume, referred to as the global end-diastolic volume index (GEDVI). Patients with cirrhosis who develop tense ascites and hepatorenal syndrome have a very high mortality and present a management challenge. Current debate stems from a lack of studies evaluating changes in effective arterial blood volume following paracentesis or targeting fluid replacement with appropriate vascular physiological measures to ensure no paracentesis-related circulatory dys- function. The study by Umgelter and colleagues addresses a goal- directed approach to fluid management in hepatorenal syndrome and raises several me