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How Do I Resuscitate the Crashing Cirrhotic Patient?

  • Krystle ShaferEmail author
Chapter

Abstract

Cirrhosis places patients at risk for numerous complications, including gastrointestinal bleeding, renal failure, and infection. It is important to maintain a broad differential for the cirrhotic patient who presents in shock to ensure that the correct diagnosis is not missed. Consideration of coagulopathy and the vasodilatory state frequently exhibited by these patients is important when choosing resuscitation fluids and end points. While always an important consideration, coagulopathy should not prevent a provider from performing an emergent, lifesaving procedure.

Keywords

Cirrhosis Resuscitation Hypotension Shock Albumin Coagulopathy 

References

  1. 1.
    Bonnel A, Bunchorntavakul C, Reddy KR. Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Heptaol. 2011;9:727–38.CrossRefGoogle Scholar
  2. 2.
    Tandon P, Guadalupe G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28(1):26–42.CrossRefGoogle Scholar
  3. 3.
    García-Pagán JC, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol. 2012;57(2):458–61.CrossRefGoogle Scholar
  4. 4.
    Polli F, Gattinoni L. Balancing volume resuscitation and ascites management in cirrhosis. Curr Opin Anaesthesol. 2010;23:151–8.CrossRefGoogle Scholar
  5. 5.
    Wells M, Chande N, Adams P, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther. 2012;35(11):1267–78.CrossRefGoogle Scholar
  6. 6.
    Galbois A, Aegerter P, Martel-Samb P, et al. Improved prognosis of septic shock in patients with cirrhosis: a multicenter study. Crit Care Med. 2014;42(7):1666–74.CrossRefGoogle Scholar
  7. 7.
    Bucsics T, Schwabl P, Mandorfer M, Peck-Radosavljevic M. Prognosis of cirrhotic patients with fungiascites and spontaneous fungal peritonitis. J Hepatol. 2016;64(6):1452–4.CrossRefGoogle Scholar
  8. 8.
    Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R. Severe sepsis in cirrhosis. Hepatology. 2009;50(6):2022–33.CrossRefGoogle Scholar
  9. 9.
    Correa T, Calvalcanti A, Cesar M. Balanced crystalloids for septic shock resuscitation. Rev Bras Ter Intensiva. 2016;28(4):463–71.CrossRefGoogle Scholar
  10. 10.
    Annane D, Siami D, Jaber S, et al. Effects of fluid resuscitation with colloids versus crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013;310(17):1809–17.CrossRefGoogle Scholar
  11. 11.
    Vercueil A, Grocott M, Mythen M. Physiology, pharmacology, and rationale for colloid administration for the maintenance of effective hemodynamic stability in critically ill patients. Transfus Med Rev. 2005;19:93–109.CrossRefGoogle Scholar
  12. 12.
    Van de Weeerdt E, Beimond B, Baake B, Vermin B, Binnekade J, et al. Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications. Tranfusion. 2017;57(10):2512–25.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineCritical Care Intensivist, OHICU and MSICU, WellSpan York HospitalYorkUSA

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