Hepatopulmonary syndrome: the anaesthetic considerations

Article Article scientifique Article Hepatopulmonary syndrome: the anaesthetic considerations eng 2013 author Fauconnet Pascal Gabriel 88898 author Klopfenstein Claude-Eric 549885 author Schiffer Eduardo 0000-0002-7415-4315 33705 721-730 10.1097/EJA.0b013e328365bb6f 24161936 0265-0215 Hepatopulmonary syndrome (HPS) is a pulmonary complication observed in patients with chronic liver disease and/or portal hypertension, attributable to an intrapulmonary vascular dilatation that induces severe hypoxaemia. Considering the favourable long-term survival of HPS patients as well as the reversal of the syndrome with a functional liver graft, HPS is now an indication for orthotopic liver transplantation (OLT). Consequently, blood gas analysis and imaging techniques should be performed when cirrhotic patients present with shortness of breath as well as when OLT candidates are placed on the transplant waiting list. If the arterial partial pressure of oxygen (PaO2) is more than 10.7 kPa when breathing room air, HPS can be excluded and no other investigation is needed. When the PaO2 when breathing room air is 10.7 kPa or less, contrast-enhanced echocardiography should be performed to exclude pulmonary vascular dilatation. Lung function tests may also help detect additional pulmonary diseases that can contribute to impaired oxygenation. When contrast-enhanced echocardiography is negative, HPS is excluded and no follow-up is needed. When contrast-enhanced echocardiography is positive and PaO2 less than 8 kPa, patients should obtain a severity score that provides them with a reasonable probability of being transplanted within 3 months. In mild-to-moderate HPS (PaO2 8 to 10.6 kPa), periodic follow-up is recommended every 3 months to detect any further deterioration in PaO2. Although no intraoperative deaths have been directly attributed to HPS, oxygenation may worsen immediately following OLT due to volume overload and postoperative infections. Mechanical ventilation is often prolonged with an extended stay in the ICU. A high postoperative mortality (mostly within 6 months) is observed in this group of patients in comparison to non-HPS patients. However, the recovery of an adequate PaO2 within 12 months after OLT explains the similar outcome of HPS and non-HPS patients following OLT over a longer time period. Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false European journal of anaesthesiology 30 12 8de67822-c791-4ef0-8465-ecebbc4800ed Article (Published version) Restricted 00003643-201312000-00002.pdf 1696728 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Hepatopulmonary syndrome: the anaesthetic considerations	European journal of anaesthesiology			2013	610	0

Archive ouverte UNIGE

Fauconnet, Pascal Gabriel