When are central line and Swan-Ganz line placement indicated in the workup of hepatorenal syndrome (HRS)?

Updated: Oct 16, 2017
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Answer

Measurement of central venous pressure and pulmonary capillary wedge pressure may be helpful in patients who do not respond to an adequate trial of plasma expansion. Hemodynamic findings in HRS include increased cardiac output, reduced mean arterial pressure (range of 60-80 mm Hg), and reduced total systemic vascular resistance. These findings, although characteristic of patients with cirrhosis, can also be observed in other conditions, such as anaphylaxis and sepsis. Invasive hemodynamic monitoring, aside from the risk of procedure-related complications, also has limitations for assessing volume status in patients. For example, a study by Kumar showed that, in healthy volunteers, neither central venous pressure nor pulmonary artery occlusion pressure was useful for predicting ventricular preload with respect to optimizing cardiac performance. [20]


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