Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Nida Qadir, MD; Tisha Wang, MD; Igor Barjaktarevic, MD, PhD; Steven Y. Chang, MD, PhD


Semin Respir Crit Care Med. 2018;39(5):546-555. 

In This Article


Patients with large-volume ascites may develop atelectasis from cephalad displacement of the diaphragm and rapid and shallow breathing from relative fixation of the diaphragm.[88] In multiple studies, paracentesis has been shown to improve pulmonary function in patients with tense ascites.[89–91] In mechanically ventilated patients, Mayr et al demonstrated that tense ascites results in substantial decreases in transpulmonary pressure, in spite of application of moderate levels of PEEP. When large-volume paracentesis was performed in these patients, improvements were seen in transpulmonary pressure, gas exchange, and pulmonary compliance.[92] Alleviation of ascites may essentially serve as a recruitment maneuver[93] with the potential to help liberate patients with ascites and respiratory failure from IMV (Figure 3).

Figure 3.

(A) Chest X-ray of 52-year-old woman with cirrhosis, acute respiratory distress syndrome, massive ascites, and anasarca. (B) Repeat imaging following diuresis and large-volume paracentesis.