Resumo

GRILO, Israel et al. Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?. Rev. esp. enferm. dig. [online]. 2017, vol.109, n.12, pp.843-849. ISSN 1130-0108.  https://dx.doi.org/10.17235/reed.2017.4930/2017.

Introduction: Different blood gas criteria have been used in the diagnosis of hepatopulmonary syndrome (HPS). Patients and methods: Arterial blood gases were prospectively evaluated in 194 cirrhotic candidates for liver transplantation (LT) in the supine and seated position. Three blood gas criteria were analyzed: classic (partial pressure of oxygen [PaO₂] < 70 mmHg and/or alveolar-arterial gradient of oxygen [A-a PO₂] ≥ 20 mmHg), modern (A-a PO₂ ≥ 15 mmHg or ≥ 20 mmHg in patients over 64) and the A-a PO₂ ≥ threshold value adjusted for age. Results: The prevalence of HPS in the supine and seated position was 27.8% and 23.2% (classic), 34% and 25.3% (modern) and 22.2% and 19% (adjusted for age), respectively. The proportion of severe and very severe cases increased in a seated position (11/49 [22.4%] vs 5/66 [7.6%], p = 0.02). No difference was observed in the pre-LT, post-LT and overall mortality in patients with HPS, regardless of the criteria used. Conclusion: Obtaining blood gas measurements in the supine position and the use of modern criteria are more sensitive for the diagnosis of HPS. Blood gas analysis with the patient seated detects a greater number of severe and very severe cases. The presence of HPS was not associated with an increase in mortality regardless of blood gas criterion used.

Palavras-chave : Cirrhosis; Ascites; Contrast echocardiography; Pulmonary vascular diseases; Macro-aggregated albumin lung perfusion scan and perioperative care.

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