Table of contents
Hepatopulmonary syndrome
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of hepatopulmonary syndrome are prepared by our editorial team based on guidelines from the Society of Critical Care Medicine (SCCM 2020), the European Association for the Study of the Liver (EASL 2018), and the International Liver Transplantation Society (ILTS 2016).
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Screening and diagnosis
Indications for testing: as per EASL 2018 guidelines, evaluate patients with the hallmarks of chronic liver disease for HPS in the presence of tachypnea and polypnea, digital clubbing, and/or cyanosis.
B
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Diagnostic criteria
Classification and risk stratification
Diagnostic investigations
Pulse oximetry: as per EASL 2018 guidelines, obtain pulse oximetry to screen for HPS in adult patients.
B
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Blood gas analysis
Contrast echocardiography
Macroaggregated albumin lung perfusion scan
Pulmonary angiography
Respiratory support
Medical management
Therapeutic procedures
TIPS: as per EASL 2018 guidelines, insufficient evidence to recommend TIPS placement for the treatment of patients with HPS.
I
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Coil embolization
ECMO
Perioperative care
Intraoperative oxygen monitoring
As per ILTS 2016 guidelines:
Obtain continuous monitoring of mixed venous oxygen saturation. Consider performing venovenous bypass if the mixed venous oxygen saturation falls < 65% on vascular exclusion of the liver.
B
Recognize that intraoperative oxygenation is not adversely affected by different anesthetic deliveries.
B
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Postoperative oxygen therapy
Postoperative fluid management
Postoperative imaging
Surgical interventions
Liver transplantation
As per EASL 2018 guidelines:
Evaluate patients with HPS and PaO2 < 60 mmHg for liver transplantation since it is the only effective treatment for HPS.
B
Obtain arterial blood gas analysis every 6 months to facilitate prioritization of liver transplantation since severe hypoxemia (PaO2 < 45-50 mmHg) is associated with increased post-liver transplantation mortality.
B