haemodynamic response to abdominal decompression in acute buddchiari syndrome background intraabdominal hypertension iah and abdominal compartment syndrome commonly occur in patients with liver diseaseaims we compared haemodynamic variables pre and postabdominal decompression in patients with acute buddchiari syndrome bcs and patients with chronic liver disease cld ascites and iahmethods patients with iah admitted to the liver icu kings college hospital were studied transpulmonary thermodilution cardiac output co monitoring was performed with the picco systemresults ten patients with decompensated bcs median age 39 years 2052 and eight patients with cld 59 years 3365 and tense ascites requiring paracentesis were studied intraabdominal pressure iap was raised in both groups preintervention bsc 23 mmhg 1740 cld 26 2040 intrathoracic blood volume itbvi was persistently low in the bcs group 632 mlm2 453924 despite volume resuscitation postintervention reduction in iap was noted in both groups bcs p0001 cld p00001 the itbvi increased p0001 in the bcs group only an increase in cardiac index ci and stroke volume index svi was noted in both groups bcs ci p0003 svi p0007 cld ci p0005 svi p002 the central venous pressure did not change in either group and did not correlate with markers of flow ci svi or iap both groups demonstrated an inverse relationship between iap ci and sviconclusion patients with bcs and iah have evidence of central hypovolaemia in addition to raised iap hepatic venous obstruction and caudate lobe hypertrophy limit venous return in patients with bcs reduction in iap and reestablishment of caval flow restores preload with improvement in co