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Cerebral hemodynamic and metabolic profiles in fulminant hepatic failure: Relationship to outcome
- Source :
- Liver Transplantation. 11:1353-1360
- Publication Year :
- 2005
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2005.
-
Abstract
- The purpose of this retrospective study was to examine the potential role of cerebral hemodynamic and metabolic factors in the outcome of patients with fulminant hepatic failure (FHF). Based on the literature, a hypothetical model was proposed in which physiologic changes progress sequentially in five phases, as defined by intracranial pressure (ICP) and cerebral blood flow (CBF) measurements. Seventy-six cerebral physiologic profiles were obtained in 26 patients (2 to 5 studies each) within 6 days of FHF diagnosis. ICP was continuously measured by an extradural fiber optic monitor. Global CBF estimates were obtained by xenon clearance techniques. Jugular venous and peripheral artery catheters permitted calculation of cerebral arteriovenous oxygen differences (AVDO2), from which cerebral metabolic rate for oxygen (CMRO2) was derived. A depressed CMRO2 was found in all patients. There was no evidence of cerebral ischemia as indicated by elevated AVDO2s. Instead, over 65% of the patients revealed cerebral hyperemia. Eight of the 26 patients underwent orthotopic liver transplantation—all recovered neurologically, including 6 with elevated ICPs. Of the 18 patients receiving medical treatment only, all 7 with increased ICP died in contrast to 9 survivors whose ICP remained normal (P < 0.004). Hyperemia, per se, was not related to outcome, although it occurred more frequently at the time of ICP elevations. Six patients were studied during brain death. All 6 revealed malignant intracranial hypertension, preceded by hyperemia. In conclusion, the above findings are consistent with the hypothetical model proposed. Prospective longitudinal studies are recommended to determine the precise evolution of the pathophysiologic changes. (Liver Transpl 2005;11:1353–1360.)
- Subjects :
- Transplantation
medicine.medical_specialty
Hepatology
business.industry
medicine.medical_treatment
Ischemia
Retrospective cohort study
Liver transplantation
medicine.disease
Pathophysiology
Surgery
Fulminant hepatic failure
Cerebral blood flow
Cerebral hemodynamics
Internal medicine
medicine
Cardiology
business
Intracranial pressure
Subjects
Details
- ISSN :
- 15276465
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Liver Transplantation
- Accession number :
- edsair.doi...........92efc0dfb6adc07ce68f6488dbe81efb