Adverse effects on cerebral perfusion of prostacyclin administered directly into patients with fulminant hepatic failure and acute renal failure.
Prior to commencing renal replacement therapy, 8 patients with fulminant hepatic failure and acute renal failure were treated with an infusion of prostacyclin, 5 ng/kg/min, for 30 min, administered directly into the femoral vein. During this period, several adverse effects were noted. There was a reduction in mean arterial blood pressure from a median of 82 (range 65-93) to 67 mm Hg (55-80), p less than 0.01; and an increase in intracranial pressure from a median of 14 (6-33) to 17 mm Hg (6-42), p less than 0.05; with a consequent reduction in cerebral perfusion pressure from a median of 63 (43-77) to 43 mm Hg (15-74), p less than 0.05. There was a reduction in arterial oxygen tension from a median of 19 (13-28) to 16 kPa (12-27), p less than 0.05; and no change in cardiac output, from a median of 6.7 (4.9-11.2) to 6.5 l/min/m2 (3.8-11.0), p greater than 0.05). The administration of prostacyclin into this group of critically ill patients, at risk of death due to cerebral oedema/hypoxia, produced both a reduction in cerebral perfusion pressure and a reduction in total cerebral oxygen delivery.
Davenport
A
A
Department of Renal Medicine, St. James's University Hospital, Leeds, UK.
Will
E J
EJ
Davison
A M
AM
D058186:Acute Kidney Injury / Q000188:drug therapy*; D000328:Adult; D001929:Brain Edema / Q000517:prevention & control; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein; D006801:Humans; D002534:Hypoxia, Brain / Q000517:prevention & control; D007275:Injections, Intravenous; D008107:Liver Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
D011464:Epoprostenol