title: Cerebral oxygenation determined by near-infrared spectrophotometry in patients with fulminant hepatic failure.
abstract: OBJECTIVE
  In severe cases of acute liver failure (ALF), cerebral hyperperfusion may result in high intracranial pressure and brain damage. The aim of this study was to determine if near-infrared spectrophotometry (NIRS) could detect a raise in cerebral blood flow and oxygenation induced by noradrenaline (NA) infusion.
  
  
  METHODS
  In seven ALF patients (five females and two males; median age 49 years (range 20-70)) changes in cerebral concentration of oxy-(deltaHbO(2)) and total-haemoglobin (deltaHbT) were compared to the jugular bulb saturation (SvjO(2)) and cerebral blood flow velocity (Vmean) during NA infusion.
  
  
  RESULTS
  Mean arterial pressure increased from 68 (64-86) to 103 (87-118) mmHg and the cerebral perfusion pressure from 61 (53-79) to 95 (74-110) mmHg (P<0.05), while the intracranial pressure (7 (6-15) mmHg) was not significantly changed. In six patients cerebral deltaHbO(2) and deltaHbT increased 2.7 (0.3-9.6) and 2.0 (0.3-14.8) micromol l(-1), respectively, but cerebral oxygenation decreased in one patient. SvjO(2) increased from 68 (55-76) to 74 (64-78) % (P<0.05) concomitant with an increase in Vmean from 47 (34-65) to 68 (50-86) cm s(-1) (P<0.05). deltaHbO(2) covariated with changes in SvjO(2) during NA in all but one patient.
  
  
  CONCLUSIONS
  In ALF patients, a change in cerebral perfusion was detected by NIRS. The combination of NIRS and transcranial Doppler sonography may be valuable non-invasive techniques to detect cerebral hyperperfusion before intracranial hypertension becomes manifest.
authors.affiliation: Department of Hepatology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark. h.bay@dadlnet.dk
authors.forename: Henning Bay
authors.initials: HB
authors.lastname: Nielsen
authors.forename: Flemming
authors.initials: F
authors.lastname: Tofteng
authors.forename: Lars Peter
authors.initials: LP
authors.lastname: Wang
authors.forename: Fin Stolze
authors.initials: FS
authors.lastname: Larsen
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000098:blood supply* / Q000378:metabolism*; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D010100:Oxygen / Q000032:analysis* / Q000097:blood; D019265:Spectroscopy, Near-Infrared; D013566:Sympathomimetics / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013566:Sympathomimetics; D010100:Oxygen; D009638:Norepinephrine