Cerebral oxygenation determined by near-infrared spectrophotometry in patients with fulminant hepatic failure.
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.
Nielsen
Henning Bay
HB
Department of Hepatology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark. h.bay@dadlnet.dk
Tofteng
Flemming
F
Wang
Lars Peter
LP
Larsen
Fin Stolze
FS
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
D013566:Sympathomimetics; D010100:Oxygen; D009638:Norepinephrine