title: Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs.
abstract: BACKGROUND
  Cerebral edema is a well-recognized and potentially fatal complication of acute liver failure (ALF). The effectiveness of treatments that address intracranial hypertension is generally assessed by measuring intracranial pressure (ICP). The aim of this study was to determine the role of cerebral microdialysis in monitoring the efficacy of fractionated plasma separation and adsorption (FPSA) treatment for ALF. We hypothesized that in ALF cerebral microdialysis reflects the benefits of FPSA treatment on cerebral edema before ICP.
  
  
  METHODS
  A surgical resection model of ALF was used in 21 pigs. We measured plasma ammonia concentration, brain concentrations of glucose, lactate, pyruvate, glutamate and glutamine, and ICP. Animals were randomized into three groups: in one group eight animals received 6 hours of FPSA treatment 2 hours after induction of ALF; in another group 10 animals received supportive treatment for ALF only; and in the final group three underwent sham surgery.
  
  
  RESULTS
  The ICP was significantly higher in the ALF group than in the FPSA group 9 hours after surgery. The lactate/pyruvate (L/P) ratio was significantly lower in the FPSA group than the ALF group 5 hours after surgery, before any significant difference in ICP was detected. Indeed, significant changes in the L/P ratio could be observed within 1 hour of treatment. Glutamine levels were significantly lower in the FPSA group than the ALF group between 6 hours and 10 hours after surgery.
  
  
  CONCLUSIONS
  Brain lactate/pyruvate ratio and concentration of glutamine measured by cerebral microdialysis reflected the beneficial effects of FPSA treatment on cerebral metabolism more precisely and rapidly than ICP in pigs with fulminant ALF. The role of glutamine as a marker of the efficacy of FPSA treatment for ALF appears promising, but needs further evaluation.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital, Basel, Switzerland. josef.prazak@usb.ch
authors.forename: Josef
authors.initials: J
authors.lastname: Prazak
authors.forename: Eva
authors.initials: E
authors.lastname: Laszikova
authors.forename: Tomas
authors.initials: T
authors.lastname: Pantoflicek
authors.forename: Ondrej
authors.initials: O
authors.lastname: Ryska
authors.forename: Eva
authors.initials: E
authors.lastname: Koblihova
authors.forename: Miroslav
authors.initials: M
authors.lastname: Ryska
mesh_terms: D000641:Ammonia / Q000097:blood; D000818:Animals; D001929:Brain Edema / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D054022:Cerebrum / Q000378:metabolism*; D005112:Extracorporeal Circulation; D005947:Glucose / Q000378:metabolism; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control*; D007427:Intracranial Pressure; D019344:Lactic Acid / Q000378:metabolism; D017114:Liver Failure, Acute / Q000097:blood / Q000150:complications / Q000628:therapy*; D017551:Microdialysis; D019289:Pyruvic Acid / Q000378:metabolism; D016060:Sorption Detoxification; D013552:Swine; D013997:Time Factors
chemical_list: D005973:Glutamine; D019344:Lactic Acid; D018698:Glutamic Acid; D000641:Ammonia; D019289:Pyruvic Acid; D005947:Glucose