title: Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure.
abstract: BACKGROUND
  About half of patients with acute liver failure (ALF) show clinical signs of cerebral edema and intracranial hypertension. Neuroimaging diagnostics and electroencephalography have poor correlation with intracranial pressure measurement.
  
  
  OBJECTIVE
  The objective of this study was to characterize the cerebral hemodynamics patterns with transcranial Doppler (TCD) sonography in patients with ALF.
  
  
  METHODS
  We studied 21 patients diagnosed with ALF, admitted to the intensive care unit (ICU) at the Centro de Investigaciones Médico Quirúrgicas of Cuba. All of these patients had a TCD performed on arrival at ICU, evaluating the following: systolic (SV), diastolic (DV), and medium (MV) flows velocities and pulsatility index (PI) in right middle cerebral artery (RMCA) via temporal windows.
  
  
  RESULTS
  The sonographic patterns of cerebral hemodynamics were as follows: low-flow, 12 patients (57.1%); high resistance, 5 patients (23.8%); and hyperemic, 4 patients (19%). Patients who died while waiting had lower MV RMCA (56.1 vs 58.1 cm/s) and higher PI (1.71 vs 1.41) than patients who could undergo transplantation (P = .800 and P = .787, respectively).
  
  
  CONCLUSIONS
  In patients diagnosed with ALF admitted to the ICU the predominating cerebral hemodynamic pattern was low-flow with resistance increase. The TCD was shown to be a useful tool in the initial evaluation for prognosis and treatment.
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba. Electronic address: aaabdo@infomed.sld.cu.
authors.forename: A
authors.initials: A
authors.lastname: Abdo
authors.affiliation: Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: J
authors.initials: J
authors.lastname: Pérez-Bernal
authors.affiliation: Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: R
authors.initials: R
authors.lastname: Hinojosa
authors.affiliation: Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: F
authors.initials: F
authors.lastname: Porras
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba.
authors.forename: R
authors.initials: R
authors.lastname: Castellanos
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba.
authors.forename: F
authors.initials: F
authors.lastname: Gómez
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba.
authors.forename: J
authors.initials: J
authors.lastname: Gutiérrez
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba.
authors.forename: A
authors.initials: A
authors.lastname: Castellanos
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba.
authors.forename: G
authors.initials: G
authors.lastname: Leal
authors.affiliation: Intensive Care Unit, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba.
authors.forename: N
authors.initials: N
authors.lastname: Espinosa
authors.affiliation: Liver Transplantation Unit, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: M
authors.initials: M
authors.lastname: Gómez-Bravo
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D003462:Cuba; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000503:physiopathology; D007362:Intensive Care Units; D007427:Intracranial Pressure; D017114:Liver Failure, Acute / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult