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Titolo:
Cerebral perfusion, cardiac output, and arterial pressure in patients withfulminant hepatic failure
Autore:
Larsen, FS; Strauss, G; Knudsen, GM; Herzog, TM; Hansen, BA; Secher, NH;
Indirizzi:
Univ Copenhagen, Rigshosp, Dept Hepatol A 2121, DK-2100 Copenhagen O, Denmark Univ Copenhagen Copenhagen Denmark O 2121, DK-2100 Copenhagen O, Denmark Univ Copenhagen, Rigshosp, Dept Neurol, DK-2100 Copenhagen, Denmark Univ Copenhagen Copenhagen Denmark DK-2100 , DK-2100 Copenhagen, Denmark Univ Copenhagen, Rigshosp, Dept Cardiol, DK-2100 Copenhagen O, Denmark Univ Copenhagen Copenhagen Denmark O diol, DK-2100 Copenhagen O, Denmark Univ Copenhagen, Rigshosp, Dept Anesthesia, DK-2100 Copenhagen O, Denmark Univ Copenhagen Copenhagen Denmark O esia, DK-2100 Copenhagen O, Denmark
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 4, volume: 28, anno: 2000,
pagine: 996 - 1000
SICI:
0090-3493(200004)28:4<996:CPCOAA>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
HIGH-VOLUME PLASMAPHERESIS; BLOOD-BRAIN-BARRIER; LIVER-FAILURE; PORTACAVAL ANASTOMOSIS; INTRACRANIAL-PRESSURE; OXYGEN-CONSUMPTION; FLOW; EDEMA; METABOLISM; RATS;
Keywords:
arterial blood pressure; autoregulation; cardiac output; cerebral brood flow; cerebral edema; cirrhosis; fulminant hepatic failure; heart rate; hepatic encephalopathy; norepinephrine; transcranial Doppler; ultrasonography;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Larsen, FS Univ Copenhagen, Rigshosp, Dept Hepatol A 2121, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark Univ Copenhagen Blegdamsvej 9 Copenhagen Denmark O O, Denmark
Citazione:
F.S. Larsen et al., "Cerebral perfusion, cardiac output, and arterial pressure in patients withfulminant hepatic failure", CRIT CARE M, 28(4), 2000, pp. 996-1000

Abstract

Objective: To evaluate whether changes in cardiac output influence cerebral perfusion directly. In fulminant hepatic failure, the circulation is characterized by wide variations in cardiac output and cerebral blood flaw (CBF). Design: A retrospective, interindividual analysis of CBF and cardiac output (part 1) and a prospective evaluation of cerebral perfusion, cardiac output, and arterial pressure during norepinephrine infusion (part 2). Setting: A four-bed specialist liver failure unit. Patients and Interventions: Twenty patients with fulminant hepatic failure(median age, 43 yrs; range, 17-54; 13 women) maintained on mechanical Ventilation (Paco(2) 33 torr [4.40 kPa]; range, 26-36 torr [3.47-4.80 kPa) after development of hepatic encephalopathy, stages 3 to 4, had mean arterial pressure (MAP) and cardiac output determined by radial and pulmonary artery catheters. Cerebral perfusion was measured by the (133)Xenon clearance technique (n = 8) and by transcranial Doppler sonography, which was used to measure mean flow velocity (V-mean). CBF and V-mean in patients with high cardiac output (>9 L/min) were compared with those with normal or low cardiac output. In the second part of the study, cerebral autoregulation was evaluated by concomitant measurement of V-mean, cardiac output, and MBP during norepinephrine infusion in nine patients. Measurements and Main Results: Median cardiac output was 8.5 L/min (range,3.2-17.3), CBF was 33 mL/100 g/min (12-77 g/min), and V-mean was 45 cm/sec(22-65 cm/sec). In patients with elevated cardiac output, MAP, V-mean, andCBF were similar compared with patients with normal cardiac output. Neither CBF nor V-mean correlated to cardiac output. During norepinephrine infusion, V-mean increased from 49 cm/sec (34-69 cm/sec) to 63 cm/sec (58-90 cm/sec; p <.05), as MBP increased from 75 mm Hg (54-105 mm Hg) to 97 mm Hg (90-128 mm Hg). On average, cardiac output remained unchanged at 5.7 L/min (range, 3.2-17.3), as it increased in five patients and decreased in four patients. The change in V-mean was related to MAP (r(2) =.76; p <.01) but not tocardiac output (r(2) = .01). Conclusion: This study shows that CBF correlates to arterial pressure rather than to cardiac output in patients with fulminant hepatic failure. The presence of pressure-passive cerebral circulation stresses the importance ofstrict cardiovascular control in securing continuous and sufficient cerebral oxygenation and in avoiding the development of cerebral hyperemia and cerebral edema.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/10/20 alle ore 21:06:05