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Transcranial Doppler sonography in fulminant hepatic failure
1Centro de Investigaciones Medico Quirúrgicas, Unidad de Cuidados Intensivos, Servicio de Transplantes, Havana, Cuba. aaabdo@cimeq.sld.cu
Insights
Fulminant hepatic failure (FHF) patients often experience cerebral hypoperfusion, indicated by lower blood flow velocities and higher pulsatile index. This pattern suggests avoiding hyperventilation to improve cerebral perfusion.
Area of Science:
- Neurology
- Hepatology
- Critical Care Medicine
Background:
- Fulminant hepatic failure (FHF) can lead to severe neurological complications like cerebral edema and hypertension.
- Understanding cerebral blood flow (CBF) patterns in FHF is crucial for effective management.
Purpose of the Study:
- To characterize the CBF pattern in FHF patients using Transcranial Doppler Sonography (TCDS).
- To inform therapeutic strategies for managing neurological complications in FHF.
Main Methods:
- Assessed TCDS patterns in five FHF patients and compared them to a control group.
- Measured pulsatile index and mean, systolic, and diastolic velocities of the middle cerebral artery.
Main Results:
- 80% of FHF patients exhibited a cerebral hypoperfusion pattern, unlike 40% of controls.
- FHF patients had lower mean velocities (36.6 cm/sec) and higher pulsatile index (2.4) compared to controls (47.8 cm/s, 1.8).
- No hyperemia was observed in FHF patients, while 20% of controls showed hyperemia.
Conclusions:
- FHF patients predominantly display cerebral hypoperfusion with reduced mean velocities and elevated pulsatile index.
- Clinicians should implement measures to enhance cerebral perfusion and prevent hypoxia.
- Hyperventilation is contraindicated as an initial therapeutic approach in FHF patients.
Unlabelled:
The clinical course of patients with fulminant hepatic failure (FHF) is often worsened by the presence of cerebral edema and endocranial hypertension. In spite of the multiple studies using Transcranial Doppler Sonography (TCDS), few have shown the cerebral blood flow (CBF) pattern among patients with encephalopathy resulting from FHF.
Objective:
Our objective was to characterize the CBF pattern in these patients through the use of TCDS to provide therapeutic strategies.
Method:
The TCDS pattern was assessed in five patients diagnosed with FHF and compared with a control group who displayed critical neurologic conditions not associated with FHF. Pulsatile index, systolic, diastolic, and mean velocity of the middle cerebral artery were measured.
Results:
The mean age of patients with FHF was 45.4 years. One hundred percent were women, with viral hepatitis as the predominant etiology. A cerebral hypoperfusion pattern was found in 80% of the FHF group and 40% of the control group. In the former group there was no evidence of hyperemia, as there was among 20% of the control group. The mean values of velocity and pulsatile index were 36.6 cm/sec and 2.4, respectively, in the FHF group and 47.8 cm/s and 1.8 in the control group (P=0.268, P=0.402).
Conclusions:
FHF patients show a predominance of cerebral hypoperfusion pattern with mean velocities lower than normal values and an increased pulsatile index. We recommend that clinicians take appropriate measures to improve cerebral perfusion and avoid hypoxia. Hyperventilation as a first level measure is contraindicated.
