Hepatic perfusion and splanchnic oxygen consumption in patients postinjury

Hepatic dysfunction following injury is felt to be due to hepatic ischemia. To test this hypothesis we measured hepatic blood flow (HBF) and splanchnic oxygen delivery and consumption in nine multiply injured patients. HBF, measured by indocyanine green clearance, was 0.4 +/- 0.1 L/min/m2 12 hours after injury. It steadily increased to 1.3 +/- 0.1 L/min/m2 by 1 week after injury. Changes in cardiac output were similar and were due largely to changes in HBF. Hepatic hypoperfusion was correlated with subsequent increases in serum bilirubin. High oxygen consumption was associated with high HBF and oxygen delivery, and splanchnic oxygen consumption became a large fraction (range, 21-67%) of total body oxygen consumption. Although splanchnic oxygen delivery was diminished with low HBF, splanchnic oxygen consumption remained normal (37 +/- 2 ml/min/m2) due to increased oxygen extraction. We conclude that hepatic blood flow is markedly reduced after injury. Reduced HBF is correlated with liver dysfunction although normal splanchnic oxygen consumption is maintained.