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Liver function and splanchnic ischemia in critically ill patients
N D Maynard1, D J Bihari, R N Dalton
1Department of Surgery, Guy's Hospital, London, United Kingdom.
Chest
|January 1, 1997
Summary
Splanchnic ischemia causes hepatic dysfunction in critically ill patients, impacting survival. The MEGX formation test effectively assesses liver function and blood flow in these patients.
Area of Science:
- Critical Care Medicine
- Hepatology
- Gastroenterology
Background:
- Critically ill patients often experience splanchnic ischemia.
- Hepatic dysfunction is a common complication in critical illness.
- Assessing liver function in critically ill patients is challenging.
Purpose of the Study:
- To investigate the link between splanchnic ischemia and hepatic dysfunction in critically ill patients.
- To evaluate the effectiveness of the MEGX formation test in assessing liver function in this population.
Main Methods:
- Prospective study of 27 critically ill patients.
- Measured hepatic metabolism of lidocaine to MEGX and indocyanine green clearance.
- Assessed gastric intramucosal pH (pHim) and standard liver function tests.
Main Results:
- MEGX levels were significantly higher in survivors and correlated with pHim.
- Nonsurvivors showed a decline in MEGX levels over 3 days.
- MEGX formation test and pHim were strong predictors of survival.
Conclusions:
- Critically ill patients develop hepatic dysfunction associated with poor outcomes.
- Hepatic dysfunction may result from a mismatch between metabolic demand and blood flow.
- The MEGX formation test is a highly effective tool for assessing liver function in critically ill patients.