TCD assessment in fulminant hepatic failure: Improvements in cerebral autoregulation after liver transplantation

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art_PASCHOAL-JR_TCD_assessment_in_fulminant_hepatic_failure_Improvements_in_2024.PDF (1.83 MB)
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1
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article
Data de publicação
2024
DOI
Scopus
Web of Science
PubMed
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ELSEVIER ESPANA
Autores
PASCHOAL-JR, Fernando M.
RONCONI, Karla de Almeida Lins
ALMEIDA, Kelson James
ROCHA, Ivana Schmidtbauer
PASCHOAL, Eric Homero Albuquerque
PASCHOAL, Joelma Karin Sagica Fernandes
Citação
ANNALS OF HEPATOLOGY, v.29, n.2, article ID 101167, 6p, 2024
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Resumo
Introduction and Objectives: Acute liver failure, also known as fulminant hepatic failure (FHF), includes a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction and hepatic encephalopathy. The objective of this study was to assess cerebral autoregulation (CA) in 25 patients (19 female) with FHF and to follow up seventeen of these patients before and after liver transplantation.Patients and Methods: The mean age was 33.8 years (range 14-56, SD 13.1 years). Cerebral hemodynamics was assessed by transcranial Doppler (TCD) bilateral recordings of cerebral blood velocity (CBv) in the middle cerebral arteries (MCA).Results: CA was assessed based on the static CA index (SCAI), reflecting the effects of a 20-30 mmHg increase in mean arterial blood pressure on CBv induced with norepinephrine infusion. SCAI was estimated at four time points: pretransplant and on the 1st, 2nd and 3rd posttransplant days showing a significant difference between pre-and posttransplant SCAI (p = 0.005). SCAI peaked on the third posttransplant day (p = 0.006). Categorical analysis of SCAI showed that for most patients, CA was reestablished on the second day post-transplant (SCAI > 0.6).Conclusions: These results suggest that CA impairment pretransplant and on the 1st day posttransplant was re-established at 48-72 h after transplantation. These findings can help to improve the management of this patient group during these specific phases, thereby avoiding neurological complications, such as brain swelling and intracranial hypertension.(c) 2023 Fundacion Clinica Medica Sur, A.C.
Palavras-chave
Acute liver failure, Cerebral edema, Cerebral autoregulation index, Hepatic encephalopathy, Cerebral blood flow velocity
URI
https://observatorio.fm.usp.br/handle/OPI/57420
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - FM/MNE
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/37
Artigos e Materiais de Revistas Científicas - LIM/62