Cerebral oxygenation determined by near-infrared spectrophotometry in patients with fulminant hepatic failure

BackgroundlAims: In severe cases of acute liver failure (ALF), cerebral hyperperfusion may result in high intracranial pressure and brain damage. The aim of this study was to determine if near-infrared spectrophotometry (NIRS) could detect a raise in cerebral blood flow and oxygenation induced by noradrenaline (NA) infusion. Methods: In seven ALF patients (five females and two males; median age 49 years (range 20-70)) changes in cerebral concentration of oxy-(DeltaHbO(2)) and total-haemoglobin (DeltaHbT) were compared to the jugular bulb saturation (SvjO(2)) and cerebral blood flow velocity (Vmean) during NA infusion. Results: Mean arterial pressure increased from 68 (64-86) to 103 (87-118) mmHg and the cerebral perfusion pressure from 61 (53-79) to 95 (74-110) mmHg (P<0.05), while the intracranial pressure (7 (6-15) mmHg) was not significantly changed. In six patients cerebral DeltaHbO(2) and DeltaHbT increased 2.7 (0.3-9.6) and 2.0 (0.3-14.8) mumol 1(-1), respectively, but cerebral oxygenation decreased in one patient. SyjO(2) increased from 68 (55-76) to 74 (64-78) % (P<0.05) concomitant with an increase in Vmean from 47 (34-65) to 68 (50-86) cm s(-1) (P<0.05). DeltaHbO(2) covariated with changes in SvjO(2) during NA in all but one patient. Conclusions: In ALF patients, a change in cerebral perfusion was detected by NIRS. The combination of NIRS and transcranial Doppler sonography may be valuable non-invasive techniques to detect cerebral hyperperfusion before intracranial hypertension becomes manifest. (C) 2002 Published by Elsevier Science B.V. on behalf of the European Association for the Study of the Liver.