Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure

Abdo, Anselmo; Pérez-Bernal, J.; Hinojosa, R.; Porras, F.; Castellanos, Roberto; Gómez, Francisco Jiménez; Gutiérrez, Juan A.; Castellanos, Arturo Rodríguez; Leal, Geydy; Espinosa, N.; Gómez‐Bravo, Miguel Ángel

doi:10.1016/j.transproceed.2015.10.006

Cited by 20 publications

(18 citation statements)

References 9 publications

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“…Furthermore, evidence of the predictive validity of TCD in ALF is limited. PI at a threshold value of ≥1.6 was not found to be predictive of mortality in one study, although in a more recent cohort a non‐significant trend toward higher PI and lower MFV was identified in patients who died from the condition …”

Section: Discussionmentioning

confidence: 89%

“…PI at a threshold value of ≥1.6 was not found to be predictive of mortality in one study, 86 although in a more recent cohort a non-significant trend toward higher PI and lower MFV was identified in patients who died from the condition. 87 Clinically significant intracranial hypertension rarely occurs in adults with CLD, 88 a feature which has been attributed to the prevalence of cerebral atrophy in adults with cirrhosis, in particular where alcohol is an etiological factor. [89][90][91][92][93] Despite a resultant expectation that the natural history of encephalopathy in these patients is divergent from HE in adult ALF, the few studies evaluating TCD in CLD have identified a number of abnormalities in cerebral blood flow in this cohort.…”

Section: Does Tcd Accurately Identify Patients With Intracranial Pamentioning

confidence: 99%

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Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review

Hunt

Tasker

Deep

2019

Pediatric Transplantation

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Research on non‐invasive neuromonitoring specific to PALF is limited. This systematic review identifies and synthesis the existing literature on non‐invasive approaches to monitoring for neurological sequelae in patients with PALF. A series of literature searches were performed to identify all publications pertaining to five different non‐invasive neuromonitoring modalities, in line with PRISMA guidelines. Each modality was selected on the basis of its potential for direct or indirect measurement of cerebral perfusion; studies on electroencephalographic monitoring were therefore not sought. Data were recorded on study design, patient population, comparator groups, and outcomes. A preponderance of observational studies was observed, most with a small sample size. Few incorporated direct comparisons of different modalities; in particular, comparison to invasive intracranial pressure monitoring was largely lacking. The integration of current evidence is considered in the context of the clinically significant distinctions between pediatric and adult ALF, as well as the implications for planning of future investigations to best support the evidence‐based clinical care of these patients.

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Section: Discussionmentioning

confidence: 89%

Section: Does Tcd Accurately Identify Patients With Intracranial Pamentioning

confidence: 99%

Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review

Hunt

Tasker

Deep

2019

Pediatric Transplantation

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“…60,65 TCD offers a noninvasive alternative to obtaining indirect evidence regarding ICP and CBF, 66 though there are limited data to guide clinical use specifically in ALF. 67,68 It may be useful in patients with severe coagulopathy at high risk for bleeding complications, and has an added advantage over standard invasive monitoring in its ability to estimate CBF. 69 Reduced blood flow on TCD can indicate cerebral edema, although it may be inaccurate for mild-to-moderate ICP elevations.…”

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confidence: 99%

Management of Cerebral Edema in Acute Liver Failure

Kok

Karvellas

2017

Semin Respir Crit Care Med

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Advances in medical care of the acute liver failure patient have led to a significant reduction in mortality related to the condition. Nevertheless, cerebral edema and ensuing brain herniation remains one of the top causes of demise in acute liver failure. Controversy remains regarding the utility of invasive intracranial pressure monitoring as well as usage of novel treatment modalities including therapeutic hypothermia. This review provides a brief summary into the pathophysiology and risk factors for developing cerebral edema in the context of acute liver failure; this review particularly provides a practical focus on general management of the patient with established cerebral edema as well as specific intracranial pressure-lowering strategies.

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“…Some centers use invasive intracranial pressure (ICP) monitoring; however, non-invasive monitoring of cerebral arterial flow is becoming a useful tool to identify ICH. 1 Two relevant articles 4,5 tried to demonstrate the usefulness of TCD to characterize the cerebral hemodynamics patterns in patients diagnosed with ALF. TCD is becoming an important tool since there is no risk of complications like bleeding or infection, which can occur in the use of invasive ICP monitoring.…”

mentioning

confidence: 99%

“…TCD is becoming an important tool since there is no risk of complications like bleeding or infection, which can occur in the use of invasive ICP monitoring. 4,6 The complication risk is around 20%, and there are limited therapeutic options for ICH, 6 which should be taken into consideration to indicate invasive procedures. Besides that, Aggarwal et al 6 studied whether TCD waveform features could be used to differentiate ALF patients with respect to ICP or cerebral perfusion pressure (CPP) levels.…”

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confidence: 99%

Pediatric Acute Liver Failure: Current Perspectives

Colleti¹,

Azevedo²,

Carvalho³

2017

Liver Res Open J

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It is well known that acute liver failure (ALF) in children is rare but potentially a life-threatening disorder. Its true incidence in the pediatric population is undetermined but is responsible for 10-15% of all pediatric liver transplantations. 1 Unlike adults, a specific cause of pediatric ALF is not identified in almost half of the cases, 2 and the etiology is classified as indeterminate in 18-47% of all patients. 1 The etiology is important because the survival rate and need for liver transplantation vary depending on the diagnosis. Spontaneous recovery is better in children with toxic etiology and worst for those with indeterminate or other causes. 1,2 There is no specific treatment for most ALF cases, and the mainstay of medical care is to minimize complications and to limit additional morbidity. 3 ALF can be associated with rapidly progressive multiorgan failure and high mortality rates. One of the leading causes of death is cerebral edema and intracranial hypertension (ICH), responsible for about 20-25% of all deaths. 3 From that perspective, it is desirable to develop new therapies/technologies for diagnostic investigation and interventions.The use of transcranial Doppler (TCD) is an important component in the assessment of cerebral edema, which should be monitored. Some centers use invasive intracranial pressure (ICP) monitoring; however, non-invasive monitoring of cerebral arterial flow is becoming a useful tool to identify ICH. 1 Two relevant articles 4,5 tried to demonstrate the usefulness of TCD to characterize the cerebral hemodynamics patterns in patients diagnosed with ALF. TCD is becoming an important tool since there is no risk of complications like bleeding or infection, which can occur in the use of invasive ICP monitoring. 4,6 The complication risk is around 20%, and there are limited therapeutic options for ICH, 6 which should be taken into consideration to indicate invasive procedures. Besides that, Aggarwal et al 6 studied whether TCD waveform features could be used to differentiate ALF patients with respect to ICP or cerebral perfusion pressure (CPP) levels. They concluded that TCD could provide information about the dynamic state of the intracranial circulation and perfusion with clinical complications.Another issue is the use of continuous renal replacement therapy (CRRT) on pediatric ALF. 7 As mentioned before, the pediatric ALF is a dramatic clinical syndrome in which children has rapid deterioration of hepatic function and can evolve to multiorgan failure and cerebral edema. As found by Deep et al 7 patients who benefited most from CRRT were those with toxic cause unlike the patients with metabolic causes. Therefore, clinicians should be careful in the selection of patients who underwent CRRT, as the cause of pediatric ALF is determinant for prognosis. That is important to consider because of the possible complications related to CRRT. Santiago et al 8 found in their study that CRRT-complications are common in children and some are potentially serious, the majority were problems o...

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Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure

Cited by 20 publications

References 9 publications

Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review

Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review

Management of Cerebral Edema in Acute Liver Failure

Pediatric Acute Liver Failure: Current Perspectives

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