Systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine in patients with cirrhosis

Bacq, Yannick; Gaudin, Christophe; Hadengue, Antoine; Roulot, Dominique; Braillon, Alain; Moreau, Richard; Lebrec, Didier

doi:10.1002/hep.1840140313

Cited by 32 publications

(11 citation statements)

References 22 publications

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“…The administration of colloids, albumin and red cells to maintain a haematocrit >30% can help to preserve intravascular volume (Strasser & McDonald, 2009;Carreras, 2012). Some authors have used continuous infusions of low doses of dopamine to maintain renal blood flow (Bacq et al, 1991), but the effectiveness of this measure has never been proven in these patients.…”

Section: Discussionmentioning

confidence: 99%

How I manage sinusoidal obstruction syndrome after haematopoietic cell transplantation

2014

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Summary Sinusoidal obstruction syndrome (SOS), also called veno‐occlusive disease of the liver, is one of the most relevant complications of endothelial origin that appears early after haematopoietic cell transplantation (HCT). Despite its relatively low incidence and the fact that most cases of SOS resolve spontaneously, the cases that evolve to multi‐organ failure (MOF; severe SOS) have a mortality rate higher than 80% and represent one of the major clinical problems after HCT. For this reason, transplantation teams must have a pre‐established policy regarding preventive measures in high‐risk patients, strict daily control of weight and fluid balance during HCT, homogeneous diagnostic criteria, appropriate complementary studies for a correct differential diagnosis and measures to prevent and manage hepatorenal syndrome; in addition they must also be ready to start early treatment with defibrotide in patients with a possible severe SOS. Due to the lack of definitive evidence to enable the establishment of general recommendations in the management of SOS, this review analyses all of these aspects based on the author's personal experience.

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Section: Discussionmentioning

confidence: 99%

How I manage sinusoidal obstruction syndrome after haematopoietic cell transplantation

2014

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“…To compare the magnitude of the estimated HBF with values reported by others, 17 studies comprising a total of 270 patients with cirrhosis was looked through. 1,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] In these studies, ICG was used and the hepatic extraction was measured and taken into account in the calculations. The median (of the reported mean HBF in the individual studies) was 1.18 L/min (range 0.93-1.90).…”

Section: Baseline Hemodynamic Datamentioning

confidence: 99%

Hepatic Blood Flow and Splanchnic Oxygen Consumption in Patients With Liver Failure. Effect of High–Volume Plasmapheresis

Clemmesen

Gerbes²,

Gülberg³

et al. 1999

Hepatology

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Liver failure represents a major therapeutic challenge, and yet basic pathophysiological questions about hepatic perfusion and oxygenation in this condition have been poorly investigated. In this study, hepatic blood flow (HBF) and splanchnic oxygen delivery (DO 2,sp ) and oxygen consumption (VO 2,sp ) were assessed in patients with liver failure defined as hepatic encephalopathy grade II or more. Measurements were repeated after high-volume plasmapheresis (HVP) with exchange of 8 to 10 L of plasma. HBF was estimated by use of constant infusion of D-sorbitol and calculated according to Fick's principle from peripheral artery and hepatic vein concentrations. In 14 patients with acute liver failure (ALF), HBF (1.78 ؎ 0.78 L/min) and VO 2,sp (3.9 ؎ 0.9 mmol/min) were higher than in 11 patients without liver disease (1.07 ؎ 0.19 L/min, P F .01) and (2.3 ؎ 0.7 mmol/min, P F .001). In 9 patients with acute on chronic liver disease (AOCLD), HBF (1.96 ؎ 1.19 L/min) and VO 2,sp (3.9 ؎ 2.3 mmol/min) were higher than in 18 patients with stable cirrhosis (1.00 ؎ 0.36 L/min, P F .005; and 2.0 ؎ 0.6 mmol/min, P F .005). During HVP, HBF increased from 1.67 ؎ 0.72 to 2.07 ؎ 1.11 L/min (n‫)11؍‬ in ALF, and from 1.89 ؎ 1.32 to 2.34 ؎ 1.54 L/min (n‫)7؍‬ in AOCLD, P F .05 in both cases. In patients with ALF, cardiac output (thermodilution) was unchanged (6.7 ؎ 2.5 vs. 6.6 ؎ 2.2 L/min, NS) during HVP. Blood flow was redirected to the liver as the systemic vascular resistance index increased (1,587 ؎ 650 vs. 2,020 ؎ 806 Dyne · s · cm ؊5 · m 2 , P F .01) whereas splanchnic vascular resistance was unchanged. In AOCLD, neither systemic nor splanchnic vascular resistance was affected by HVP, but as cardiac output increased from 9.1 ؎ 2.8 to 10.1 ؎ 2.9 L/min (P F .01) more blood was directed to the splanchnic region. In all liver failure patients treated with HVP (n‫,)81؍‬ DO 2,sp increased by 15% (P F .05) whereas VO 2,sp was unchanged. Endothelin-1 (ET-1) and ET-3 were determined before and after HVP. Changes of ET-1 were positively correlated with changes in HBF (P F .005) and VO 2,sp (P F .05), indicating a role for ET-1 in splanchnic circulation and oxygenation. ET-3 was negatively correlated with systemic vascular resistance index before HVP (P F .05) but changes during HVP did not correlate. Our data suggest that liver failure is associated with increased HBF and VO 2,sp . HVP further increased HBF and DO 2,sp but VO 2,sp was unchanged, indicating that splanchnic hypoxia was not present.(HEPATOLOGY 1999;29: 347-355.)A basic requirement for organ function is adequate blood flow and oxygen delivery. Hepatic blood flow (HBF) and splanchnic oxygenation in patients with liver failure (in the present study, defined as having developed hepatic encephalopathy [HE] grade II or more) have not been assessed because a method to estimate HBF in such patients has not been available until recently. 1,2 Knowledge in this field, therefore, rests on indirect evidence and animal experiments. The observation that whole-body (systemic) oxygen consumpti...

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“…Other agents that have been used include phentolamine, and prostagalndins A 1 and E. A single study found infusion of renal dose dopamine to induce a diuresis in patients with HRS. 3 Similarly, an initial study found a beneficial effect of vasodilatory prostaglandins in hepatorenal syndrome. 4 Large scale studies to corroborate these pilot data are now required.…”

Section: Renal Vasodilatorsmentioning

confidence: 96%

Hepatorenal syndrome

Sanyal

2002

J of Gastro and Hepatol

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Systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine in patients with cirrhosis

Cited by 32 publications

References 22 publications

How I manage sinusoidal obstruction syndrome after haematopoietic cell transplantation

How I manage sinusoidal obstruction syndrome after haematopoietic cell transplantation

Hepatic Blood Flow and Splanchnic Oxygen Consumption in Patients With Liver Failure. Effect of High–Volume Plasmapheresis

Hepatorenal syndrome

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