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Transcranial doppler sonography and internal jugular bulb saturation during hyperventilation in patients with fulminant hepatic failure
Author(s) -
Strauss Gitte Irene,
Møller Kirsten,
Holm Søren,
Sperling Bjørn,
Knudsen Gitte Moos,
Larsen Fin Stolze
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.23075
Subject(s) - hyperventilation , medicine , fulminant hepatic failure , middle cerebral artery , transcranial doppler , anesthesia , cerebral blood flow , fulminant , ischemia , transplantation , liver transplantation
Mechanical hyperventilation is often used to postpone or ameliorate intracranial hypertension in patients with fulminant hepatic failure (FHF). Because such treatment may critically reduce cerebral blood flow (CBF), bedside techniques to monitor CBF are warranted. In this study, we evaluated the efficacy of transcranial Doppler (TCD) sonography of the middle cerebral artery (MCA) and internal jugular bulb saturation (svJ O 2 ) to determine relative changes in CBF during mechanical hyperventilation in 8 patients with FHF (median age, 40 years; range, 20 to 54 years). We found that TCD and svJ O 2 decreased during hyperventilation in parallel with CBF, determined by the xenon 133 ( 133 Xe) washout technique. Quantitatively, the TCD method was less accurate to determine carbon dioxide ( CO 2 ) reactivity compared with svJ O 2 and the 133 Xe technique. This indicates a slight change in MCA diameter during hyperventilation. We conclude that TCD and svJ O 2 monitoring may give valuable information on relative changes in CBF during hyperventilation. However, the TCD method appears less accurate for quantitative estimation of CO 2 reactivity in patients with FHF. ( Liver Transpal 2001;7:352‐358. )