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The Values of Cerebrovascular Pressure Reactivity and Brain Tissue Oxygen Pressure Reactivity in Experimental Anhepatic Liver Failure

  • Translational Research
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Abstract

Background

We investigated in a porcine model of anhepatic acute liver failure (ALF), the value of two parameters describing cerebrovascular autoregulatory capacity, pressure reactivity index (PRx) and brain tissue oxygen pressure reactivity (ORx), regarding their power to predict the development of intracranial hypertension.

Methods

In six pigs, hepatectomy was performed. Only one animal was sham operated. All animals received neuromonitoring including arterial blood pressure, intracranial pressure (ICP), and brain tissue partial oxygen pressure (PbrO2). The average time of neuromonitoring was 31.0 h. Cerebral perfusion pressures (CPP), cerebrovascular pressure reactivity index (PRx) and brain tissue oxygen reactivity index (ORx) were calculated.

Results

Perioperative disturbance of AR improved within 4 h after surgery. From 6 to 16 h post hepatectomy, ICP did slowly increase by 4 mmHg from baseline; CPP remained stable around 40 mmHg. PRx and ORx, however, indicated in this period a progressive loss of AR, reflected in a decrease of PbrO2 despite unchanged CPP. Beyond 16 h, ICP rose quickly. At CPP levels below 35 mmHg, PbrO2 fell to ischemic levels.

Conclusions

The loss of cerebrovascular autoregulatory capacity, indicated by a rise of PRx and ORx precedes the final crisis of uncontrollable intracranial hypertension in this animal model by hours. During this phase cerebral blood flow, as reflected in tissue oxygenation, deteriorates despite unchanged CPP. Monitoring of AR during ALF therefore seems to carry the power to identify a risk for development of critical CBF and intracranial hypertension.

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Abbreviations

AR:

Autoregulation

PRx:

Cerebrovascular pressure reactivity index

ORx:

Brain tissue oxygen pressure reactivity

CBF:

Cerebral blood flow

CPP:

Cerebral perfusion pressure

ALF:

Acute liver failure

TCD:

Transcraniel Doppler

MAP:

Mean arterial pressure

PbrO2 :

Brain tissue oxygen

LLA:

Lower limit of the autoregulation

NO:

Nitric oxide

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Acknowledgments

The authors thank T. O. Greiner, A. Stolz, and M. Seitzer for their excellent veterinary and technical assistance. The authors owe great thanks to P. Lewis, M. Jaeger, and M. Czosnyka for critically reading and commenting on the manuscript.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, Eberhard Karls University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Gerd Grözinger, Martin Schenk, Christian Thiel & Karolin Thiel

  2. Division of Pediatric Neurosurgery, Department of Neurosurgery, Eberhard Karls University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Gerd Grözinger, Matthias H. Morgalla & Martin U. Schuhmann

Authors
  1. Gerd Grözinger
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Correspondence to Gerd Grözinger.

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Grözinger, G., Schenk, M., Morgalla, M.H. et al. The Values of Cerebrovascular Pressure Reactivity and Brain Tissue Oxygen Pressure Reactivity in Experimental Anhepatic Liver Failure. Neurocrit Care 17, 271–280 (2012). https://doi.org/10.1007/s12028-012-9714-0

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  • DOI: https://doi.org/10.1007/s12028-012-9714-0

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