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

Background/Aims: 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-(ΔHbO2) and total-haemoglobin (ΔHbT) were compared to the jugular bulb saturation (SvjO2) 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 ΔHbO2 and ΔHbT increased 2.7 (0.3–9.6) and 2.0 (0.3–14.8) μmol l−1, respectively, but cerebral oxygenation decreased in one patient. SvjO2 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). ΔHbO2 covariated with changes in SvjO2 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.