Department of Anesthesiology and Intensive Care, CHU Beaujon, DMU Parabol APHP.Nord - Clichy, Paris, France.
Liver Unit, CHU Beaujon - Clichy, Paris, France.
Clin Transplant. 2023 Jun;37(6):e14975. doi: 10.1111/ctr.14975. Epub 2023 Mar 25.
Acute liver failure (ALF) is characterized by hepatic encephalopathy (HE) often due to intracranial hypertension (ICH). The risk/benefit-balance of intraparenchymal pressure catheter monitoring is controversial during ALF.
Perform an evaluation of transcranial Doppler (TCD) use in patients with ALF listed for emergency liver transplantation.
Single center retrospective cohort study including all patients registered on high emergency LT list between 2012 and 2018. All TCD measurements performed during ICU stay after listing and after LT (when performed) were recorded. TCD was considered abnormal when pulsatility index (PI) was >1.2.
Among 106 patients with ALF, forty-seven (44%) had a TCD while on list. They had more severe liver and extrahepatic organ failure. When performed, TCD was abnormal in 51% of patients. These patients more frequently developed ICH events (45% vs. 13%, p = .02) and more frequently required increase in sedative drugs and vasopressors. While 22% of patients with normal TCD spontaneously survived, all of those with abnormal TCD died or were transplanted (p = .02). All transplanted patients who had abnormal exams normalized their TCD within 2 (1-2) days after LT.
TCD may be a useful non-invasive tool for ICH detection and management, then guide sedation withdrawal.
急性肝衰竭（ALF）的特征是肝性脑病（HE），通常由于颅内压升高（ICH）引起。在 ALF 期间，脑实质内压力导管监测的风险/获益平衡存在争议。
评估经颅多普勒（TCD）在 ALF 患者中的应用，这些患者已被列入紧急肝移植名单。
这是一项单中心回顾性队列研究，纳入了 2012 年至 2018 年期间登记在高紧急 LT 名单上的所有患者。记录了列入名单后 ICU 住院期间和 LT 后（如果进行）进行的所有 TCD 测量。当搏动指数（PI）>1.2 时，TCD 被认为异常。
在 106 例 ALF 患者中，有 47 例（44%）在名单上进行了 TCD。他们的肝和肝外器官衰竭更为严重。当进行 TCD 检查时，51%的患者出现异常。这些患者更频繁地发生 ICH 事件（45% vs. 13%，p=0.02），更频繁地需要增加镇静药物和血管加压素。虽然 22%的 TCD 正常患者自发存活，但所有 TCD 异常的患者均死亡或接受了移植（p=0.02）。所有 TCD 异常的移植患者在 LT 后 2（1-2）天内其 TCD 恢复正常。
TCD 可能是一种有用的 ICH 检测和管理的非侵入性工具，然后指导镇静剂的撤药。
