M. De Lima Oliveira, M. Fernando Paschoal Junior, K Almeida Lins, R. Carvalho De Nogueira, M. Jacobsen Teixeira, E. Bonr-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: The clinical course of patients with fulminant hepatic failure (FHF) is often worsened by loss autoregulation of cerebral blood flow (CBF), which leads to cerebral edema and intracranial hypertension. The development these complications is an important event in patients with FHF that needs intensive care and urgent liver transplantation. To evaluate the hemodynamic and cerebrovascular autoregulation capacity of patients with fulminant hepatic failure before and after liver transplantation and those not undergoing transplantation.

Material and Methods: We evaluated 25 patients with diagnosis of FHF admitted to the Intensive Care Unit of liver transplantation in Hospital das Clinicas, Sao Paulo University Medical School, of whom 17 patients were evaluated before and after liver transplantation. The cerebral hemodynamics was evaluated by cerebral blood flow velocity in the middle cerebral arteries, using a device transcranial Doppler, equipped with a 2 MHz probe. Assessment of cerebral autoregulation was evaluated by the ratio of static autoregulation that takes into account the effects of increased PAM on cerebral blood flow velocity. For this, promoted the increase in MAP (20 mmHg to 30 mmHg) after infused with norepinephrine.

Discussion: The results of this study demonstrate that impaired autoregulation is present in most patients diagnosed with FHF before liver transplantation as well as in most cerebral autoregulation is restoring the first 48 hours after transplantation.

Key words: brain vascular autoregulation, fulminant hepatic failure, transcranial Doppler.

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