Abstract
Acute liver failure (ALF) is a potentially serious syndrome characterized by liver dysfunction and encephalopathy. Brain swelling and endocranial hypertension complicate 75–80% of patients with grade III or IV hepatic encephalopathy and are the leading cause of death. Invasive intracranial pressure measurement has been considered the gold standard method of monitoring endocranial hypertension. Noninvasive neuromonitoring is a suitable alternative without the adverse events of invasive techniques. This chapter shows evidence of the usefulness of transcranial Doppler ultrasound (TCD/TCCS) and proposes to the reader a protocol based on noninvasive neuromonitoring. We conclude that the study of cerebral hemodynamics by TCD allows us to establish five hemodynamic patterns (hypoperfusion, high resistance, hyperemia, vasospasm, cerebral circulatory arrest) with prognostic and therapeutic implications in patients with ALF.
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Algorithm
Algorithm
ABCD Airway-breathing-circulation-disability, SAH Subarachnoid hemorrhage, ICP Intracranial pressure, ABP Arterial blood pressure, CA Cerebral autoregulation, CPP cerebral perfusión pressure, ICH Intracerebral hemorrhage, MLS Midline shift, US Ultrasound, MAP mean arterial pressure, CO Cardiac output, ECBD Extracorporeal blood depuration, CCA Cerebral circulatory arrest
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Abdo-Cuza, A.A. (2022). Acute Liver Failure (ALF) in ICU: Usefulness of Transcranial Doppler (TCD/TCCS). In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_50
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DOI: https://doi.org/10.1007/978-3-030-81419-9_50
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