BACKGROUND: Cerebral edema is a well-recognized and potentially fatal complication of acute liver failure (ALF). The effectiveness of treatments that address intracranial hypertension is generally assessed by measuring intracranial pressure (ICP). The aim of this study was to determine the role of cerebral microdialysis in monitoring the efficacy of fractionated plasma separation and adsorption (FPSA) treatment for ALF. We hypothesized that in ALF cerebral microdialysis reflects the benefits of FPSA treatment on cerebral edema before ICP. METHODS: A surgical resection model of ALF was used in 21 pigs. We measured plasma ammonia concentration, brain concentrations of glucose, lactate, pyruvate, glutamate and glutamine, and ICP. Animals were randomized into three groups: in one group eight animals received 6 hours of FPSA treatment 2 hours after induction of ALF; in another group 10 animals received supportive treatment for ALF only; and in the final group three underwent sham surgery. RESULTS: The ICP was significantly higher in the ALF group than in the FPSA group 9 hours after surgery. The lactate/pyruvate (L/P) ratio was significantly lower in the FPSA group than the ALF group 5 hours after surgery, before any significant difference in ICP was detected. Indeed, significant changes in the L/P ratio could be observed within 1 hour of treatment. Glutamine levels were significantly lower in the FPSA group than the ALF group between 6 hours and 10 hours after surgery. CONCLUSIONS: Brain lactate/pyruvate ratio and concentration of glutamine measured by cerebral microdialysis reflected the beneficial effects of FPSA treatment on cerebral metabolism more precisely and rapidly than ICP in pigs with fulminant ALF. The role of glutamine as a marker of the efficacy of FPSA treatment for ALF appears promising, but needs further evaluation.
- MeSH
- akutní selhání jater komplikace krev terapie MeSH
- amoniak krev MeSH
- časové faktory MeSH
- edém mozku etiologie metabolismus prevence a kontrola MeSH
- glukosa metabolismus MeSH
- glutamin metabolismus MeSH
- intrakraniální hypertenze etiologie prevence a kontrola MeSH
- intrakraniální tlak MeSH
- kyselina glutamová metabolismus MeSH
- kyselina mléčná metabolismus MeSH
- kyselina pyrohroznová metabolismus MeSH
- mikrodialýza * MeSH
- mimotělní oběh MeSH
- prasata MeSH
- sorpční detoxikace * MeSH
- velký mozek * metabolismus MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- algoritmy MeSH
- biomechanika MeSH
- kardiovaskulární systém patologie MeSH
- lidé MeSH
- minutový srdeční výdej fyziologie MeSH
- modely kardiovaskulární * MeSH
- plicní oběh MeSH
- počítačová simulace využití MeSH
- podpůrné srdeční systémy * využití MeSH
- srdeční frekvence fyziologie MeSH
- srdeční selhání * patologie terapie MeSH
- statistika jako téma MeSH
- teoretické modely MeSH
- Check Tag
- lidé MeSH
- MeSH
- artroplastiky kloubů metody využití MeSH
- biomechanika MeSH
- kyselina hyaluronová terapeutické užití MeSH
- lidé MeSH
- lubrikanty * chemie terapeutické užití MeSH
- mechanické jevy MeSH
- protézy a implantáty MeSH
- protézy kloubů * využití MeSH
- synoviální tekutina * MeSH
- testování materiálů metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
