Fractioned plasmatic separation and adsorption has no influence on the haemodynamic parameters in experimental acute liver failure
Authors:
Lásziková Eva 1,5; Pražák Josef 2; Pantoflíček Tomáš 3,5; Ryska Ondřej 3; Koblihová Eva 3,5; Jurenka Božetěch 1; Ryska Miroslav 3,5
Authors‘ workplace:
Anesteziologicko-resuscitační oddělení ÚVN Praha
1; Klinika anesteziologie, resuscitace a intenzivní péče 2. LF UK a ÚVN Praha
2; Chirurgická klinika 2. LF UK a ÚVN Praha
3; Chirurgická klinika 1. LF Praha UK, Nemocnice na Bulovce, Praha
4; Centrum buněčné terapie a tkáňových náhrad 2. LF UK a ÚVN Praha
5
Published in:
Anest. intenziv. Med., 21, 2010, č. 4, s. 191-198
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
Acute liver failure (ALF) is a relatively sparse disease with a very poor prognosis. Its onset is accompanied by haemodynamic instability. The aim of our study was to evaluate the influence of fractioned plasmatic separation and adsorption (FPSA) on the haemodynamics using an ALF experimental model in large laboratory animals, comparing the results of the experimental and control groups.
Design:
Experimental study.
Setting:
Department of Anaesthesiology and Resuscitation, Central Military Hospital, Prague.
Materials and methods:
Our experiment included 21 laboratory pigs ( 25–45 kg ) with ALF induced by surgical devascularization. The onset of ALF was documented by hypoglycaemia (< 3.5 mmol/l). FPSA therapy was commenced in 14 of the animals, the remaining animals were used as the control group. We reported the haemodynamic parameters at hour 0, 3, 6, 9 and 12 of our experiment, as well as the biochemical parameters and intracranial pressure (ICP). The results were statistically analysed using the T-test and Mann-Whitney’s test. A difference greater than pResults: As compared with the values measured at the beginning of our experiment, a significant decrease of systemic vascular resistance index (SVRI) determined at hour 3, 6, 9, and 12 of our experiment, and a significant increase of the heart rate (HR) and cardiac index (CI) at hour 6, 9, and 12 of the experiment were noted in both the groups. Compared to the control group, we did not find any significant difference of mean arterial pressure (MAP), systemic vascular resistance index (SVRI) and lactate (p > 0.05) in the experimental group of animals treated with FPSA therapy. A significant decrease of ICP (p < 0.05), a significant decrease of HR at hour 3, a significant increase of CI at hour 9 and a significant decrease of pulmonary artery wedge pressure (PAWP) at hours 6 and 12 were observed.
Conclusion:
Our study did not show significant changes of the haemodynamic parameters during the treatment of acute liver failure using the Prometheus device in large laboratory animals.
Keywords:
experimental acute liver failure – fractioned plasmatic separation and adsorption – haemodynamic parameters
Sources
1. Laleman, W., Wilmer, A., Devenepoel, P., Elst, I. V., Zeegers, M., Zaman, Z., Verslype, C., Fevery, J., Nevens, F. Effect of the Molecular Adsorbent Recirculating System and Prometheus device on Systemic hemodynamics and Vasoactive Agents in Patiens with Acute-on-Chronic Alcoholic Liver Failure. Crit. Care, 2006, 10, 4, p. R108.
2. Rifai, K., Manns, M. P. Review Article: Clinical Experience With Prometheus. Ther. Apher. Dial, 2006, 10, 2, p. 132–137.
3. Ryska, M., Kieslichová, E., Pantoflíček, T., Ryska, O., Zazula, R., Skibová, J., Hájek, M. Devascularization Surigical Model of Acute Liver Failure in Minipigs. Eur. Surg. Res., 2004, 36, p. 179–184.
4. Rahman, T., Hodgson, H. Clinical management of acute hepatic failure. Intensive care Med., 2001, 27, p. 467–476.
5. Ytrebo, L. M., Sen, S., Pose, C., Davies, N. A. Nedredal, G. I., Fuskevaag, O. M., Ten Have, G. A., Prinzen, F. W., Williams, R., Deutz, N. E., Jalan, R., Revhaug, A. Systemic and regional hemodynamics in Pigs with acute Liver Failure and the Effect of albumin Dialysis. Scand. J. gastroenterol., 2006, 41, 11, p.1350–1360.
6. Kaptanoglu, L., Blei, A. T. Current status of liver support system. Clin. Liver. Dis., 2000, 4, p. 711–729.
7. Clemmesen, O., Ott, P., Larsen, F. S. Splanchnic Metabolism in Acute Liver Failure and Sepsis. Curr. Opin. Care, 2004, 10, 2, p. 152–155.
8. Murphy, N. D., Kodakat, S. K., Wendon, J. A., Jooste, C. A., Muesan, P., Rela, M., Heaton, N. D. Liver and Intestinale Lactate Metabolism in Patiens with Acute Liver Failure undergoing Liver Transplantation. Crit. Care Med., 2001, 29, 1, p. 2111–2118.
9. Newsome, P. N., Plevris, J. N., Nelson, L. J. Animal models of fulminant hepatic failure: A critical evaluation. Liver. Transplant., 2000, 1, p. 21–31.
10. Kieslichová, E., Ryska, M., Pantoflíček, T., Ryska, O., Zazula, R., Skibová, J. Hemodynamic Parameters in a Surgical Devascularisation Model of Fulminant Hepatic Failure in the Minipig. Physiol. Res., 2005, 54, p. 485–490.
11. Steiner, C., Mitzner, S. Experiences with MARS Liver Support Therapy in Liver Failure: Analysis of 176 Patients of the International MARS Registry. Liver, 2002, 22, p. 20–25.
12. Schmidt, L. E., Sorense, V. R., Svendsen, L. B., Hansen, B. A., Larsen, F. S. Hemodynamic Changes during a single Treatment with the Molecular Adsorbents recirculating System in Patiens with acute-on-chronic Livet Failure. Liver Transpl., 2001, 7,12, p. 1034–1039.
13. Dethloff, T., Tofteng, F., Frederiksen, H. J., Hojskov, M., Hansen, B. A., Larsen, F. S. Effect of Prometheus liver assist system on hemodynamics in patiens with cirrhosis: a randomized controlled study. World J. Gastroenterol., 2008, 14, 13, p. 2065–2071.
14. Ryska, M., Lásziková, E., Pantoflíček, T., Ryska, O., Pražák, J., Koblihová, E. Prometheus Significantly Decreases Intracranial Pressure on Acute Liver Failure. Experimental Study. Eur. Surg. Res., 2009, 42, 4, p. 230–235.
15. Stadlbauer, V., Krispen, P., Signet, B. et al. Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure. Crit. Care, 2006, 10, 6, p. R169.
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2010 Issue 4
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