• Vladimir L Cousin, Ramy Charbel, Narjess Ghali, Clémence Marais, and Pierre Tissières.
• Pediatric Intensive Care and Neonatal Medicine, AP-HP Paris Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre, Bicêtre, France.
• Pediatr Crit Care Me. 2022 Aug 1; 23 (8): e382-e385.

ObjectivesTo report our single-center use of transcranial Doppler (TCD) for noninvasive neuromonitoring in pediatric patients with acute liver failure (ALF).DesignRetrospective cohort from January 2016 to June 2019.SettingPICU in Bicêtre Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), a national referral center for pediatric liver transplantation.PatientsPediatric patients with severe ALF (prothrombin time < 30% and Hepatic Encephalopathy score ≥ 3), on continuous venovenous high-flow hemofiltration.InterventionsNone.Measurements And Main ResultsTen children were identified, six were transplanted (1/6 died) and four were not (3/4 died). TCD was performed several times per patient and the evolution of cerebral perfusion parameters was followed. Of interest, zero of six patients who survived lost end-diastolic velocity (EDV), whereas four of four patients who died did (difference, 100%; 95% CI, 37-100%; χ 2 , 9; degrees of freedom, 1; p = 0.0027). We failed to identify an association between pulsatility index (PI) or EDV, and severity of hepatic encephalopathy.ConclusionsTCD was a noninvasive and bedside available tool to detect and screen for presence of abnormal cerebral flow in children with ALF, according to age-related reference values. TCD detected reduced EDV and elevated PI in children with ALF awaiting transplant who died compared with those who survived.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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