Complications of intracranial pressure monitoring in fulminant hepatic failure

Blei, Andrés T.; Ólafsson, Stefán; Webster, Stephen D.; Levy, Robert M.

doi:10.1016/0140-6736(93)90016-a

Cited by 260 publications

(103 citation statements)

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“…24 Intracranial monitoring devices are invasive and problematic during acute liver failure, especially in the setting of coagulopathy. 25 In at least one study, significant morbidity (intracranial bleeding, 22%) and mortality (death, 9%) resulted from ICP monitoring of patients with FHF. 26 A safer, noninvasive method of assessing cerebral edema in FHF is therefore needed.…”

Section: Discussionmentioning

confidence: 99%

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

1998

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Section: Discussionmentioning

confidence: 99%

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

1998

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“…Subdural bolts and parenchymal monitors carry complication rates (mainly bleeding) of 20% and 22% respectively. 36 Colonization of ICP devices increases significantly after about 5 days of insertion, and the risk of superficial wound infection and meningitis rises. In adults, the average ICP ranges from 0 to 10 mmHg.…”

Section: Intracranial Pressure Monitoringmentioning

confidence: 99%

Management in Acute Liver Failure

Shalimar

Acharya

2015

Journal of Clinical and Experimental Hepatology

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Acute liver failure (ALF) is a rare, potentially fatal complication of severe hepatic illness resulting from various causes. In a clinical setting, severe hepatic injury is usually recognised by the appearance of jaundice, encephalopathy and coagulopathy. The central and most important clinical event in ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is responsible for most of the fatalities in this serious clinical syndrome. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a central role in the pathogenesis. The role of newer ammonia lowering agents is still evolving. Liver transplant is the only effective therapy that has been identified to be of promise in those with poor prognostic factors, whereas in the others, aggressive intensive medical management has been documented to salvage a substantial proportion of patients. A small fraction of patients undergo liver transplant and the remaining are usually treated with medical therapy. Therefore, identification of the complications and causes of death in such patients, and use of appropriate prognostic models to identify those who need liver transplant and those who can be managed with medical treatment is a vital component of therapeutic strategy. In this review, we discuss the various pathogenetic mechanisms and treatment options available. ( J CLIN EXP HEPATOL 2015;5:S104-S115)A cute liver failure (ALF) can be a fatal complication of acute hepatic injury and occurs unpredictably. It is a rare clinical entity marked by the sudden loss of hepatic function and a severe life-threatening course in a person with no prior history of liver disease. ALF represents a syndrome rather than a specific disease, having multiple causes that vary in course and outcome. ALF is difficult to identify in its early stages, resulting in frequent delays in initiation of treatment. The causes of ALF include viral hepatitis, drug induced and toxin-induced liver damage, metabolic errors, ischemia, and miscellaneous rare causes.ALF is defined by three criteria: (1) rapid development of hepatocellular dysfunction (jaundice, coagulopathy), (2) encephalopathy, and (3) absence of a prior history of liver disease. 1 However, the interval between onset of acute hepatic injury (jaundice) and onset of liver failure (encephalopathy with or without coagulopathy) in such patients (icterus-encephalopathy interval; IEI) has been described to be between 4 weeks (Indian definition) 2-4 to 24 weeks (AASLD-ALF study group). 5 Further, due to the diverse natural course, ALF has been sub-classified as hyperacute (IEI # 7 day), acute (IEI # 4 weeks) and sub-acute ALF (IEI $ 5 week to #12 weeks) by British authors. 6 Despite these differences in definitions, the central and most important clinical event in ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is responsible for most of the fatalities in this serious clinical syndrome. The pathogenesis of encephalopathy and cerebral edema in ALF is unique an...

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“…Blei et al reported a series of patients with ALF, with a lesser index of complications (3.8%) with the use of epidural transducers, compared with complications observed with subdural and intraparenchymal devices, which presented a procedurerelated bleeding incidence of 20% and 22% respectively. Fatal haemorrhage occurred in 1%, 5%, and 4% of patients with epidural, subdural, and intraparenchymal monitors, respectively 1 . In a study of 36 patients with intracranial hypertension and encephalopathy grade IV, Keays et al reported few complications, including bleeding at the placement site of epidural ICP transducers 3 .…”

Section: Discussionmentioning

confidence: 99%

“…diagnosis and monitoring of intracranial hypertension contributes to the care of candidates for liver transplantation, both before and during the surgical procedure. Nevertheless, in the case of patients with ALF, it is important to consider the disadvantages related with the use of an invasive method, not only because of the severe disorders of the coagulation, but also because of the immunological compromise associated with this type of pathology [1][2][3] .…”

Section: Discussionmentioning

confidence: 99%

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Intraparenchymal intracranial pressure monitoring in patients with acute liver failure

Rabadán

Spaho

Hernández

et al. 2008

Arq. Neuro-Psiquiatr.

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-Background: Elevated intracranial pressure (ICP) is a common cause of death in acute liver failure (ALF) and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. Method: Twenty-three patients with ALF were treated, and 19 of them received a liver transplant. Seventeen patients had ICP monitoring because of grade III-IV encephalopathy. All patients received fresh plasma (2-3 units) before and during placing the intraparenchymal device. Results: Eleven cases (64.7%) had elevated ICP, and 6 patients (35.2%) had normal values. One patient (5.9%) had an asymptomatic small intraparenchymal haemorrhage <1cm 3 in CTscan, which did not prevent the liver transplantation. Conclusion: In our experience, intraparenchymal ICP monitoring in patients with ALF seems to be an accurate method with a low risk of complications.KEy wOrdS: fulminant hepatic failure, hemorrhagic complications, intracranial pressure monitoring. monitoreo intraparenquimatoso de presión intracraneana en pacientes con falla hepática agudaResumen -Antecedentes: La presión intracraneana elevada (PIC) es una causa frecuente de muerte en la falla hepática aguda (FHA) y es determinante para la toma de decisiones respecto del momento del transplante hepático. El tipo de dispositivo para el monitoreo de OIC es controversial em los pacientes em FHA. Los dispositivos epidurales tienen menos riesgo de complicaciones hemorrágicas, pero son menos confiables que los intraparenquimatosos. Método: Veintitrés pacientes con FHA fueron tratados, y 19 de ellos recibieron un transplante hepático. diecisiete pacientes tuvieron monitoreo de PIC debido a encefalopatía grado III-IV. Todos los pacientes recibieron plasma fresco (2-3 unidades) antes y durante la colocación de la fibra intraparenquimatosa. Resultados: Once casos (64.7%) tuvieron PIC elevada, y 6 pacientes (35.2%) tuvieron valores normales. Un paciente (5.9%) tuvo una pequeña hemorragia intraparenquimatosa asintomática <1cm 3 en TAC, la cual no impidió el transplante hepático. Conclusión: En nuestra experiencia, el monitoreo intraparenquimatoso de presión intracraneana en pacientes con FHA parece ser un método preciso y con bajo riesgo de complicaciones.PALABrAS CLAVE: falla hepática fulminante; complicaciones hemorrrágicas; monitoreo de presión intracraneana.Servicio

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Complications of intracranial pressure monitoring in fulminant hepatic failure

Cited by 260 publications

References 8 publications

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

Management in Acute Liver Failure

Intraparenchymal intracranial pressure monitoring in patients with acute liver failure

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