Modifications of Intracranial Pressure After Molecular Adsorbent Recirculating System Treatment in Patients With Acute Liver Failure: Case Reports

Pugliese, Francesco; Ruberto, Franco; Perrella, S.; Cappannoli, A.; Bruno, Katelyn A.; Martelli, S.; Celli, Paolo; Summonti, D; DaLio, Andrew L.; Tosi, Antonella; Novelli, G.; Morabito, Vincenzo; Poli, L.; Rossi, Massimo; Berloco, P.; Pietropaoli, P

doi:10.1016/j.transproceed.2007.05.061

Cited by 13 publications

(4 citation statements)

References 18 publications

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“…In adults suffering from ALF, a significant (p Ͻ .001) decrease in HE closely related to a decreased cerebral blood flow and falling serum ammonium levels during MARS has been reported (26,27).…”

Section: Discussionmentioning

confidence: 97%

Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure*

Ringe

Varnholt²,

Zimmering³

et al. 2011

Pediatric Critical Care Medicine

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In childhood acute liver failure, treatment with single-pass albumin dialysis was generally well tolerated and seems to be effective in detoxification and in improving blood pressure, thus stabilizing the critical condition of children before liver transplantation and facilitating bridging to liver transplantation. It may be beneficial in avoiding severe neurologic sequelae after acute liver failure and thereby improve survival. Single-pass albumin dialysis is an inexpensive albumin-based detoxification system that is easy to set up and requires little training. Whether and to what extent single-pass albumin dialysis can support children with acute liver failure until native liver recovery remains unclear.

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Section: Discussionmentioning

confidence: 97%

Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure*

Ringe

Varnholt²,

Zimmering³

et al. 2011

Pediatric Critical Care Medicine

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“…It was demonstrated that MARS improves hepatic encephalopathy in chronic liver failure (23). Clinical data evaluating the effect of MARS on ICP are lacking, despite a promising preliminary report (24). Personally, the authors observed the development of intracranial hypertension, brain stem herniation, and brain death during MARS treatment in a young patient waiting for urgent liver transplantation (unpublished personal data).…”

Section: Discussionmentioning

confidence: 99%

Effects of Large‐Pore Hemofiltration in a Swine Model of Fulminant Hepatic Failure

et al. 2012

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Among the different potential mechanisms that could lead to brain edema and intracranial hypertension in fulminant hepatic failure (FHF), the inflammatory hypothesis implies that systemic inflammation might be in part responsible for an increase in cerebral blood flow (CBF) and brain water content. In this study, the authors used a validated ischemic FHF swine model to evaluate the effects of 80 kDa large‐pore membrane hemofiltration (LPHF) on intracranial pressure (ICP) and CBF, in relation with the clearance of proinflammatory cytokines and blood liver tests, as primary end points. Fifteen pigs were randomized into one of three groups: SHAM, FHF, and FHF + LPHF. All experiments lasted 6 h. In the FHF groups, liver failure was induced by liver ischemia. After 2 h, the FHF + LPHF group underwent 4 h of a zero‐balance continuous veno‐venous hemofiltration using a 0.7‐m2, large‐pore (78 Å) membrane with a cutoff of 80 kDa. ICP, CBF, mean arterial pressure, central venous pressure, and heart rate were continuously monitored and recorded. Arterial aspartate aminotransferase, total bilirubin, creatinine, international normalized ratio, glucose, lactate and serum cytokines interleukin (IL)‐6, IL‐10, and tumor necrosis factor‐α were measured at T0, T120, and T360. Over the 6 h following liver ischemia, the FHF group developed a significant increase in ICP. This ICP rise was not observed in the SHAM group and was attenuated in the FHF + LDHF group. However, the ICP levels were not different at T360 in the FHF + LDHF group compared to the FHF group. No significant effect of LPHF on liver tests or levels of proinflammatory cytokines could be demonstrated. In this model, 80 kDa LPHF was not efficient to control FHF intracranial hypertension and to decrease serum cytokine levels.

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“…Along with this two-stage procedure, there have been other efforts, such as the use of liver support devices, to sustain the acute or fulminant liver failure patients until a liver graft is ready [13,14]. Bioartificial liver support using charcoal columns and extracorporeal devices filled with the liver tissue has been reported [13], and more recently the MARS has been introduced as a nonbiological liver support device [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Bioartificial liver support using charcoal columns and extracorporeal devices filled with the liver tissue has been reported [13], and more recently the MARS has been introduced as a nonbiological liver support device [14,15]. The application of these devices is a relatively common clinical practice because they remove toxic materials from the patients' plasma, thus providing the patients with more time to wait for a liver graft by improving the hemodynamic profiles and alleviating the increased intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

Two-stage liver transplantation in a surgically complicated liver failure patient after hepatic tumor resection -A case report-

Lee

Yang

Kim

2010

Korean J Anesthesiol

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Two-stage liver transplantation, involving a total hepatectomy with a temporary portocaval shunt followed by liver transplantation, requires intensive perioperative care, especially during the prolonged anhepatic period. The pathophysiology and management of this prolonged anhepatic state is not fully elucidated and the proper management during this period is a great challenge to clinicians in the intensive care unit and anesthesiologists. We report a case and management of a total hepatectomy with a temporary portocaval shunt followed by living-donor liver transplantation in a patient with a surgically complicated liver failure after a hepatic tumor resection.

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Modifications of Intracranial Pressure After Molecular Adsorbent Recirculating System Treatment in Patients With Acute Liver Failure: Case Reports

Cited by 13 publications

References 18 publications

Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure*

Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure*

Effects of Large‐Pore Hemofiltration in a Swine Model of Fulminant Hepatic Failure

Two-stage liver transplantation in a surgically complicated liver failure patient after hepatic tumor resection -A case report-

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