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      Intracranial Pressure Monitoring in Patients with Fulminant Hepatic Failure Treated with Plasma Exchange and Continuous Hemodiafiltration

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          Background/Aims: To study the influence of our artificial liver support (ALS) on intracranial pressure (ICP) and to evaluate the significance of ICP monitoring in fulminant hepatic failure (FHF) patients treated with ALS. Methods:ICP was measured in 13 consecutive FHF patients treated with ALS. Maximum value in ICP every day was employed as ICP<sub>max</sub> of the day. We analyzed the correlation: (a) between ICP<sub>max </sub>and consciousness level; (b) between ICP and colloid osmotic pressure (COP), and (c) between ICP and PaCO<sub>2</sub>. Results: ICP in 11 patients of 13 was controlled <20 mm Hg through our ALS. A significant positive correlation between ICP<sub>max</sub> and consciousness level was found (p < 0.01). Although there was a significantly negative correlation between ICP and COP (p < 0.001), there was no correlation between ICP and PaCO<sub>2</sub>. Conclusions:We conclude that our ALS does not have any adverse effects on ICP and that ICP monitoring is one of the inevitable monitorings in the management of FHF.

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          Most cited references 19

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          Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound.

          Development of elevated intracranial pressure (ICP) in hepatic failure indicates poor prognosis. Its detection by invasive methods poses methodological problems. We applied ultrasound studies of the optic nerves to noninvasively estimated ICP status. A total of 22 pediatric patients with hepatic failure were examined by serial B scan ultrasound and followed up clinically. Outcome was scored as survival or death due to multiorgan failure (MOF) or raised ICP. In 18 patients, transplantations were performed. Four patients died before transplantation was possible (raised ICP: n=3, MOF: n=1). After OLT there were 10 survivors and 8 patients died (MOF: n=3, raised ICP: n=5). In 10 patients we found optic nerve sheath diameter (ONSD) above normal limits. Eight patients died, mostly because of raised ICP (n=7). Only 2 of the 10 survivors experienced a transient ONSD increase, steadily normalized after transplantation. Preoperatively, normal ONSD was detected in four of seven patients. The outcome of these four cases was clearly superior (three survivors and one MOF) compared with abnormal pre-OLT ultrasound findings (raised ICP: n=3). Patients with poor prognosis related to raised ICP in pediatric liver failure can be identified by ultrasound measurement of ONSD without the disadvantages of invasive procedures. Although the exact intracranial pressure level cannot be deduced from single examinations, ONSD trends can reflect the evolution of ICP in hepatic encephalopathy.
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            Acute Liver Failure

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              Moderate hypothermia for uncontrolled intracranial hypertension in acute liver failure


                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                March 2005
                28 February 2005
                : 23
                : 2
                : 113-118
                Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chuo, Japan
                83205 Blood Purif 2005;23:113–118
                © 2005 S. Karger AG, Basel

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                Figures: 2, Tables: 1, References: 24, Pages: 6
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