title: Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure.
abstract: Raised intracranial pressure due to cerebral oedema is a major cause of death in fulminant hepatic failure and in the present study we have carried out a controlled clinical trial of continuous hyperventilation in the prevention of this complication. Twenty patients were electively hyperventilated to maintain PaCO2 between 3.5 and 5 kPa. In the other 35 patients mechanical ventilation was instituted only if severe hypoxia or hypercapnia occurred. Cerebral oedema, diagnosed clinically or by a rise in intracranial pressure to greater than 30 mm Hg, occurred in 85% of hyperventilated patients and in 86% of those not so treated. Although there was no significant reduction in the number of episodes of cerebral oedema in the hyperventilated patients (4.8 episodes/24 h) as compared with the controls (5.3 episodes/24 h), hyperventilation did appear to delay the onset of coning but on the basis of these results could not be recommended to be used routinely as a prophylactic measure in the prevention of cerebral oedema in this condition.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ede
authors.forename: A E
authors.initials: AE
authors.lastname: Gimson
authors.forename: D
authors.initials: D
authors.lastname: Bihari
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D001929:Brain Edema / Q000517:prevention & control*; D002245:Carbon Dioxide / Q000097:blood; D002986:Clinical Trials as Topic; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000628:therapy; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial
chemical_list: D002245:Carbon Dioxide