Complications of intracranial pressure monitoring in fulminant hepatic failure.
In patients with fulminant hepatic failure, brain oedema and the resulting intracranial hypertension often lead to death; intracranial pressure (ICP) monitoring may therefore be valuable. However, there is uncertainty about the hazards of implanting ICP monitoring devices. We carried out a survey of complications associated with ICP monitoring among centres performing liver transplantation in the USA (n = 262 patients). Epidural transducers were the most commonly used devices and had the lowest complication rate (3.8%); subdural bolts and parenchymal monitors (fibreoptic pressure transducers in direct contact with brain parenchyma and intraventricular catheters) were associated with complication rates of 20% and 22%, respectively. Fatal haemorrhage occurred in 1% of patients undergoing epidural ICP monitoring, whereas subdural and intraparenchymal devices had fatal haemorrhage rates of 5% and 4%. Thus, in the setting of fulminant hepatic failure, epidural transducers may be the safest choice for ICP monitoring, even though they are known to be less precise than the other devices.
Blei
A T
AT
Department of Medicine, Northwestern University School of Medicine, Chicago, Illinois.
Olafsson
S
S
Webster
S
S
Levy
R
R
D000328:Adult; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D002648:Child; D006501:Hepatic Encephalopathy / Q000503:physiopathology*; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D007427:Intracranial Pressure; D008991:Monitoring, Physiologic / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods