title: Complications and use of intracranial pressure monitoring in patients with acute liver failure and severe encephalopathy.
abstract: Monitoring of intracranial pressure (ICP) in acute liver failure (ALF) is controversial as a result of the reported complication risk (approximately 20%) and limited therapeutic options for intracranial hypertension. Using prospectively collected information from 332 patients with ALF and severe encephalopathy, we evaluated a recent experience with ICP monitoring in the 24 centers constituting the U.S. ALF Study Group. Special attention was given to the rate of complications, changes in management, and outcome after liver transplantation (LT). ICP monitoring was used in 92 patients (28% of the cohort), but the frequency of monitoring differed between centers (P < 0.001). ICP monitoring was strongly associated with the indication of LT (P < 0.001). A survey performed in a subset of 58 patients with ICP monitoring revealed intracranial hemorrhage in 10.3% of the cohort, half of the complications being incidental radiological findings. However, intracranial bleeding could have contributed to the demise of 2 patients. In subjects listed for LT, ICP monitoring was associated with a higher proportion of subjects receiving vasopressors and ICP-related medications. The 30-day survival post-LT was similar in both monitored and nonmonitored groups (85% vs. 85%). In conclusion, the risk of intracranial hemorrhage following ICP monitoring may have decreased in the last decade, but major complications are still present. In the absence of ICP monitoring, however, patients listed for LT appear to be treated less aggressively for intracranial hypertension. In view of the high 30-day survival rate after LT, future studies of the impact of intracranial hypertension should also focus on long-term neurological recovery from ALF.
authors.affiliation: Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Vaquero
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Anne M
authors.initials: AM
authors.lastname: Larson
authors.forename: Nathan M T
authors.initials: NM
authors.lastname: Bass
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Davern
authors.forename: A Obaid
authors.initials: AO
authors.lastname: Shakil
authors.forename: Steven
authors.initials: S
authors.lastname: Han
authors.forename: M Edwyn
authors.initials: ME
authors.lastname: Harrison
authors.forename: Todd R
authors.initials: TR
authors.lastname: Stravitz
authors.forename: Santiago
authors.initials: S
authors.lastname: Muñoz
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Andres T
authors.initials: AT
authors.lastname: Blei
mesh_terms: D000328:Adult; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology*; D017114:Liver Failure, Acute / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome