Modifications of intracranial pressure after molecular adsorbent recirculating system treatment in patients with acute liver failure: case reports.
Cerebral dysfunction may be fatal in patients with acute liver failure (ALF); intracranial pressure (ICP) monitoring may be mandatory to direct measures to prevent further cerebral edema. Recently the introduction of dialysis with the molecular adsorbent recirculating system (MARS) has improved the outcomes among patients with ALF. The aim of this study was to evaluate ICP changes after MARS treatment among patients with ALF.


METHODS
Three patients -- 14, 18 and 16 years old -- were admitted to the ICU for acute liver failure induced by HBV in two cases and by acetaminophen in the other one. Because of Glasgow Coma Score (GCS) <8, they were intubated and ventilated to protect the airway and maintain moderate hypocapnia. Invasive monitoring of intracranial pressure MARS treatments were performed in all patients.


RESULTS
The patients received MARS treatments every day after their admission to liver transplantation. After MARS therapy the ICP decreased on average from 21 to 7 mm Hg. Significant hemodynamic modifications were not observed and their neurological conditions improved.


CONCLUSIONS
MARS treatment improved the clinical pictures of these patients increasing the available time to obtain an urgent liver graft.
Pugliese
F
F
Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Università degli Studi di Roma La Sapienza, Roma, Italy. mavif@tiscali.it
Ruberto
F
F
Perrella
S M
SM
Cappannoli
A
A
Bruno
K
K
Martelli
S
S
Celli
P
P
Summonti
D
D
D'Alio
A
A
Tosi
A
A
Novelli
G
G
Morabito
V
V
Poli
L
L
Rossi
M
M
Berloco
P B
PB
Pietropaoli
P
P
D000293:Adolescent; D001929:Brain Edema / Q000517:prevention & control; D005112:Extracorporeal Circulation / Q000379:methods; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000628:therapy*; D007427:Intracranial Pressure; D017114:Liver Failure, Acute / Q000209:etiology*; D016031:Liver Transplantation; D016060:Sorption Detoxification; D016896:Treatment Outcome