title: State-of-the-art management and monitoring of brain edema and intracranial hypertension in fulminant hepatic failure. A proposed algorithm.
abstract: OBJECTIVE
  Develop an evidence-based clinical algorithm integrating clinical decision making on intracranial pressure (ICP) monitoring and intracranial hypertension (ICH) management in the setting of fulminant hepatic failure (FHF).
  
  
  METHODS
  An English-language literature review was conducted using the PubMed database in November 2007. In compiling evidence on current management trends of ICP and FHF, the paired keywords: fulminant hepatic failure and either mannitol, hypertonic saline, hyperventilation, bioartificial liver, hypothermia, indomethacin, thiopental, or propofol were used. In compiling evidence on ICP monitoring in FHF, the terms "intracranial pressure monitoring" and "liver failure" were used. Excluded references were either pertinent to animal research or irrelevant to ICP monitoring and ICH management in the setting of FHF.
  
  
  RESULTS
  State-of-the-art management of ICH due to brain edema in FHF includes Class I therapies such as mannitol and hypertonic saline. Bioartificial liver, hypothermia and hyperventilation are supported by Class II evidence. Indomethacin and sedation remain Class III. Monitoring ICP is supported by Class II and III evidence. A clinical algorithm was created based on the existing therapeutic armamentarium and corresponding evidence support.
authors.affiliation: Division of Neurological Surgery, University of Texas Medical Branch, Galveston, TX 77555-0517, USA. jagascot@utmb.edu
authors.forename: Jaime
authors.initials: J
authors.lastname: Gasco
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.forename: Brodus
authors.initials: B
authors.lastname: Franklin
authors.forename: Philip G
authors.initials: PG
authors.lastname: Thomas
authors.forename: Joel T
authors.initials: JT
authors.lastname: Patterson
mesh_terms: D000465:Algorithms; D001929:Brain Edema / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D017114:Liver Failure, Acute / Q000150:complications; D008991:Monitoring, Physiologic / Q000379:methods*