title: Artificial liver support system reduces intracranial pressure more effectively than bioartificial system: an experimental study.
abstract: OBJECTIVE
  Extracorporeal liver support (ELS) may play a role in bridging therapy in patients with acute liver failure (ALF). The aim of this study was to compare the influence of nonbiological and biological methods on intracranial pressure (ICP) in an animal model of ALF.
  
  
  METHODS
  A surgical devascularization model of ALF in pigs (35-40 kg) was used. Elimination therapy started after the onset of hypoglycemia. Biochemical parameters (bilirubin, ammonia, lactate, etc.) as well as ICP and cerebral perfusion pressure (CPP) were monitored for 12 hours. Of the total 31 pigs with ALF, 14 animals were treated by fractionated plasma separation and absorption (FPSA), 10 were treated with a bioartificial liver (BAL), and 7 animals were used as a control group.
  
  
  RESULTS
  FPSA and BAL treatment started on average 3 hours 17 minutes and 2 hours 21 minutes, after devascularization and lasted for 5 hours 54 minutes and 5 hours 43 minutes, respectively. Ammonia levels were lower in the FPSA group, and bilirubin levels differed significantly in both the FPSA and BAL groups compared with controls. However, ICP values were reduced more effectively in pigs treated by FPSA: 19.1 vs. 27.0 mm Hg at 9 hours, 22.5 vs. 28.7 mm Hg at 11 hours, and 24.0 vs. 33.0 mm Hg at 12 hours (p<0.05).
  
  
  CONCLUSIONS
  The artificial liver support system FPSA reduced ICP values more effectively than the Performer O. Liver RanD BAL system. Compared with this BAL system, the nonbiological elimination method of FPSA is a simpler application with the advantage that it can be applied in a more continuous way.
authors.affiliation: Surgery Department, First Faculty of Medicine, Charles University, Faculty Hospital, Bulovka, Prague, Czech Republic. ondrejryska@centrum.cz
authors.forename: Ondrej
authors.initials: O
authors.lastname: Ryska
authors.forename: Tomas
authors.initials: T
authors.lastname: Pantoflicek
authors.forename: Eva
authors.initials: E
authors.lastname: Laszikova
authors.forename: Josef
authors.initials: J
authors.lastname: Prazak
authors.forename: Eva
authors.initials: E
authors.lastname: Koblihova
authors.forename: Miroslav
authors.initials: M
authors.lastname: Ryska
mesh_terms: D000641:Ammonia / Q000097:blood; D000818:Animals; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002560:Cerebrovascular Circulation; D004195:Disease Models, Animal; D004867:Equipment Design; D006464:Hemoperfusion / Q000295:instrumentation*; D019586:Intracranial Hypertension / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007427:Intracranial Pressure; D019344:Lactic Acid / Q000097:blood; D017114:Liver Failure, Acute / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019164:Liver, Artificial; D010956:Plasmapheresis / Q000295:instrumentation*; D013552:Swine; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D000641:Ammonia; D001663:Bilirubin