title: Multimodal brain monitoring in fulminant hepatic failure.
abstract: Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.
authors: Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil.
authors: Fernando Mendes
authors: FM
authors: Paschoal
authors: Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil.
authors: Ricardo Carvalho
authors: RC
authors: Nogueira
authors: Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil.
authors: Karla De Almeida Lins
authors: Kde A
authors: Ronconi
authors: Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil.
authors: Marcelo
authors: M
authors: de Lima Oliveira
authors: Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil.
authors: Manoel Jacobsen
authors: MJ
authors: Teixeira
authors: Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil.
authors: Edson
authors: E
authors: Bor-Seng-Shu
keywords: Cerebral edema; Fulminant hepatic failure; Intracranial hypertension; Liver transplantation; Multimodality methods