Monitoring of intracranial pressure in acute liver failure is controversial.
This is due to the reported 20% complication risk and limited therapeutic options for intracranial hypertension.
Dr Andres Blei and colleagues used prospectively collected information from 332 patients with acute liver failure and severe encephalopathy.
The research team evaluated recent experience with intracranial pressure monitoring in 24 centers constituting the U.S. Acute Liver Failure Study Group.
Special attention was given to the rate of complications, changes in management, and outcome after liver transplantation.
The team used intracranial pressure monitoring in 92 patients, but the frequency of monitoring differed between centers.
|30-day survival post- liver transplantation was 85% in both groups|
The research team found that intracranial pressure monitoring was strongly associated with the indication of liver transplantation.
A survey performed in a subset of 58 patients with intracranial pressure monitoring revealed intracranial hemorrhage in 10% of the cohort.
Half of these complications were incidental radiological findings.
However, the researchers noted that intracranial bleeding could have contributed to the demise of 2 patients.
In subjects listed for liver transplantation, intracranial pressure monitoring was associated with subjects receiving vasopressors and intracranial pressure-related medications.
The researchers observed that the 30-day survival post- liver transplantation was 85% in both monitored and nonmonitored groups.
Dr Blei's team concludes, “The risk of intracranial hemorrhage following intracranial pressure monitoring may have decreased in the last decade, but major complications are still present.”
“In the absence of intracranial pressure monitoring, however, patients listed for liver transplantation appear to be treated less aggressively for intracranial hypertension.”
“In view of the high 30-day survival rate after liver transplantation, future studies of the impact of intracranial hypertension should also focus on long-term neurological recovery from acute liver failure.”