Intracranial Pressure Monitoring in Patients with Fulminant Hepatic Failure Treated with Plasma Exchange and Continuous Hemodiafiltration

Abstract

Background/Aims: To study the influence of our artificial liver support (ALS) on intracranial pressure (ICP) and to evaluate the significance of ICP monitoring in fulminant hepatic failure (FHF) patients treated with ALS. Methods:ICP was measured in 13 consecutive FHF patients treated with ALS. Maximum value in ICP every day was employed as ICP_max of the day. We analyzed the correlation: (a) between ICP_maxand consciousness level; (b) between ICP and colloid osmotic pressure (COP), and (c) between ICP and PaCO₂. Results: ICP in 11 patients of 13 was controlled <20 mm Hg through our ALS. A significant positive correlation between ICP_max and consciousness level was found (p < 0.01). Although there was a significantly negative correlation between ICP and COP (p < 0.001), there was no correlation between ICP and PaCO₂. Conclusions:We conclude that our ALS does not have any adverse effects on ICP and that ICP monitoring is one of the inevitable monitorings in the management of FHF.

Intracranial pressure monitoring: Vital information ignored

“…However a subgroup of these patients with normal CT scans have an incidence of raised ICP of only 13% unless they have any two of the following three risk factors: age >40 years, systolic BP <90 mmHg or motor posturing. [14] The other groups of patients in whom there is some data on ICP monitoring are subarachnoid hemorrhage [20,27] and hepatic failure, [28] though indications are not as well defined as those for trauma.…”