Intracranial hypertension in acute liver failure: pathophysiological basis of rational management.

@article{Jalan2003IntracranialHI,
  title={Intracranial hypertension in acute liver failure: pathophysiological basis of rational management.},
  author={Rajiv Jalan},
  journal={Seminars in liver disease},
  year={2003},
  volume={23 3},
  pages={
          271-82
        }
}
  • R. Jalan
  • Published 1 August 2003
  • Medicine
  • Seminars in liver disease
Increased intracranial pressure (ICP) in patients with acute liver failure (ALF) remains a major cause of morbidity and mortality. Conventional methods of ammonia reduction such as the use of lactulose do not improve outcome, and metabolic substrates such as L-ornithine L aspartate may offer more promise. Mannitol remains the mainstay of therapy. An important role for cerebral hyperemia in the pathogenesis of increased ICP has led to a reevaluation of established therapies such as… 

Figures from this paper

Therapy of intracranial hypertension in patients with fulminant hepatic failure
TLDR
The pathophysiology of IH in patients with FHF is reviewed and various therapeutic strategies currently available in managing these patients in the critical care setting are outlined.
Keeping cool in acute liver failure: rationale for the use of mild hypothermia.
Acute liver failure: current management and future prospects.
  • R. Jalan
  • Medicine
    Journal of hepatology
  • 2005
Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension.
TLDR
Moderate hypothermia is an effective and safe bridge to OLT in patients with ALF who have increased ICP that is resistant to standard medical therapy and a large multicenter trial of hypthermia in ALF is justified.
Neurological Monitoring in Acute Liver Failure.
Therapeutic Hypothermia for Acute Liver Failure: Toward a Randomized, Controlled Trial in Patients with Advanced Hepatic Encephalopathy
TLDR
A randomized, controlled trial comparing the management of ALF patients under normothermic and hypothermic conditions is a logical extension of preliminary observations and considers the many difficulties which will be encountered in the design of such a trial in patients with ALF at high risk of developing cerebral edema.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 83 REFERENCES
Cerebral edema and intracranial pressure monitoring.
  • J. Córdoba, A. Blei
  • Medicine
    Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 1995
TLDR
Two aspects of the development of brain swelling in fulminant hepatic failure are discussed: elucidation of its pathogenesis should lead to a more rational therapeutic approach and the relationship between hepatic encephalopathy and brain edema, a source of controversy.
Moderate hypothermia prevents cerebral hyperemia and increase in intracranial pressure in patients undergoing liver transplantation for acute liver failure
TLDR
Moderate hypothermia is safe and successfully prevents increases in ICP during OLT for ALF and is associated with an increase in cerebral blood flow, which was not observed in group III.
Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure
TLDR
Intracranial pressure monitoring represents a potentially important tool in the preoperative and intraoperative management of comatose patients with fulminant hepatic failure and warrants further study.
Thiopental infusion in the treatment of intracranial hypertension complicating fulminant hepatic failure
TLDR
The response of otherwise intractable intracranial hypertension and the 38% survival rate are remarkable for a group of patients with such a poor prognosis.
Pathogenesis of hepatic encephalopathy in acute liver failure.
TLDR
Comparison of HE in acute liver failure with that of cirrhosis allows recognition of important differences and similarities and a key role for ammonia in the pathogenesis of both HE and brain edema is firmly supported by clinical and experimental data.
FACTORS ASSOCIATED WITH SEVERE INTRACRANIAL HYPERTENSION IN CANDIDATES FOR EMERGENCY LIVER TRANSPLANTATION
TLDR
It is suggested that vigorous treatment of fever, arterial hypertension, and agitation are important aspects of the intensive care management of FHF patients to maintain their OLT candidacy.
Brain edema in liver failure: Basic physiologic principles and management
  • F. Larsen, J. Wendon
  • Medicine
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2002
TLDR
Basic physiologic principles that determine water flux across the blood‐brain barrier are focused on, finding that rational fluid therapy, adequate ventilation, and temperature control are of direct importance to controlling cerebral capillary water flux in patients with acute liver failure.
...
1
2
3
4
5
...