Neurocritical Care

, Volume 11, Issue 2, pp 242–246 | Cite as

Prolonged Hypothermia as a Bridge to Recovery for Cerebral Edema and Intracranial Hypertension Associated with Fulminant Hepatic Failure

  • Shibin Jacob
  • Ahmed Khan
  • Elizabeth R. Jacobs
  • Prem Kandiah
  • Rahul Nanchal
Practical Pearl

Abstract

Background

To review evidence-based treatment options in patients with cerebral edema complicating fulminant hepatic failure (FHF) and discuss the potential applications of hypothermia.

Method

Case-based observations from a medical intensive care unit (MICU) in a tertiary care facility in a 27-year-old female with FHF from acetaminophen and resultant cerebral edema.

Results

Our patient was admitted to the MICU after being found unresponsive with presumed toxicity from acetaminophen which was ingested over a 2-day period. The patient had depressed of mental status lasting at least 24 h prior to admission. Initial evaluation confirmed FHF from acetaminophen and cerebral edema. The patient was treated with hyperosmolar therapy, hyperventilation, sedation, and chemical paralysis. Her intracranial pressure remained elevated despite maximal medical therapy. We then initiated therapeutic hypothermia which was continued for 5 days. At re-warming, patient had resolution of her cerebral edema and intracranial hypertension. At discharge, she had complete recovery of neurological and hepatic functions.

Conclusion

In patients with FHF and cerebral edema from acetaminophen overdose, prolonged therapeutic hypothermia could potentially be used as a life saving therapy and a bridge to hepatic and neurological recovery. A clinical trial of hypothermia in patients with this condition is warranted.

Keywords

Acute liver failure Cerebral edema Hypothermia Fulminant hepatic failure 

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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Shibin Jacob
    • 1
  • Ahmed Khan
    • 1
  • Elizabeth R. Jacobs
    • 1
  • Prem Kandiah
    • 1
  • Rahul Nanchal
    • 1
  1. 1.Division of Pulmonary and Critical Care MedicineThe Medical College of WisconsinMilwaukeeUSA

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