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Moderate hypothermia with intracranial pressure monitoring as a therapeutic paradigm for the management of acute liver failure: a systematic review

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Abstract

Objective

To systematically review the literature and present data on the safety and efficacy of induced moderate hypothermia combined with ICP monitoring in critically ill patients with acute liver failure.

Design

We conducted a retrospective observational search of MEDLINE database using both OVID and PubMed with the following MeSH terms, “Hypothermia, Induced,” “Brain Edema,” “Intracranial Hypertension” (ICH), “Liver failure, Acute” and “Liver Failure, Fulminant.” We limited our search to case series involving at least three human subjects and all other clinical trials. Baseline ICP, cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) as well as the response of these variables to hypothermia were recorded when available. Additional clinical and demographic data were also recorded.

Results

Five case series were identified. Pre-existing coagulopathy from liver failure was reversed by various modalities in all studies prior to insertion of ICP monitors. Induction of moderate hypothermia combined with ICP monitoring consistently improved ICP, CPP and CBF in four trials; one trial demonstrated the feasibility and effectiveness of moderate induced hypothermia as part of a protocolized strategy for the management of ICH.

Conclusions

Limited data exist concerning the safety and efficacy of moderate hypothermia and ICP monitoring for the treatment of ICH in acute liver failure. The available evidence shows that induction of moderate hypothermia in this clinical setting is feasible and possibly efficacious. Well-designed prospective clinical trials are warranted in this challenging context, given the potential of providing a bridge to liver transplantation or even clinical recovery.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, 7 Desloge Towers, St Louis, MO, 63104, USA

    Dayton Dmello & George M. Matuschak

  2. Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St Louis, MO, USA

    Salvador Cruz-Flores

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  1. Dayton Dmello
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  2. Salvador Cruz-Flores
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  3. George M. Matuschak
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Correspondence to Dayton Dmello.

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Dmello, D., Cruz-Flores, S. & Matuschak, G.M. Moderate hypothermia with intracranial pressure monitoring as a therapeutic paradigm for the management of acute liver failure: a systematic review. Intensive Care Med 36, 210–213 (2010). https://doi.org/10.1007/s00134-009-1702-2

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  • DOI: https://doi.org/10.1007/s00134-009-1702-2

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