Clinical monitoring of intracranial pressure in fulminant hepatic failure.

TLDR

Cerebral oedema is the most common immediate cause of death in fulminant hepatic failure. The study aimed to assess the value of intracranial pressure monitoring and to evaluate the impact of dexamethasone and mannitol on ICP. In ten grade IV encephalopathy patients, mean ICP was 15.5 mmHg; dexamethasone failed to prevent ICP rises in most deaths, while survivors had peaks of 47 and 35 mmHg; mannitol consistently halted ICP increases below 60 mmHg, demonstrating that ICP monitoring provides essential information for managing these patients.

Abstract

Cerebral oedema is the commonest immediate cause of death in fulminant hepatic failure and an investigation was carried out to determine the value of monitoring intracranial pressure (ICP) and to examine the effects of ICP of dexamethasone therapy and mannitol administration. ICP values in 10 patients at the time of insertion of a subdural pressure transducer (grade IV encephalopathy) averaged 15.5 +/- SD 14.8 mmHg. Despite dexamethansone therapy, which had been started on admission, rises in ICP were subsequently observed in seven of the eight patients who died. In the two patients who survived, the highest reading were 47 and 35 mmHg. Mannitol consistently reversed or arrested ICP rises when pressure was < 60 mmHg. ICP monitoring provides additional information in the managment of patients and is essential if mannitol therapy is to be used.