Clinical-liver, pancreas, and biliary tractModerate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension
Section snippets
Patients and methods
Studies were undertaken with the approval of the local research ethics committee and with written informed consent from the next of kin of each patient and were in accordance with the Declaration of Helsinki (1951) of the World Medical Association.
Patients
Patient details are summarized in Table 1. The core temperature was reduced from 36.3°C ± .2°C to 33.1°C ± .5°C within 1 hour of starting cooling and remained lowered at 32.6°C ± .4°C at 24 hours. However, the effect of cooling on ICP was evident within the first hour of starting cooling, even before the target temperature of 32°C was reached. Cooling was associated with a significant and sustained increase in systemic vascular resistance (P < .01), mean arterial pressure (P < .001), and
Discussion
The results of this study extend and confirm those of our pilot study suggesting that in patients with ALF who have uncontrolled intracranial hypertension and are at immediate risk of cerebral herniation, moderate hypothermia can be used successfully and safely to control ICP, improve neurologic end points, and possibly improve survival by bridging patients to OLT.5
Brain herniation from the effects of elevated ICP is the immediate cause of death in 35% of patients with ALF who fulfill criteria
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Supported by a grant from the Wellcome Trust (UK) (to S.W.M.O.D.).