Therapeutic hypothermia for acute liver failure: Toward a randomized, controlled trial in patients with advanced hepatic encephalopathy

R. Todd Stravitz, William M. Lee, Andreas H. Kramer, David J. Kramer, Linda Hynan, Andres T. Blei

Research output: Contribution to journalReview article

23 Scopus citations

Abstract

Acute liver failure (ALF), the abrupt loss of liver function in a patient without previous liver disease, remains a highly mortal condition. Patients with ALF often succumb to their liver injury after the development of cerebral edema, resulting in intracranial hypertension and brain herniation. While the management of cerebral edema in ALF always includes the administration of osmotically active agents, osmotherapy often reduces intracranial pressure (ICP) insufficiently, such that herniation may be delayed but not prevented. Therapeutic hypothermia, the intentional reduction of body core temperature, has been increasingly used to treat cerebral edema in patients with traumatic and hypoxic brain injury. Data in animal models of ALF also suggest that hypothermia is effective in the prevention and treatment of cerebral edema, and case reports in humans have suggested that hypothermia is an effective bridge to orthotopic liver transplantation. A randomized, controlled trial comparing the management of ALF patients under normothermic and hypothermic conditions is a logical extension of these preliminary observations. Herein, we consider 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.

Original languageEnglish (US)
Pages (from-to)90-96
Number of pages7
JournalNeurocritical Care
Volume9
Issue number1
DOIs
StatePublished - Aug 1 2008

Keywords

  • Acute liver failure
  • Cerebral edema
  • Hypothermia

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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