State-of-the-art management and monitoring of brain edema and intracranial hypertension in fulminant hepatic failure. A proposed algorithm

Jaime Gasco, Leonardo Rangel-Castilla, Brodus Franklin, Philip G. Thomas, Joel T. Patterson

Research output: Chapter in Book/Report/Conference proceedingConference contribution

7 Scopus citations


Aim: Develop an evidence-based clinical algorithm integrating clinical decision making on intracranial pressure (ICP) monitoring and intracranial hypertension (ICH) management in the setting of fulminant hepatic failure (FHF). Material and Methods: An English-language literature review was conducted using the PubMed database in November 2007. In compiling evidence on current management trends of ICP and FHF, the paired keywords: fulminant hepatic failure and either mannitol, hypertonic saline, hyperventilation, bioartificial liver, hypothermia, indomethacin, thiopental, or propofol were used. In compiling evidence on ICP monitoring in FHF, the terms "intracranial pressure monitoring" and "liver failure" were used. Excluded references were either pertinent to animal research or irrelevant to ICP monitoring and ICH management in the setting of FHF. Results: State-of-the-art management of ICH due to brain edema in FHF includes Class I therapies such as mannitol and hypertonic saline. Bioartificial liver, hypothermia and hyperventilation are supported by Class II evidence. Indomethacin and sedation remain Class III. Monitoring ICP is supported by Class II and III evidence. A clinical algorithm was created based on the existing therapeutic armamentarium and corresponding evidence support.

Original languageEnglish (US)
Title of host publicationBrain Edema XIV
PublisherSpringer-Verlag Wien
Number of pages4
ISBN (Print)9783211987582
StatePublished - 2009
Externally publishedYes

Publication series

NameActa Neurochirurgica, Supplementum
ISSN (Print)0065-1419


  • Brain edema
  • intracranial hypertension
  • intracranial pressure monitoring
  • liver failure

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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