PMID- 18664779
OWN - NLM
STAT- MEDLINE
DCOM- 20080825
LR  - 20131121
IS  - 1530-0293 (Electronic)
IS  - 0090-3493 (Linking)
VI  - 36
IP  - 8
DP  - 2008 Aug
TI  - Results of a protocol for the management of patients with fulminant liver 
      failure.
PG  - 2244-8
LID - 10.1097/CCM.0b013e31818029a3 [doi]
AB  - OBJECTIVE: To assess the safety and efficacy of a protocol to support management 
      of intracerebral pressure in patients with fulminant liver failure (FLF). DESIGN 
      AND SETTING: A prospective series was conducted between May 2004 and September 
      2006 at Banner Good Samaritan Medical Center, a 650-bed teaching hospital in 
      Phoenix, Arizona. PATIENTS: We recruited consecutive patients with FLF and stage 
      3 or 4 encephalopathy. INTERVENTIONS: We placed an intracranial pressure monitor 
      in each patient and employed a protocol to support decisions regarding hemostatic 
      management and prevention and treatment of intracranial hypertension (IHTN). 
      Treatment modalities included hypothermia, hypocarbia, intravenous pentobarbital, 
      intravenous mannitol and vasopressor titration for maintenance of cerebral 
      perfusion pressure. The main outcome measure was survival in transplant 
      candidates. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients entered the study 
      and 21 (95%) had at least one episode of IHTN. Eighty-two discrete episodes of 
      IHTN occurred, and 78 of these (95%) resolved with treatment. Overall survival 
      was 55%. Eleven of 18 (61%) of transplant candidates survived with good 
      neurologic outcome. No patient died from isolated cerebral edema. Three patients 
      had intracranial hemorrhages related to the intracranial pressure monitor. 
      CONCLUSIONS: Protocol-driven management of intracranial pressure in FLF can 
      result in good clinical outcomes in most transplant candidates, even if IHTN 
      occurs.
FAU - Raschke, Robert A
AU  - Raschke RA
AD  - Banner Good Samaritan Medical Center, Phoenix, AZ, USA. 
      Robert.Raschke@bannerhealth.com
FAU - Curry, Steven C
AU  - Curry SC
FAU - Rempe, Silke
AU  - Rempe S
FAU - Gerkin, Richard
AU  - Gerkin R
FAU - Little, Ester
AU  - Little E
FAU - Manch, Richard
AU  - Manch R
FAU - Wong, Mark
AU  - Wong M
FAU - Ramos, Alberto
AU  - Ramos A
FAU - Leibowitz, Alan I
AU  - Leibowitz AI
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (Hemostatics)
RN  - 0 (Hypnotics and Sedatives)
RN  - I4744080IR (Pentobarbital)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Brain Edema/etiology
MH  - Female
MH  - Hemostatics/therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - Hypnotics and Sedatives/*therapeutic use
MH  - Hypothermia, Induced
MH  - Intracranial Hypertension/*etiology/prevention & control/*therapy
MH  - Intracranial Pressure
MH  - Liver Failure, Acute/classification/*complications/therapy
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic/methods
MH  - Pentobarbital/*therapeutic use
MH  - Severity of Illness Index
EDAT- 2008/07/31 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/31 09:00
PHST- 2008/07/31 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/31 09:00 [entrez]
AID - 00003246-200808000-00004 [pii]
AID - 10.1097/CCM.0b013e31818029a3 [doi]
PST - ppublish
SO  - Crit Care Med. 2008 Aug;36(8):2244-8. doi: 10.1097/CCM.0b013e31818029a3.