Abstract | BACKGROUND: METHODS: An institutional Acute Liver Failure Clinical Protocol (ALF-CP) was created to correct ALF coagulopathy prior to placing parenchymal ICP monitoring bolts. We aimed to investigate the frequency, severity, and clinical significance of hemorrhagic complications associated with ICPm bolt placement in the setting of an ALF-CP. All assessed patients were managed with the ALF-CP and had rigorous radiologic follow-up allowing assessment of the occurrence and chronology of hemorrhagic complications. We also aimed to compare our outcomes to other studies that were identified through a comprehensive review of the literature. RESULTS: Fourteen ALF patients were included in our analysis. There was no symptomatic hemorrhage after ICP monitor placement though four patients were found to have minor intraparenchymal asymptomatic hemorrhages after liver transplant when the ICP monitor had been removed, making the rate of radiographically identified clinically asymptomatic hemorrhage 28.6%. These results compare favorably to those found in a comprehensive review of the literature which revealed rates as high as 17.5% for symptomatic hemorrhages and 30.4% for asymptomatic hemorrhage. CONCLUSION: This study suggests that an intraparenchymal ICPm can be placed safely in tertiary referral centers which utilize a protocol such as the ALF-CP that aggressively corrects coagulopathy. The ALF-CP led to advantageous outcomes for ICPm placement with a 0% rate of symptomatic and low rate of asymptomatic hemorrhagic complications, which compares well to results reported in other series. A strict ICPm placement protocol in this setting facilitates management of ALF patients with cerebral edema during the wait time to transplantation or spontaneous recovery.
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Authors | Sayuri P Jinadasa, Qing Zhao Ruan, Ahmed B Bayoumi, Sunjay V Sharma, M Dustin Boone, Raza Malik, Clark C Chen, Ekkehard M Kasper |
Journal | Neurocritical care
(Neurocrit Care)
Vol. 35
Issue 1
Pg. 87-102
(08 2021)
ISSN: 1556-0961 [Electronic] United States |
PMID | 33205356
(Publication Type: Journal Article)
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Copyright | © 2020. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. |
Topics |
- Brain Edema
(etiology)
- Humans
- Intracranial Hypertension
(etiology, therapy)
- Intracranial Pressure
- Liver Failure, Acute
(therapy)
- Monitoring, Physiologic
- Review Literature as Topic
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