Intraparenchymal intracranial pressure monitoring in patients with acute liver failure.

BACKGROUND Elevated intracranial pressure (ICP) is a common cause of death in acute liver failure (ALF) and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. METHOD Twenty-three patients with ALF were treated, and 19 of them received a liver transplant. Seventeen patients had ICP monitoring because of grade III-IV encephalopathy. All patients received fresh plasma (2-3 units) before and during placing the intraparenchymal device. RESULTS Eleven cases (64.7%) had elevated ICP, and 6 patients (35.2%) had normal values. One patient (5.9%) had an asymptomatic small intraparenchymal haemorrhage<1cm3 in CTscan, which did not prevent the liver transplantation. CONCLUSION In our experience, intraparenchymal ICP monitoring in patients with ALF seems to be an accurate method with a low risk of complications.