Reuters Health Information (2004-11-24): Hypothermia cuts intracranial hypertension in liver failure
Hypothermia cuts intracranial hypertension in liver failure
Last Updated: 2004-11-24 12:52:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients with acute
liver failure and uncontrolled intracranial hypertension, induction of
moderate hypothermia can ameliorate the hypertension and permit
survival until liver transplantation can be performed, Scottish
researchers report in the November issue of Gastroenterology.
In 1999, a team headed by Dr. Alistair Lee of the Royal Infirmary of
Edinburgh used moderate hypothermia to treat four patients with acute
liver failure and uncontrolled intracranial hypertension. All four
survived until transplantation could be performed. Now, Dr. Lee and his
colleagues report on a study that confirms their original findings.
In 14 patients awaiting liver transplantation, all of whom had acute
liver failure and intracranial hypertension unresponsive to medical
therapy, the researchers used cooling blankets to reduce core
temperature to between 32 and 33 degrees C. Mean intracranial pressure
was 36.5 mm Hg at baseline and 16.3 mmHg by four hours after cooling
was started. The decrease in pressure was sustained at 24 hours.
Thirteen of the 14 patients survived to undergo transplantation
after a median of 32 hours of cooling. None of the patients had any
complications related to the cooling, and all had complete neurologic
The researchers, who call for larger trials, conclude that
"hypothermia produced sustained and significant reduction in arterial
ammonia concentration and its brain metabolism, cerebral blood flow,
brain cytokine production, and markers of oxidative stress."
In an accompanying editorial, Drs. Javier Vaquero and Andres T. Blei
of Northwestern University, Chicago, Illinois note that this bridging
approach is particularly attractive, but stress that at present it
should be reserved only for patients with uncontrolled intracranial