Clinical

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 recoveries.

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 hypertension.

Gastroenterology 2004;127:1338-1346,1626-1629.