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Therapeutic hypothermia for acute liver failure
R Todd Stravitz1, Fin Stolze Larsen
1Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, Virginia, USA. rstravit@vcu.edu
Critical Care Medicine
|June 19, 2009
Summary
Therapeutic hypothermia (32°C-35°C) may help patients with acute liver failure and cerebral edema by reducing brain swelling and intracranial pressure. Further clinical trials are needed to confirm its safety and efficacy in improving survival.
Area of Science:
- Neurology
- Hepatology
- Critical Care Medicine
Background:
- Cerebral edema is a life-threatening complication of acute liver failure (ALF).
- Patients with hyperacute ALF, such as from acetaminophen overdose, face the highest risk.
- Severe cerebral edema can lead to brain death or permanent neurologic damage due to intracranial hypertension.
Purpose of the Study:
- To evaluate the potential of therapeutic hypothermia as a bridge therapy for patients with ALF and cerebral edema.
- To explore hypothermia's mechanisms in reducing intracranial hypertension and improving brain viability.
Main Methods:
- Review of experimental and human data on therapeutic hypothermia in ALF.
- Analysis of hypothermia's effects on cerebral edema, intracranial pressure, and liver injury.
- Consideration of potential risks associated with hypothermia in ALF patients.
Main Results:
- Hypothermia (32°C-35°C) may reduce cerebral edema and intracranial hypertension in ALF.
- Mechanisms include decreased ammonia production, restored cerebral hemodynamics, and lowered brain metabolism.
- Hypothermia might also ameliorate liver injury.
Conclusions:
- Therapeutic hypothermia shows promise in managing cerebral edema and intracranial hypertension in ALF.
- Potential benefits include bridging patients to liver transplantation or regeneration.
- Further multicenter, randomized, controlled trials are essential to confirm safety and efficacy, as risks like infection and bleeding exist.
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