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Targeted temperature management in acute liver failure: A systematic review
Juliette Ribaud1, Siobhan McLernon2, Georg Auzinger3
1Intensive Care Unit, London Bridge Hospital, London, UK.
Nursing in Critical Care
|July 1, 2020
Summary
Targeted temperature management (TTM) helps stabilize critical patients with acute liver failure by managing intracranial hypertension, but it does not improve survival rates. Further controlled studies are needed to confirm TTM
Area of Science:
- Critical Care Medicine
- Hepatology
- Neurology
Background:
- Targeted temperature management (TTM), or therapeutic hypothermia, involves inducing body temperatures below 36°C in intensive care settings.
- Its efficacy in improving outcomes for acute liver failure (ALF), particularly refractory intracranial hypertension, lacks robust evidence.
- This review critically examines existing literature to assess TTM's impact on ALF patient outcomes.
Approach:
- A systematic review and meta-analysis of nine studies published between 1999 and 2016.
- Searched six databases using keywords related to acute liver failure and TTM.
- Included observational studies and randomized controlled trials, applying standardized data extraction and appraisal.
Key Points:
- Early studies suggested TTM benefits for intracranial hypertension and survival in ALF.
- More recent controlled studies indicate TTM does not prevent intracranial hypertension.
- TTM did not increase coagulopathy risk, but infection and dysrhythmia risks require further investigation.
Conclusions:
- TTM effectively manages acute intracranial hypertension episodes and stabilizes critical ALF patients without increasing bleeding risk.
- TTM does not significantly improve overall patient survival in acute liver failure.
- Heterogeneity in study designs and quality may explain conflicting findings, necessitating controlled trials.
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