Intracranial pressure monitoring in the perioperative period of patients with acute liver failure undergoing orthotopic liver transplantation

Table 1 Summary of recommendations for intracranial pressure monitor in patients with acute liver failure

Society	Recommendation	Quality of evidence
AASLD 2005[1]	ICPM is mainly considered for patients who are listed for transplantation. In the absence of ICPM, frequent evaluation for signs of intracranial hypertension is needed to identify early evidence of uncal herniation	Evidence level III
AASLD Revised 2011[28]	The use of recombinant factor rVIIa may be considered	NA
ALSFG 2007[30]	Insufficient data to recommend ICPM placement in all patients with ALF. However, most members of the ALFSG place ICPM in patients with advanced (stage III/IV) hepatic encephalopathy	NA
EASL 2017[32]	ICPM should be considered in a highly selected subgroup of patients, who have progressed to grade 3 or 4 coma, are intubated and ventilated and deemed at high risk of intracranial hemorrhage, based on the presence of more than one of the following variables: (1) Young patients with hyperacute or acute presentations; (2) ammonia level over 150–200 lmol/L that does not drop with initial treatment interventions (RRT and fluids); (3) renal impairment; and (4) vasopressor support (> 0.1 lg/kg/min)	(Evidence level II-3, grade of Recommendation 1)

AASLD: American Association for the Study of Liver Diseases; ALSFG: United States Acute Liver Failure Study Group; EASL: European Association for the study of the Liver; ICPM: Intracranial pressure monitor; RRT: Renal replacement therapy; ALF: Acute liver failure; rFVIIa: Recombinant factor VIIa; NA: Not available.