Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 8, 2016; 8(22): 915-923
Published online Aug 8, 2016. doi: 10.4254/wjh.v8.i22.915
Multimodal brain monitoring in fulminant hepatic failure
Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Manoel Jacobsen Teixeira, Edson Bor-Seng-Shu
Fernando Mendes Paschoal Jr, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Edson Bor-Seng-Shu, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil
Manoel Jacobsen Teixeira, Department of Neurology, Division of Neurosurgery, Hospital das Clinicas, Sao Paulo University Medical School, São Paulo 04107-021, Brazil
Author contributions: Paschoal Jr FM wrote the paper; Nogueira RC, Ronconi KDAL, de Lima Oliveira M, Teixeira MJ and Bor-Seng-Shu E collected the data.
Conflict-of-interest statement: The authors declare there is no conflict of interest regarding the publication of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fernando Mendes Paschoal Jr, MD, Laboratory for Neurosonology and Cerebral Hemodynamics, Department of Neurology, Hospital das Clinicas, Sao Paulo University Medical School, Rua Paula Ney, 480, apt 42, São Paulo 04107-021, Brazil. tenpaschoal@gmail.com
Telephone: +55-11-30690435 Fax: +55-11-30633018
Received: February 20, 2016
Peer-review started: February 22, 2016
First decision: March 30, 2016
Revised: April 22, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 8, 2016
Abstract

Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.

Keywords: Fulminant hepatic failure, Cerebral edema, Multimodality methods, Intracranial hypertension, Liver transplantation

Core tip: Cerebral edema and intracranial hypertension are common causes of mortality in patients with fulminant hepatic failure (FHF). The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.