Mendoza Vasquez LE, Payne S, Zamper R. Intracranial pressure monitoring in the perioperative period of patients with acute liver failure undergoing orthotopic liver transplantation. World J Transplant 2023; 13(4): 122-128 [PMID: 37388394 DOI: 10.5500/wjt.v13.i4.122]
Corresponding Author of This Article
Raffael Zamper, PhD, Assistant Professor, Department of Anesthesia and Perioperative Medicine, London Health Science Centre, 339 Windermere Road, London N6A 5A5, Ontario, Canada. rzamper@me.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Transplant. Jun 18, 2023; 13(4): 122-128 Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.122
Intracranial pressure monitoring in the perioperative period of patients with acute liver failure undergoing orthotopic liver transplantation
Luis Eduardo Mendoza Vasquez, Sonja Payne, Raffael Zamper
Luis Eduardo Mendoza Vasquez, Sonja Payne, Raffael Zamper, Department of Anesthesia and Perioperative Medicine, London Health Science Centre, London N6A 5A5, Ontario, Canada
Author contributions: All authors contribute to the review of literature, first author Mendoza Vasquez LE wrote the initial manuscript that was extensively reviewed and changed by the other two authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raffael Zamper, PhD, Assistant Professor, Department of Anesthesia and Perioperative Medicine, London Health Science Centre, 339 Windermere Road, London N6A 5A5, Ontario, Canada. rzamper@me.com
Received: December 23, 2022 Peer-review started: December 23, 2022 First decision: March 15, 2023 Revised: March 28, 2023 Accepted: April 12, 2023 Article in press: April 12, 2023 Published online: June 18, 2023
Abstract
Acute liver failure (ALF) may result in severe neurological complications caused by cerebral edema and elevated intracranial pressure (ICP). Multiple pathogenic mechanisms explain the elevated ICP, and newer hypotheses have been described. While invasive ICP monitoring (ICPM) may have a role in ALF management, these patients are typically coagulopathic and at risk for intracranial hemorrhage. ICPM is the subject of much debate, and significant heterogeneity exists in clinical practice regarding its use. Contemporary ICPM techniques and coagulopathy reversal strategies may be associated with a lower risk of hemorrhage; however, most of the evidence is limited by its retrospective nature and relatively small sample size.
Core Tip: Despite its rare occurrence, acute liver failure generates academic interest from multiple disciplines because of its multiorgan involvement and high morbidity and mortality. Severe neurological complications may arise, requiring invasive monitoring with the potential risk of fatal intracranial bleeding. Newer strategies could decrease the risks while keeping the benefits.
