Clinical monitoring of intracranial pressure in fulminant hepatic failure

Abstract

Cerebral oedema is the commonest immediate cause of death in fulminant hepatic failure and an investigation was carried out to determine the value of monitoring intracranial pressure (ICP) and to examine the effects on ICP of dexamethasone therapy and mannitol administration. ICP values in 10 patients at the time of insertion of a subdural pressure transducer (grade IV encephalopathy) averaged 15.5±SD 14.8 mmHg. Despite dexamethasone therapy, which had been started on admission, rises in ICP were subsequently observed in seven of the eight patients who died. In the two patients who survived, the highest readings were 47 and 35 mmHg. Mannitol consistently reversed or arrested ICP rises when pressure was <60 mmHg. ICP monitoring provides additional information in the management of patients and is essential if mannitol therapy is to be used.