Complications of intracranial pressure monitoring in fulminant hepatic failure

Abstract

In patients with fulminant hepatic failure, brain oedema and the resulting intracranial hypertension often lead to death; intracranial pressure (ICP) monitoring may therefore be valuable. However, there is uncertainty about the hazards of implanting ICP monitoring devices. We carried out a survey of complications associated with ICP monitoring among centres performing liver transplantation in the USA (n = 262 patients). Epidural transducers were the most commonly used devices and had the lowest complication rate (3.8%); subdural bolts and parenchymal monitors (fibreoptic pressure transducers in direct contact with brain parenchyma and intraventricular catheters) were associated with complication rates of 20% and 22%, respectively. Fatal haemorrhage occurred in 1% of patients undergoing epidural ICP monitoring, whereas subdural and intraparenchymal devices had fatal haemorrhage rates of 5% and 4%. Thus, in the setting of fulminant hepatic failure, epidural transducers may be the safest choice for ICP monitoring, even though they are known to be less precise than the other devices.