Complications of intracranial pressure monitoring in fulminant hepatic failure

Lancet. 1993 Jan 16;341(8838):157-8. doi: 10.1016/0140-6736(93)90016-a.


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.

MeSH terms

  • Adult
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / etiology*
  • Cerebral Hemorrhage / mortality
  • Child
  • Hepatic Encephalopathy / physiopathology*
  • Humans
  • Infections / epidemiology
  • Infections / etiology
  • Intracranial Pressure*
  • Monitoring, Physiologic / adverse effects*
  • Monitoring, Physiologic / instrumentation
  • Monitoring, Physiologic / methods