EFFECT OF POSTURE ON INTRACRANIAL-PRESSURE AND CEREBRAL PERFUSION-PRESSURE IN PATIENTS WITH FULMINANT HEPATIC AND RENAL-FAILURE AFTER ACETAMINOPHEN SELF-POISONING

We measured the effect of posture on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in eight patients admitted with grade 4 hepatic coma due to fulminant hepatic failure complicated by renal failure. Upward head elevation >20° did not consistently reduce ICP; instead, ICP increased in three patients who later died of cerebral edema. CPP was reduced significantly by elevation >20°, falling to <50 mm Hg in those patients who subsequently died of cerebral edema. Our study does not support the current practice of nursing patients with hepatic coma, who are at risk of dying from cerebral edema, in head-upright postures >20°.