Therapeutic hypothermia in the management of acute liver failure

被引:26
作者
Vaquero, Javier [1 ]
机构
[1] Hosp Gen Univ Gregorio Maranon CIBERehd, Lab Invest Hepatol & Gastroenterol, Madrid 28009, Spain
关键词
Hypothermia; Acute liver failure; Intracranial pressure; Ammonia; Brain edema; TRAUMATIC BRAIN-INJURY; FULMINANT HEPATIC-FAILURE; CEREBRAL-BLOOD-FLOW; MILD HYPOTHERMIA; INTRACRANIAL-PRESSURE; CARDIAC-ARREST; MODERATE HYPOTHERMIA; AMINO-ACIDS; PATHOPHYSIOLOGICAL BASIS; PARTIAL-HEPATECTOMY;
D O I
10.1016/j.neuint.2011.09.006
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
A large body of experimental data and preliminary clinical studies point to the induction of mild hypothermia (32-35 degrees C) as a valuable approach to control the development of brain edema and intracranial hypertension in acute liver failure (ALF). The ability of hypothermia to affect multiple processes probably explains its efficacy to prevent these cerebral complications. Remarkably, mild hypothermia has been shown to prevent or attenuate most of the major alterations involved in the pathogenesis of the cerebral complications of ALF, including the accumulation of ammonia in the brain and the circulation, the alterations of brain glucose metabolism, the brain osmotic disturbances, the accumulation of glutamate and lactate in brain extracellular space, the development of inflammation and oxidative/nitrosative stress, and others. Limited information suggests that the systemic effects of hypothermia may also be beneficial for some peripheral complications of ALF. Translation of the beneficial effects of therapeutic hypothermia into standard clinical practice, however, needs to be confirmed in adequately designed clinical trials. Such trials will be important to determine the safety of therapeutic hypothermia, to identify which patients might benefit from it, and to provide the optimal guidelines for its use in patients with ALF. (C) 2011 Elsevier Ltd. All rights reserved.
引用
收藏
页码:723 / 735
页数:13
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