In patients with hepatic encephalopathy, the development of elevated intracranial pressure or cerebral edema represents a serious complication requiring prompt, targeted intervention. Managing this condition demands a specific approach directed at reducing ICP and resolving cerebral edema in the context of underlying liver dysfunction.
This protocol applies to patients with hepatic encephalopathy who present with elevated intracranial pressure or cerebral edema. The coexistence of hepatic encephalopathy significantly shapes the management strategy for this neurological complication.
The first-line strategy centres on intravenous hyperosmolar therapy to directly address elevated intracranial pressure and cerebral edema. The clinical goal is reduction of elevated intracranial pressure and resolution of cerebral edema.
The complete protocol specifies the agents, selection criteria, and full management algorithm — see below for access.
DOI: 10.1007/s12028-020-00959-7
We suggest using either hypertonic sodium solutions or mannitol for the management of ICP or cerebral edema in patients with hepatic encephalopathy (conditional recommendation, very low-quality evidence).
The evidence identified by the panel suggests that hyperosmolar therapy can effectively treat elevated ICP or cerebral edema in the setting of fulminant liver failure and HE; however, more research is needed to determine optimal treatment strategies.
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