Hypothermia for the management of intracranial hypertension in acute liver failure

Increased intracranial pressure (ICP) in patients with acute liver failure (ALF) remains a major cause of mortality. Treatment options are limited and without urgent liver transplantation, mortality rates of up to 90% are common in those who fulfil criteria for poor prognosis. Several studies in animal models of acute liver failure set the stage for the clinical application of moderate hypothermia in man. Although the number of patients treated with hypothermia for increased ICP is limited, data clearly show that moderate hypothermia is a safe and effective method of treatment of increased ICP, that is unresponsive to other medical therapies. Hypothermia can be used to facilitate a successful bridge to liver transplantation. Recent data also suggest that increases in ICP can be prevented during the dissection and reperfusion phases of liver transplantation, if patients are maintained hypothermic during the surgical procedure. The present review focusses on the current state of knowledge with respect to the use of moderate hypothermia for the treatment of increased ICP in patients with ALF.