Arterial ammonia levels in the management of fulminant liver failure
Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutiv...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Curry S [verfasserIn] Remke S [verfasserIn] Little E [verfasserIn] Gerkin R [verfasserIn] Manch R [verfasserIn] Leibowitz A. [verfasserIn] Raschke R [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2011 |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
In: Southwest Journal of Pulmonary and Critical Care - Arizona Thoracic Society, 2011, 2(2011), Seite 85-92 |
|---|---|
| Übergeordnetes Werk: |
volume:2 ; year:2011 ; pages:85-92 |
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DOAJ042576229 |
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| 520 | |a Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. | ||
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(DE-627)DOAJ042576229 (DE-599)DOAJ1aff0898a87e46c98bc285c9a834fa0d DE-627 ger DE-627 rakwb eng R5-130.5 RC86-88.9 Curry S verfasserin aut Arterial ammonia levels in the management of fulminant liver failure 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. liver failure ammonia hepatic encephaolopathy intercranial hypertension intracranial monitoring General works Medical emergencies. Critical care. Intensive care. First aid Remke S verfasserin aut Little E verfasserin aut Gerkin R verfasserin aut Manch R verfasserin aut Leibowitz A. verfasserin aut Raschke R verfasserin aut In Southwest Journal of Pulmonary and Critical Care Arizona Thoracic Society, 2011 2(2011), Seite 85-92 (DE-627)1760634441 21606773 nnns volume:2 year:2011 pages:85-92 https://doaj.org/article/1aff0898a87e46c98bc285c9a834fa0d kostenfrei http://www.swjpcc.com/critical-care/2011/6/18/arterial-ammonia-levels-in-the-management-of-fulminant-liver.html?SSScrollPosition=142 kostenfrei https://doaj.org/toc/2160-6773 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2011 85-92 |
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(DE-627)DOAJ042576229 (DE-599)DOAJ1aff0898a87e46c98bc285c9a834fa0d DE-627 ger DE-627 rakwb eng R5-130.5 RC86-88.9 Curry S verfasserin aut Arterial ammonia levels in the management of fulminant liver failure 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. liver failure ammonia hepatic encephaolopathy intercranial hypertension intracranial monitoring General works Medical emergencies. Critical care. Intensive care. First aid Remke S verfasserin aut Little E verfasserin aut Gerkin R verfasserin aut Manch R verfasserin aut Leibowitz A. verfasserin aut Raschke R verfasserin aut In Southwest Journal of Pulmonary and Critical Care Arizona Thoracic Society, 2011 2(2011), Seite 85-92 (DE-627)1760634441 21606773 nnns volume:2 year:2011 pages:85-92 https://doaj.org/article/1aff0898a87e46c98bc285c9a834fa0d kostenfrei http://www.swjpcc.com/critical-care/2011/6/18/arterial-ammonia-levels-in-the-management-of-fulminant-liver.html?SSScrollPosition=142 kostenfrei https://doaj.org/toc/2160-6773 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2011 85-92 |
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(DE-627)DOAJ042576229 (DE-599)DOAJ1aff0898a87e46c98bc285c9a834fa0d DE-627 ger DE-627 rakwb eng R5-130.5 RC86-88.9 Curry S verfasserin aut Arterial ammonia levels in the management of fulminant liver failure 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. liver failure ammonia hepatic encephaolopathy intercranial hypertension intracranial monitoring General works Medical emergencies. Critical care. Intensive care. First aid Remke S verfasserin aut Little E verfasserin aut Gerkin R verfasserin aut Manch R verfasserin aut Leibowitz A. verfasserin aut Raschke R verfasserin aut In Southwest Journal of Pulmonary and Critical Care Arizona Thoracic Society, 2011 2(2011), Seite 85-92 (DE-627)1760634441 21606773 nnns volume:2 year:2011 pages:85-92 https://doaj.org/article/1aff0898a87e46c98bc285c9a834fa0d kostenfrei http://www.swjpcc.com/critical-care/2011/6/18/arterial-ammonia-levels-in-the-management-of-fulminant-liver.html?SSScrollPosition=142 kostenfrei https://doaj.org/toc/2160-6773 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2011 85-92 |
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(DE-627)DOAJ042576229 (DE-599)DOAJ1aff0898a87e46c98bc285c9a834fa0d DE-627 ger DE-627 rakwb eng R5-130.5 RC86-88.9 Curry S verfasserin aut Arterial ammonia levels in the management of fulminant liver failure 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. liver failure ammonia hepatic encephaolopathy intercranial hypertension intracranial monitoring General works Medical emergencies. Critical care. Intensive care. First aid Remke S verfasserin aut Little E verfasserin aut Gerkin R verfasserin aut Manch R verfasserin aut Leibowitz A. verfasserin aut Raschke R verfasserin aut In Southwest Journal of Pulmonary and Critical Care Arizona Thoracic Society, 2011 2(2011), Seite 85-92 (DE-627)1760634441 21606773 nnns volume:2 year:2011 pages:85-92 https://doaj.org/article/1aff0898a87e46c98bc285c9a834fa0d kostenfrei http://www.swjpcc.com/critical-care/2011/6/18/arterial-ammonia-levels-in-the-management-of-fulminant-liver.html?SSScrollPosition=142 kostenfrei https://doaj.org/toc/2160-6773 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2011 85-92 |
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Arterial ammonia levels in the management of fulminant liver failure |
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Arterial ammonia levels in the management of fulminant liver failure |
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Curry S |
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Southwest Journal of Pulmonary and Critical Care |
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Curry S Remke S Little E Gerkin R Manch R Leibowitz A. Raschke R |
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Curry S |
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verfasserin |
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arterial ammonia levels in the management of fulminant liver failure |
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R5-130.5 |
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Arterial ammonia levels in the management of fulminant liver failure |
| abstract |
Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. |
| abstractGer |
Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. |
| abstract_unstemmed |
Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels. |
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Arterial ammonia levels in the management of fulminant liver failure |
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https://doaj.org/article/1aff0898a87e46c98bc285c9a834fa0d http://www.swjpcc.com/critical-care/2011/6/18/arterial-ammonia-levels-in-the-management-of-fulminant-liver.html?SSScrollPosition=142 https://doaj.org/toc/2160-6773 |
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