Effect of albumin dialysis on intracranial pressure increase in pigs with acute liver failure: A randomized study

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Item Type:	Article
Title:	Effect of albumin dialysis on intracranial pressure increase in pigs with acute liver failure: A randomized study
Creators Name:	Sen, S., Rose, C., Ytrebo, L.M., Davies, N.A., Nedredal, G.I., Drevland, S.S., Kjonno, M., Prinzen, F.W., Hodges, S.J., Deutz, N.E., Williams, R., Butterworth, R.F., Revhaug, A. and Jalan, R.
Abstract:	Background: Increased intracranial pressure (ICP) worsens the outcome of acute liver failure (ALF). This study investigates the underlying pathophysiological mechanisms and evaluates the therapeutic effect of albumin dialysis in ALF with use of the Molecular Adsorbents Recirculating System without hemofiltration/dialysis (modified, M-MARS). Methods: Pigs were randomized into three groups: sham, ALF, and ALF + M-MARS. ALF was induced by hepatic devascularization (time = 0). M-MARS began at time = 2 and ended with the experiment at time = 6. ICP, arterial ammonia, brain water, cerebral blood flow (CBF), and plasma inflammatory markers were measured. Results: ICP and arterial ammonia increased significantly over 6 hrs in the ALF group, in comparison with the sham group. M-MARS attenuated (did not normalize) the increased ICP in the ALF group, whereas arterial ammonia was unaltered by M-MARS. Brain water in the frontal cortex (grey matter) and in the subcortical white matter at 6 hrs was significantly higher in the ALF group than in the sham group. M-MARS prevented a rise in water content, but only in white matter. CBF and inflammatory mediators remained unchanged in all groups. Conclusion: The initial development of cerebral edema and increased ICP occurs independently of CBF changes in this non-inflammatory model of ALF. Factor(s) other than or in addition to hyperammonemia are important, however, and may be more amenable to alteration by albumin dialysis.
Keywords:	Acute Liver Failure, Albumins, Ammonia, Animal Disease Models, Brain Edema, Cerebrovascular Circulation, Hemodiafiltration, Inflammation Mediators, Intracranial Hypertension, Intracranial Pressure, Random Allocation, Risk Factors, Sensitivity and Specificity, Survival Rate, Sus scrofa, Animals
Source:	Critical Care Medicine
ISSN:	0090-3493
Publisher:	Lippincott Williams & Wilkins
Volume:	34
Number:	1
Page Range:	158-164
Date:	January 2006
Official Publication:	https://doi.org/10.1097/01.CCM.0000196203.39832.3C
PubMed:	View item in PubMed

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