Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda: Caso clínico

• Luis Castillo F ^[1] ; Cristian Pérez R ^[1] ; Carolina Ruiz B ^[1] ; Guillermo Bugedo T ^[1] ; Glenn Hernández P ^[1] ; Jorge Martínez C ^[1] ; Nicolás Jarufe C ^[1] ; Rosa Pérez A ^[1] ; Patricio Mellado T ^[1] ; Pilar Domínguez ^[1]
  1. [1] Pontificia Universidad Católica de Chile

     Pontificia Universidad Católica de Chile

     Santiago, Chile

     
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 137, Nº. 6, 2009, págs. 801-806
• Idioma: español
• Títulos paralelos:
  • Intravascular hypothermia for the management of Intracranial hypertension in acute liver failure: Case report
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• Resumen

  • Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization.