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In patients with fulminant hepatic failure,brain oedema and the resulting intracranial hypertension often lead to death;intracranial pressure(ICP) monitoring may therefore be valuable.However,there is uncertainty about the hazards of implanting ICP monitoring devices.We carried out a survey of complications associated with ICP monitoring among centres performing liver transplantation in the USA(n=262 patients).Epidural transducers were the most commonly used devices and had the lowest complication rate(3.8%); subdural bolts and parenchymal monitors(fibreoptic pressure transducers in direct contact with brain parenchyma and intraventricular catheters)were associated with complication rates of 20%and 22%,respectively.Fatal haemorrhage occurred in 1%of patients undergoing epidural ICP monitoring, whereas subdural and intraparenchymal devices had fatal haemorrhage rates of 5%and 4%.Thus,in the setting of fulminant hepatic failure,epidural transducers may be the safest choice for ICP monitoring,even though they are known to be less precise than the other devices. |
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