Targeted temperature management in acute liver failure: A systematic review.
Juliette Ribaud, Siobhan McLernon, Georg Auzinger
PMID 32602249WHAT IT FOUND
Cooling adults with acute liver failure did not improve survival or prevent raised pressure in the skull.
It lowered pressure during episodes and helped circulation, without more bleeding, but nurses must watch skin, lines, infection and slow rewarming.
Key findings
01Targeted cooling did not improve survival in acute liver failure.
02It reduced intracranial pressure during established episodes, but it did not prevent episodes.
03It did not increase bleeding, but it may mildly increase dysrhythmias and pulmonary infections at lower temperatures.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only nine studies, and four came from the same team. Most evidence is old, with a median publication year of 2004 and only three studies after 2010. The evidence base is weak and heterogeneous: three case reports, five cohort series and one randomised trial. Follow-up was short or absent, so long-term neurological and survival effects are unclear. Liver transplantation confounds outcomes because many survivors were transplanted, making it hard to separate cooling's effect. Cooling was given alongside standard intensive care, sometimes continuous renal replacement therapy, and transplantation, so the effect of cooling alone cannot be separated. There is no primary nursing research on targeted cooling in acute liver failure, so nursing guidance is indirect.
The easy way to misread this
Do not conclude that cooling acute liver failure patients improves survival or prevents raised intracranial pressure. The review found no survival benefit and no prevention benefit; the positive finding was short-term reduction of pressure during established episodes.