A healthy 18-year-old woman, two weeks prior to admission presented with jaundice, asthenia, adynamia and progressive consciousness compromise.
Upon admission, there was an increase in transpeptidase, gamma-glutpeptide, and renal dysfunction.
There was no evidence of drug consumption and the viral and immunological markers were negative except for a titer of lower intensity for hepatitis A virus in which the patient presented rapid signs of brainstem computerized tomography (CT) suggestive of invasive mechanical edema.
Electroencephalographic monitoring showed slow and symmetric bilateral rhythms.
The initial INR of 5.0 was corrected to 1.6 with 40 ug/kg of recombinant activated Factor VII (rFVIIa) prior to the installation of intraparenchymatous catheter Raudemic® for measuring dementia.
The initial ICP values fluctuated between 20 and 25 mmHg, with brain temperature of 37°C. Transcranial Doppler determined normal systolic velocity and pulsatility index, being listed for liver transplantation King's criteria according to College.
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ICH became refractory to first-line measurements, starting intravascularly with ICY® via the Alsius Co.ard® route, decreasing femoral catheter hypothermia 33oC.
She received sedation with opiates (Fentanyl) and continuous muscle relaxant infusion (see section) to prevent chills; 3.5 h achieved a target of 33oC.
At 72 h, a cadaveric donor liver graft was offered and an orthotopic transplant was performed under active intravascular hypothermia.
Subsequently, in the intensive care unit, after checking for graft perfusion, controlled slow rewarming was restarted, achieving normothermia at 76 h with continuous improvement in liver function tests at 122 h.
He developed myoneuropathy of the critical patient and required mechanical ventilation for 15 days, requiring percutaneous fixation to facilitate mechanical ventilator weaning.
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After a slow awakening, the tracheostomy cannula was removed at day 37.
She was discharged after 69 days of hospitalization in good general condition, nutritional, neurological and linked to a physical rehabilitation program.
Currently she attends her secondary studies and remains in outpatient control.
