Title: Effect of plasma adsorption and low-volume plasma exchange on intracranial pressure in
acute-on-chronic liver failure: A prospective observational study
Version: 1 Date: 09 Sep 2024
Reviewer's report:
This is a prospective single center observational study that  followed patients with acute on
chronic liver failure that underwent plasma adsorption followed by low volume plasma exchange
to monitor ICP, MAP and CPP during this treatment.  ICP was measured non-invasively by
flashed  visual evoked potential and TCD.The authors found that ICP measured by either
method did not significantly (statistically and clinically) change during treatment.  I have some
comments:
- The methods section needs to be further developed : please describe how flashed visual evoked
potential works and how  can calculate ICP. Please describe how TCD was performed and how
was it used to estimate ICP (which equations were used?) were both devices used at the same
time points ? How was MAP measured? invasively ? at what level : heart or Monroe foramen ?
CPP was calculated as usually is MAP -ICP  was this calculated manually ? or did the monitor
calculate it ?
- Please describe the equation used for sample size calculation
- Please justify the exclusion criteria such as primary hypertension, chronic kidney diseases,
mental illness and  stroke.
- Please provide more detail regarding patients characteristics: were these patients admitted due
to acute on chronic liver failure or were they already in hospital due to other reasons and then
presented with decompensation of chronic liver failure. Were these patients admitted to the
ICU ? Did they have other signs of organ failure?  What was their outcome ? Were they on the
transplant list ? Any imaging such as CT head performed to assess cerebral edema ? Did all
patients have encephalopathy ?
- What is the standard medical management of these patients in your institution?
- I would include in the limitations that this is a single center study and may not be applicable
to other centers
Title: Effect of plasma adsorption and low-volume plasma exchange on intracranial pressure in
acute-on-chronic liver failure: A prospective observational study
Version: 1 Date: 09 Sep 2024
Reviewer's report:
This is a prospective single center observational study that  followed patients with acute on
chronic liver failure that underwent plasma adsorption followed by low volume plasma exchange
to monitor ICP, MAP and CPP during this treatment.  ICP was measured non-invasively by
flashed  visual evoked potential and TCD.The authors found that ICP measured by either
method did not significantly (statistically and clinically) change during treatment.  I have some
comments:
- The methods section needs to be further developed : please describe how flashed visual evoked
potential works and how  can calculate ICP. Please describe how TCD was performed and how
was it used to estimate ICP (which equations were used?) were both devices used at the same
time points ? How was MAP measured? invasively ? at what level : heart or Monroe foramen ?
CPP was calculated as usually is MAP -ICP  was this calculated manually ? or did the monitor
calculate it ?
- Please describe the equation used for sample size calculation
- Please justify the exclusion criteria such as primary hypertension, chronic kidney diseases,
mental illness and  stroke.
- Please provide more detail regarding patients characteristics: were these patients admitted due
to acute on chronic liver failure or were they already in hospital due to other reasons and then
presented with decompensation of chronic liver failure. Were these patients admitted to the
ICU ? Did they have other signs of organ failure?  What was their outcome ? Were they on the
transplant list ? Any imaging such as CT head performed to assess cerebral edema ? Did all
patients have encephalopathy ?
- What is the standard medical management of these patients in your institution?
- I would include in the limitations that this is a single center study and may not be applicable
to other centers
Please review this paper.
user
Title: Effect of plasma adsorption and low-volume plasma exchange on intracranial pressure in
acute-on-chronic liver failure: A prospective observational study
Version: 1 Date: 09 Sep 2024
Reviewer's report:
This is a prospective single center observational study that  followed patients with acute on
chronic liver failure that underwent plasma adsorption followed by low volume plasma exchange
to monitor ICP, MAP and CPP during this treatment.  ICP was measured non-invasively by
flashed  visual evoked potential and TCD.The authors found that ICP measured by either
method did not significantly (statistically and clinically) change during treatment.  I have some
comments:
- The methods section needs to be further developed : please describe how flashed visual evoked
potential works and how  can calculate ICP. Please describe how TCD was performed and how
was it used to estimate ICP (which equations were used?) were both devices used at the same
time points ? How was MAP measured? invasively ? at what level : heart or Monroe foramen ?
CPP was calculated as usually is MAP -ICP  was this calculated manually ? or did the monitor
calculate it ?
- Please describe the equation used for sample size calculation
- Please justify the exclusion criteria such as primary hypertension, chronic kidney diseases,
mental illness and  stroke.
- Please provide more detail regarding patients characteristics: were these patients admitted due
to acute on chronic liver failure or were they already in hospital due to other reasons and then
presented with decompensation of chronic liver failure. Were these patients admitted to the
ICU ? Did they have other signs of organ failure?  What was their outcome ? Were they on the
transplant list ? Any imaging such as CT head performed to assess cerebral edema ? Did all
patients have encephalopathy ?
- What is the standard medical management of these patients in your institution?
- I would include in the limitations that this is a single center study and may not be applicable
to other centers
assistant