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ICP should be monitored, maintaining it between 20 and 25 mmHg, with a brain perfusion pressure above 50 mmHg.99 When ICP is above 25 mmHg, boluses of hypertonic saline solution or intravenous mannitol at 20% should be added to the treatment.100 29 The presence of HE in a patient with ACLF confers a poor prognosis, increasing the risk for mortality in both the short and long terms