Intensive Care Management of Acute Liver Failure: Considerations While Awaiting Liver Transplantation

Abstract

Acute liver failure is a unique clinical phenomenon characterized by abrupt deterioration in liver function and altered mentation. The development of high-grade encephalopathy and multisystem organ dysfunction herald poor prognosis. Etiologic-specific treatments and supportive measures are routinely employed; however, liver transplantation remains the only chance for cure in those who do not spontaneously recover. The utility of artificial and bioartificial assist therapies as supportive care-to allow time for hepatic recovery or as a bridge to liver transplantation-has been examined but studies have been small, with mixed results. Given the severity of derangements, intensive critical care is needed to successfully bridge patients to transplant, and evaluation of candidates occurs rapidly in parallel with serial reassessments of operative fitness. Psychosocial assessment is often suboptimal and relative contraindications to transplant, such as ventilator-dependence may be overlooked. While often employed to guide evaluation, no single prognostic model discriminates those who will spontaneously recover and those who will require transplant. The purpose of this review will be to summarize approaches in critical care, prognostic modeling, and medical evaluation of the acute liver failure transplant candidate. Citation of this article: Seetharam A. Intensive care management of acute liver failure: Considerations while awaiting liver transplantation.

Adolescent With Acute Liver Failure in the Setting of Ethanol, Cocaine, and Ecstasy Ingestion Treated With a Molecular Adsorbent Recirculating System

“…Early care in an intensive care unit and transport to a specialty center is essential for the management of multi-organ dysfunction. Initial medical management consists of crystalloid fluid resuscitation, vasopressor use to maintain a mean arterial pressure above 75 mmHg in adult patients, correction of electrolyte imbalance, and administration of etiology-specific antitoxins when appropriate [12]. In this case, the administration of FFP, cryoprecipitate, and platelets contributed at least partially to the improvements noted in coagulopathy.…”

Prognostic Scores in Acute Liver Failure Due to Viral Hepatitis

“…Once a patient progresses to ALF, the management protocol of the patient becomes standardized, as shown in Figure 1 . Ideally, all ALF patients should receive care in an intensive care unit (ICU) or SLU which has been shown to improve survival in ALF patients in multiple studies [ 20 , 85 ]. The key decisions in management are to triage patients who need a transplant and to time the transplant correctly so as to maximize the chances of recovery and survival [ 4 ].…”

Outcomes of critically ill patients with liver failure who require mechanical ventilation: A retrospective, single‐center study

“…Patients who require organ‐specific support, such as mechanical ventilation, have higher mortality risks, 8,9 and mechanically ventilated patients with cirrhosis often progress to multiorgan failure, 10 which results in poor prognosis 6 . Therefore, respiratory complications might be a major reason for the hesitation of clinicians to place mechanically ventilated patients on waiting lists for liver transplantation 2 . However, the appropriate management of respiratory complications in patients with severe LF remains obscure, although there are reports in the literature regarding possible clinical management options 2,11–18 …”

“…6 Therefore, respiratory complications might be a major reason for the hesitation of clinicians to place mechanically ventilated patients on waiting lists for liver transplantation. 2 However, the appropriate management of respiratory complications in patients with severe LF remains obscure, although there are reports in the literature regarding possible clinical management options. 2,[11][12][13][14][15][16][17][18] This study was conducted with an aim to evaluate the management and treatment outcomes of patients with LF, especially those who needed mechanical ventilation therapy and are admitted to the general ICU.…”