Critical care management of acute liver failure.
Surender Singh SehrawatMadhumita PremkumarPublished in: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (2024)
The management of acute liver failure (ALF) in modern hepatology intensive care units (ICU) has improved patient outcomes. Critical care management of hepatic encephalopathy, cerebral edema, fluid and electrolytes; prevention of infections and organ support are central to improved outcomes of ALF. In particular, the pathogenesis of encephalopathy is multifactorial, with ammonia, elevated intra-cranial pressure and systemic inflammation playing a central role. Although ALF remains associated with high mortality, the availability of supportive care, including organ failure support such as plasma exchange, timely mechanical ventilation or continuous renal replacement therapy, either conservatively manages patients with ALF or offers bridging therapy until liver transplantation. Thus, appropriate critical care management has improved the likelihood of patient recovery in ALF. ICU care interventions such as monitoring of cerebral edema, fluid status assessment and interventions for sepsis prevention, nutritional support and management of electrolytes can salvage a substantial proportion of patients. In this review, we discuss the key aspects of critical care management of ALF.
Keyphrases
- liver failure
- mechanical ventilation
- intensive care unit
- hepatitis b virus
- healthcare
- respiratory failure
- palliative care
- chronic kidney disease
- early onset
- end stage renal disease
- stem cells
- subarachnoid hemorrhage
- physical activity
- type diabetes
- metabolic syndrome
- acute respiratory distress syndrome
- bone marrow
- adipose tissue
- coronary artery disease
- skeletal muscle
- health insurance
- anaerobic digestion
- chemotherapy induced
- affordable care act