- For resuscitation, one should use gelatin solutions, especially albumin; HETAStarch should be avoided.
- The mean arterial pressure target should be 65 mmHg in patients with ALF and ACLF as this results in adequate perfusion of body organs.
- An arterial catheter should be placed to monitor blood pressure as it allows for quick decisions on treatment. Further, a clinical assessment of haemodynamics should be done with a pulmonary catheter or a central line.
- If there is a need to use a vasopressor, the first choice should be epinephrine. It may be combined with low dose vasopressin.
- Thromboelastography is recommended over the measurement of INR, platelets, and fibrinogen as it allows real-time functional evaluation of the liver.
- If the haemoglobin is less than 7g/dl, transfusion should be considered.
- To prevent DVT and pulmonary emboli, LMWH should be used.
- For ventilated patients, a low tidal volume strategy is recommended. At the same time, high PEEP should be avoided in patients with ALF.
- Patients with hepatic hydrothorax should have tube thoracostomy when TIPS is not an option. Patients with hepatorenal syndrome may benefit from the use of vasopressors.
- The serum blood glucose should be maintained between 110-180 mg/dl and in patients with septic shock, a stress dose of glucocorticoid is recommended, especially if the patient is found to have adrenal insufficiency.
- Patients with ALF or ACLF should not be fed a low-protein diet but instead one should set targeted protein goals. Enteral nutrition is recommended over parenteral nutrition.
Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU
Published on : Tue, 3 Mar 2020
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