Recommendations

Document Overview

Design and created by Guideline Central in participation with the Society of Critical Care Medicine.

Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Cardiovascular, Endocrine, Hematologic, Pulmonary and Renal Considerations

Society of Critical Care Medicine

Publication Date: Feb 1, 2020

Page Last Updated: May 5, 2026

Recommendation Grading

Grade Definitions on Strength of Recommendation and Guide to Interpretation
Strength	Wording in the guideline	For the patient	For the clinician
Strong	"should use" or "should be used"	Most individuals in this situation would want the recommended course and only a small proportion would not.	Most individuals should receive the recommended course of action. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.
Conditional	"may be used" or "may consider" or "Y (less preferred drug) may be used instead of X (preferred drug)" or "may consider Y instead of X (preferred drug)"	The majority of individuals in this situation would want the suggested course, but many would not.	Different choices would be appropriate for different patients. Decision aids may be useful in helping individuals in making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working towards a decision.

Grade Definitions of Quality and Certainty of the Evidence
Quality Grade	Definition
High	Very confident that the true effect lies close to that of the estimate of the effect.
Moderate	Moderately confident in the effect estimate. The true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.
Low	Confidence in the estimate is limited. The true effect may be substantially different from the estimate of effect.
Very low	Very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

Document Overview

Document Title: Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Cardiovascular, Endocrine, Hematologic, Pulmonary and Renal Considerations

Authoring Society: Society of Critical Care Medicine

Document Publication Date: Feb 1, 2020

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.17.aspx

Source Citation: Nanchal R, Subramanian R, Karvellas CJ, Hollenberg SM, Peppard WJ, Singbartl K, Truwit J, Al-Khafaji AH, Killian AJ, Alquraini M, Alshammari K, Alshamsi F, Belley-Cote E, Cartin-Ceba R, Dionne JC, Galusca DM, Huang DT, Hyzy RC, Junek M, Kandiah P, Kumar G, Morgan RL, Morris PE, Olson JC, Sieracki R, Steadman R, Taylor B, Alhazzani W. Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Cardiovascular, Endocrine, Hematologic, Pulmonary, and Renal Considerations. Crit Care Med. 2020 Mar;48(3):e173-e191. doi: 10.1097/CCM.0000000000004192. PMID: 32058387.

Supplemental Implementation Resources

Algorithm

Document Scope, Criteria, and Use Cases

Document Objectives: The purpose of these guidelines was to develop evidence-based recommendations addressing common clinical questions surrounding the unique manifestations of liver failure in the critically ill patient.

Scope: Assessment and Screening, Management, Treatment

Diseases/Conditions (MeSH)

D017114 - Liver Failure, Acute

D017093 - Liver Failure

D008099 - Liver

D016638 - Critical Illness

D007362 - Intensive Care Units

D065290 - Acute-On-Chronic Liver Failure