Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU

Patient Guideline Summary

Publication Date: February 1, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the Society of Critical Care Medicine (SCCM) for adult acute and acute-on-chronic liver failure in the ICU. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Acute liver failure (ALF)is a life-threatening condition requiring immediate hospitalization, most likely in an intensive care unit.
  • ALF can damage every organ system in the body.
  • We will use the abbreviation ALF throughout this summary to refer to acute liver failure.
  • Some of the most common causes of acute liver failure are virus infections and drugs like acetaminophen.
  • Symptoms include vomiting, diarrhea, liver pain, jaundice (yellow skin and eyes), mental changes, shaking, bleeding.
  • This patient summary focuses on intensive care of acute liver failure.

Diagnosis

Diagnosis

  • Since ALF can damage every vital organ in the body, you will undergo extensive initial evaluation upon entering the hospital.
  • Your liver will probably be subjected to viscoelastic testing since it hardens when it is diseased.
  • Laboratory blood test are also helpful.
  • Your heart and blood pressure will need constant monitoring.
  • Both bleeding and clotting can occur.
  • Your lungs and chest can fill with fluid, requiring chest x-rays and breathing tests.
  • Your kidneys will require blood tests and urine monitoring.
  • Your brain may swell, causing mental deterioration, confusion and sleepiness.
  • Your digestive system may not work properly.

Treatment

Treatment

  • Medications may be needed to maintain your blood pressure.
  • Blood product transfusions may be needed to replace blood loss from bleeding.
  • Medications or surgical procedures may be needed to manage blood clotting.
  • You may need oxygen and assisted ventilation, perhaps even with a tube in your throat.
  • If your kidneys fail, temporary dialysis (a mechanical replacement for kidney function) may be required.
  • Fluid buildup in your chest or abdomen may be drained with a needle or tube.
  • If your brain swells, medical or surgical reduction in the built-up pressure will be necessary.
  • If your digestive system is not working properly, intravenous or tube feeding will maintain your nutrition.
  • Liver transplantation is frequently necessary if your liver does not recover.
  • Throughout your hospitalization:
    • Frequent monitoring of all your vital functions will continue and dictate changes in management as your status changes.
    • Supportive care will improve your comfort, relieve your symptoms, prevent bed sores and decrease your stress.
      • You may be sedated during the most uncomfortable treatments.

Abbreviations

  • ALF: Acute Liver Failure

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.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.