Intensive care of patients with acute liver failure: Recommendations of the U.S. Acute Liver Failure Study Group

  title={Intensive care of patients with acute liver failure: Recommendations of the U.S. Acute Liver Failure Study Group},
  author={R. Todd Stravitz and Andreas H. Kramer and Timothy J. Davern and A. Obaid S. Shaikh and Stephen Hugh Caldwell and Ravindra L. Mehta and Andres T. Blei and Robert John Fontana and Brendan M. Mcguire and Lorenzo Rossaro and Alastair D. Smith and William M. Lee},
  journal={Critical Care Medicine},
Objective:To provide a uniform platform from which to study acute liver failure, the U.S. Acute Liver Failure Study Group has sought to standardize the management of patients with acute liver failure within participating centers. Methods:In areas where consensus could not be reached because of divergent practices and a paucity of studies in acute liver failure patients, additional information was gleaned from the intensive care literature and literature on the management of intracranial… 

Intensive Care Management of Severe Acute Liver Failure

Clinical management guidelines may assist in the treatment of severe acute liver failure patients by providing an evidence-based framework for care by staff at the bedside, which ensures that all important priorities are adequately addressed.

Outcomes in Adults With Acute Liver Failure Between 1998 and 2013

This large cohort study found that despite similar causes and severity of ALF among patients referred to specialty centers from 1998 to 2013, the proportion of patients listed for liver transplantation decreased and survival improved among those who did not receive a transplant as well asThose who did.

Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure.

Management of acute liver failure

Advances in the intensive care management of patients with ALF are highlighted that have contributed to a marked improvement in their overall survival over the past 20 years, including therapies that limit the extent of liver injury and maximize the likelihood of spontaneous recovery.

Multiple organ involvement and ICU considerations for the care of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in children

The effects of ALF and ACLF on individual organ systems with diagnostic and management considerations in the ICU while awaiting liver transplantation are outlined.

Acute Liver Failure: Current Evidence-Based Management for ICU Care

The authors evaluate the evidence for a variety of therapeutic maneuvers that have been put forward to ameliorate the course of ALF and decide whether orthotopic liver transplant may be a viable option.

Recent advances in management of acute liver failure

Liver transplantation remains the only therapeutic intervention with proven survival benefit in patients with irreversible ALF and public health measures to control hepatitis A, B, E, and drug-induced liver injury will reduce the incidence and mortality.

[Intensive care of patients with acute liver failure].

  • L. YtrebøP. Klepstad
  • Medicine
    Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke
  • 2010
The article defines the diseases, discusses etiological factors, treatment strategies, indications for referral to the transplantation unit at Rikshospitalet and prognostic factors of importance, and identifies literature identified through a non-systematic search in PubMed.

Invasive intracranial pressure monitoring is a useful adjunct in the management of severe hepatic encephalopathy associated with pediatric acute liver failure*

  • P. KamatS. Kunde J. Fortenberry
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2012
In this series of patients, intracranial pressure monitoring had a low complication rate and was associated with a high survival rate despite severe hepatic encephalopathy and cerebral edema in the setting of pediatric acute liver failure.

Management of Hepatic Encephalopathy

  • J. Frontera
  • Medicine
    Current Treatment Options in Neurology
  • 2014
Opinion statementHepatic encephalopathy management varies depending on the acuity of liver failure. However, in patients with either acute or chronic liver failure five basic steps in management are



Acute liver failure: results of a 5-year clinical protocol.

  • M. DaasD. Plevak J. Steers
  • Medicine
    Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 1995
Outcome is improved if transplantation occurs before grade IV encephalopathy, and ICP monitoring can be accomplished without significant risk of hemorrhage, in patients with acute liver failure.

Acute liver failure: redefining the syndromes

Liver transplantation in Europe for patients with acute liver failure.

In selected patients, auxiliary partial orthotopic liver transplantation may be a therapeutic option, with the potential for native liver generation and eventual immunosuppression withdrawal in approximately two-thirds of patients.

Acute Liver Failure in the United States

The most frequent causes of acute liver failure were overdose of acetaminophen, other drug reactions, and hepatitis A or B virus infection and older age and being in a coma at the time of presentation were associated with worse outcomes.

The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure

Induction and maintenance of hypernatremia can reduce the incidence and severity of intracranial hypertension in patients presenting with ALF.

Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension.

Moderate hypothermia is an effective and safe bridge to OLT in patients with ALF who have increased ICP that is resistant to standard medical therapy and a large multicenter trial of hypthermia in ALF is justified.

Infection and the progression of hepatic encephalopathy in acute liver failure.

Earlier identification of patients at risk from acetaminophen-induced acute liver failure.

The crude admission APACHE II score correlated well with mortality in patients with acetaminophen-induced acute liver failure, however, the calculated APAChe II risk of death, using the original drug overdose coefficient, was poorly calibrated.