Critical Care Management of Acute-on-Chronic Liver Failure: Certainties and Unknowns.

IF 4.3 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Seminars in liver disease Pub Date : 2023-05-01 Epub Date: 2023-06-27 DOI:10.1055/s-0043-1769907
Enric Reverter, David Toapanta, Octavi Bassegoda, Juliana Zapatero, Javier Fernandez
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引用次数: 0

Abstract

Intensive care unit (ICU) admission is frequently required in patients with decompensated cirrhosis for organ support. This entity, known as acute-on-chronic liver failure (ACLF), is associated with high short-term mortality. ICU management of ACLF is complex, as these patients are prone to develop new organ failures and infectious or bleeding complications. Poor nutritional status, lack of effective liver support systems, and shortage of liver donors are also factors that contribute to increase their mortality. ICU therapy parallels that applied in the general ICU population in some complications but has differential characteristics in others. This review describes the current knowledge on critical care management of patients with ACLF including organ support, prognostic assessment, early liver transplantation, and futility rules. Certainties and knowledge gaps in this area are also discussed.

急性慢性肝衰竭的重症监护管理:确定与未知。
肝硬化失代偿期患者经常需要入住重症监护室(ICU)进行器官支持。这种情况被称为急性慢性肝衰竭(ACLF),短期死亡率很高。ICU 对 ACLF 的管理非常复杂,因为这些患者很容易出现新的器官衰竭、感染或出血并发症。营养状况差、缺乏有效的肝脏支持系统以及肝脏供体短缺也是导致其死亡率上升的因素。在某些并发症方面,重症监护病房的治疗方法与普通重症监护病房的治疗方法相似,但在另一些并发症方面却有不同的特点。本综述介绍了目前有关 ACLF 患者重症监护管理的知识,包括器官支持、预后评估、早期肝移植和无效规则。同时还讨论了这一领域的确定性和知识差距。
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来源期刊
Seminars in liver disease
Seminars in liver disease 医学-胃肠肝病学
CiteScore
8.20
自引率
2.40%
发文量
38
期刊介绍: Seminars in Liver Disease is a quarterly review journal that publishes issues related to the specialties of hepatology and gastroenterology. As the premiere review journal in the field, Seminars in Liver Disease provides in-depth coverage with articles and issues focusing on topics such as cirrhosis, transplantation, vascular and coagulation disorders, cytokines, hepatitis B & C, Nonalcoholic Steatosis Syndromes (NASH), pediatric liver diseases, hepatic stem cells, porphyrias as well as a myriad of other diseases related to the liver. Attention is also given to the latest developments in drug therapy along with treatment and current management techniques. Seminars in Liver Disease publishes commissioned reviews. Unsolicited reviews of an exceptional nature or original articles presenting remarkable results will be considered, but case reports will not be published.
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