2025 Multiprofessional Critical Care Review: Adult Online-Hepatic Failure

Video Transcription

Video Summary

This lecture differentiates acute liver failure (ALF) and decompensated cirrhosis, emphasizing their distinct physiologies and management. ALF, marked by rapid hepatic encephalopathy and elevated INR without prior liver disease, requires early transplant referral and aggressive treatments like high-dose continuous renal replacement therapy (CRRT) to reduce hyperammonemia, while avoiding prophylactic fresh frozen plasma to preserve INR as a prognostic marker. Etiologies include drugs, viral hepatitis, autoimmune conditions, and pregnancy-related liver diseases. Decompensated cirrhosis often presents with variceal bleeding, managed pharmacologically, endoscopically, and via TIPS if needed, plus prevention of infections. Hepatorenal syndrome demands early volume resuscitation, vasoconstrictors, and ultimately transplant. Portopulmonary hypertension and hepatopulmonary syndrome represent critical pulmonary complications requiring careful management before transplantation. Extracorporeal liver support like MARS may aid in bridging patients but lacks conclusive survival benefits. The lecture underscores multidisciplinary ICU care, tailored interventions, and timely transplant evaluation to improve outcomes in liver failure patients.

Keywords

acute liver failure

decompensated cirrhosis

hepatic encephalopathy

renal replacement therapy

variceal bleeding

liver transplantation

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