SCCM Resource Library-Managing Multiorgan Disease in Acute-On-Chronic Liver Failure: Improving Critical Care Management of the HRS/AKI Patient

Video Transcription

Video Summary

The session discussed the management of multi-organ disease and acute on chronic liver failure. The speakers highlighted the challenges in managing cirrhosis and multi-organ failure, such as hepatic encephalopathy, acute kidney injury, and portal hypertension. They emphasized the importance of early diagnosis and treatment of acute kidney injury in cirrhotic patients, particularly in the ICU setting. The use of bedside echocardiography was discussed as a tool to assess volume status and cardiac output in these patients. The speakers also discussed the diagnosis and management of hepatorenal syndrome, noting that it is a diagnosis of exclusion and highlighting the importance of vasoconstrictor therapy and albumin administration. They discussed the use of trilocylin as a preferred vasoconstrictor and the potential challenges in using it in the ward setting. They also noted the importance of urine output as a predictor of acute kidney injury in these patients and the need to consider renal replacement therapy on a case-by-case basis. Overall, the session provided valuable insights into the management of multi-organ disease and acute on chronic liver failure, highlighting the importance of early diagnosis and treatment and the challenges in managing these complex patients.

Asset Subtitle

Pulmonary, GI and Nutrition, Renal, 2022

Asset Caption

This session is for critical care medicine professionals involved in managing multiorgan failure arising as a consequence of acute-on-chronic liver failure (ACLF), including hepatorenal syndrome/acute kidney injury (HRS/AKI), and the risks of acute respiratory distress syndrome (ARDS) in patients undergoing albumin revolumization.

Learning Objectives:
-Discuss the terms cirrhosis, decompensation, and acute-on-chronic liver failure (ACLF), as well as their clinical significance and risk to patient mortality
-Review current evidence for the whole-patient management of multiorgan failure arising from ACLF, including risks to renal and respiratory function
-Apply evidence-based fluid management protocols to revolumize patients with ascites following large-volume paracentesis in AKI patients to establish a diagnosis of HRS/AKI, while mitigating risks from fluid overload
-Intervene with proactive evidence-based vasoconstrictor therapy for patients who meet diagnostic criteria for HRS/AKI based on American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) algorithms
-Monitor patients with cirrhosis, ascites, and HRS/AKI for treatment-emergent adverse events that may worsen prognosis

This program is supported by an education grant from Mallinckrodt

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Knowledge Area Renal

Knowledge Area GI and Nutrition

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Acute Respiratory Distress Syndrome ARDS

Tag Liver

Tag Renal

Tag Updates and Future Directions

Year 2022

Keywords

multi-organ disease

acute on chronic liver failure

cirrhosis

hepatic encephalopathy

acute kidney injury

portal hypertension

early diagnosis

bedside echocardiography

hepatorenal syndrome

renal replacement therapy

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