Lecture Summary

Acute on chronic liver failure (ACLF ~ cirrhosis with multiorgan failure) is associated with significant morbidity and mortality. ACLF require ICU admission often for vasopressor support, intubation/mechanical ventilation for acute lung injury/hepatic encephalopathy and renal support for acute kidney injury often as a bridge to listing and receipt of a liver transplant. This lecture will review the definition of ACLF, discuss organ system management and discuss current challenges in getting these patients through a successful liver transplant.

Target Audience

Critical Care Doctors
Experienced or advanced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

• Understand the definition of Acute-on-chronic liver failure and how it differs from decompensated cirrhosis
• Review the management of sepsis/shock in ACLF and why these patients are prone to infections
• Review current management of acute kidney injury and hepatorenal syndrome in ACLF
• Review the challenges with determining futility in ACLF regarding ‘too sick to transplant’

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

EB Medicine designates this internet-enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Needs Assessment

The need for this educational activity was determined by surveys of the target audience and experts in the specialty. Further assessment was provided by examining the topics of recently published evidence-based medicine reviews, national clinical guidelines, and specialty society recommendations, as well as suggestions from evaluations of previous learning programs to determine practice gaps.

CME Faculty Disclosure

It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.

Earning Credit

In order to earn CME credit, the participant must take the pre-test, watch the course, take the CME post-test, and complete the post-test evaluation.

Hardware/Software Requirements

Online learners will need a computer or web-enabled device to access the podcast, additional learning materials, and CME test.