Cirrhosis in the ICU (acute on chronic liver failure) and the role of liver transplantation

A review of the literature

The lecture duration is 39min.

0.75 CPD Points, 0.75 CEUs, 0.75 CME credits approval pending.
Accredited by CPDUK, CBRN and Provider Pending.

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Dean Karvellas
Professor of Critical Care Medicine and Gastroenterology/Hepatology at the University of Alberta, Canada
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’