Critical Matters Management of Acute-on-Chronic Liver Failure in the ICU
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Aug 24, 2023 Rahul Nanchal, a critical care physician and professor specializing in liver disease, shares deep insights on acute-on-chronic liver failure management. He breaks down key differences among acute liver failure types and discusses common triggers, including infections and alcohol. Nanchal emphasizes antibiotic prophylaxis post-GI bleed and the critical timing for interventions like endoscopy and diagnosis of spontaneous bacterial peritonitis. He also highlights the importance of timely transplant referrals, offering invaluable takeaways for clinicians in critical care.
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Refer Early And Support Organ Failures
- Recognize ACLF early and refer to a liver transplant center when appropriate.
- Support organ failures in ICU because ACLF can reverse with timely care and transplant evaluation.
ACLF Is Defined By Organ Failures
- ACLF definitions vary internationally but share organ failure as the core feature.
- Common ACLF triggers include infection, alcoholic hepatitis, HBV reactivation, and variceal bleeding.
Give Antibiotics After Variceal Bleeding
- Give prophylactic antibiotics after variceal or upper GI bleeding in cirrhosis.
- Use a third-generation cephalosporin like ceftriaxone for this prophylaxis.
