Critical Matters Critical Care of Patients with Cirrhosis
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Jun 12, 2019 Dr. Ram Subramanian, Medical Director of Liver Transplantation at Emory School of Medicine, sheds light on the intricate management of critically ill patients with cirrhosis. He shares insights on navigating complications like hepatic encephalopathy and acute GI bleeds, highlighting proactive strategies for better outcomes. The conversation dives into transplant eligibility criteria and the importance of multidisciplinary approaches for patient care, emphasizing tailored interventions like TIPS and the role of support systems in improving patient survival.
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Cirrhosis Causes Multisystem ICU Presentations
- Cirrhotic patients present to ICU with both hepatic and extrahepatic organ dysfunction that can affect any system from brain to kidneys to lungs.
- Expect complex multisystem problems like variceal bleeding, hepatorenal syndrome, hepatopulmonary syndrome, and portopulmonary hypertension.
ACLF Can Occur Without End-Stage Signs
- Acute-on-chronic liver failure (ACLF) can occur in patients without classic end-stage cirrhosis and carries high short-term mortality.
- Intensivists should recognize that even mild chronic liver disease can suddenly cause multiorgan failure requiring aggressive care.
Immediate Steps For Suspected Variceal Bleed
- For suspected variceal bleeding, secure large-bore IV access, intubate if needed, and optimize hematologic parameters before definitive therapy.
- Use octreotide, antibiotics, and early GI/IR involvement; choose banding for esophageal varices and consider TIPS or BRTO for gastric varices.
