Severe Hepatic Encephalopathy in ICU Patients

Severe hepatic encephalopathy in ICU patients presents as the most severe form of hepatic encephalopathy, often leading to intubation. Patients with chronic hepatic dysfunction have a poor prognosis without a liver transplant, though temporary salvage is possible during their ICU course. Identifying these patients can be challenging, but clinical features such as asterixis, respiratory alkalosis, and a history of hepatic encephalopathy can provide clues. However, asterixis may also be present in other metabolic encephalopathies, making it less distinguishing. Despite the difficulty in identification, temporary salvage of patients through their ICU course is achievable, albeit with a generally poor overall prognosis.