Hot topics in liver intensive care

Area of Science:

• Critical Care Medicine
• Hepatology
• Nephrology

Background:

• Liver dysfunction independently predicts mortality in intensive care unit (ICU) patients.
• Early restoration of liver function is a critical therapeutic goal for critically ill patients.
• Current management strategies for liver-related complications in the ICU require further elucidation.

Purpose of the Study:

• To provide an overview of critical liver-related issues in intensive care.
• To highlight current knowledge gaps and areas for future research in managing liver dysfunction in critically ill patients.

Main Methods:

• Review of current literature on "hottest topics" in liver dysfunction in intensive care.
• Discussion of management strategies for hepatic encephalopathy, hepatorenal syndrome, and coagulation disorders.
• Evaluation of extracorporeal liver support systems (e.g., MARS, Prometheus).

Main Results:

• Management of intracranial pressure in severe hepatic encephalopathy remains challenging, with limited reproducible data on systems like MARS.
• Intracranial pressure monitoring application varies due to unclear risk-benefit ratios.
• Terlipressin with fluid and albumin shows promise for hepatorenal syndrome; extracorporeal systems require further investigation for efficacy and indications.

Conclusions:

• Optimal management protocols for intracranial pressure and bleeding risk in severe liver dysfunction are needed.
• The role and effectiveness of extracorporeal liver support systems require further clinical validation.
• Addressing liver dysfunction and its complications is paramount for improving outcomes in critically ill patients.