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Hepatic Encephalopathy-the Old and the New
1Division of Neuro Critical Care, Department of Neurosurgery, Co-appointment in Surgical Critical Care, Emory University Hospital, 1364 Clifton Road Northeast, 2nd Floor, 2D ICU-D264, Atlanta, GA 30322, USA.
Critical Care Clinics
|June 25, 2016
Summary
Hepatic encephalopathy (HE) management has improved due to critical care advances, not a single intervention. This review clarifies HE concepts, pathophysiology, and strategies for better patient outcomes.
Area of Science:
- Hepatology
- Critical Care Medicine
- Neurology
Background:
- Hepatic encephalopathy (HE) is a universal complication of advanced liver failure.
- HE's impact on mortality varies with liver failure acuity and severity.
- Mortality associated with HE has decreased in specific liver failure types over two decades.
Purpose of the Study:
- To review and clarify key concepts, rationales, and management strategies for hepatic encephalopathy.
- To address misconceptions regarding HE presentation, pathophysiology, and outcomes.
- To highlight practical advances contributing to improved HE-related mortality.
Main Methods:
- Literature review focusing on hepatic encephalopathy.
- Analysis of trends in mortality associated with liver failure and HE.
- Synthesis of current understanding and management approaches.
Main Results:
- Mortality related to HE has declined in certain liver failure subsets.
- Improvements are attributed to critical care advancements, not isolated treatments.
- Heterogeneity in HE presentation, pathophysiology, and outcomes contributes to misconceptions.
Conclusions:
- Effective management of hepatic encephalopathy relies on a comprehensive approach incorporating critical care insights.
- Further understanding and dissemination of HE knowledge are crucial.
- Advances in critical care have significantly impacted HE-associated mortality positively.
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