Management of patients with liver disease on the intensive care unit

Abstract

There are two groups of patients with liver disease who may be found on an intensive care unit: those with chronic liver disease (CLD), and those with fulminant hepatic failure (FHF) and late onset hepatic failure. Many of the problems and haemodynamic abnormalities are common to both groups; however, there are specific differences, in particular the development of cerebral oedema in patients with FHF and the development of variceal bleeding in patients with CLD. Fulminant hepatic failure is the term used to describe patients with a very rapid progression of symptoms and signs, normally defined as the onset of encephalopathy within 8 weeks of the development of symptoms (Trey and Davidson, 1970) in patients without preceding liver disease. A similar group of patients is those with late onset hepatic failure (LOHF), defined as the onset of encephalopathy within 8 weeks to 6 months of the development of jaundice, again in patients without preceding liver disease (Gimson et al, 1986). The stratification of patients with respect to speed of onset of encephalopathy is of great importance since this in association with aetiology carries prognostic implications; this is a point of special importance when transplantation is being considered as a therapeutic option (O'Grady et al, 1989). AETIOLOGY