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Intensive care management of acute liver failure

Auzinger, Georg; Wendon, Julia

Current Opinion in Critical Care: April 2008 - Volume 14 - Issue 2 - p 179–188
doi: 10.1097/MCC.0b013e3282f6a450
Gastrointestinal system: Edited by Julia Wendon

Purpose of review The mortality of acute liver failure remains unacceptably high and liver transplantation is the only effective treatment available to date. This review focuses on new research developments in the field and aims to provide a pragmatic organ-based treatment approach for liver failure patients requiring intensive care support.

Recent findings The pathophysiological basis for cerebral edema formation in acute liver failure continued to be the focus of various investigations. In-vivo observations confirmed the link between ammonia, cerebral glutamine content and intracranial hypertension. The role of arterial ammonia as an important prognostic indicator formed the basis of prospective, observational studies. Reduced monocytic HLA-DR expression linked acute liver failure with poor prognosis, and the cerebral effects and side effects of vasoactive therapy with terlipressin were investigated with two studies showing contradictory results.

Summary Despite increased knowledge of the pathophysiological events leading to organ dysfunction in acute liver failure, supportive treatment options remain limited in their efficacy and largely noncurative.

Liver Intensive Care Unit, King's College Hospital, London, UK

Correspondence to Dr Georg Auzinger, Consultant LITU, Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK Tel: +44 3 299 9000 ext 2624; fax: +44 3 2993899; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.