GASTROINTESTINAL SYSTEM: Edited by Ram M. SubramanianUpdate on the management of acute liver failureJayalakshmi, Vadivukkarasi T.; Bernal, WilliamAuthor Information Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, London, UK Correspondence to William Bernal, Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. Tel: +44 203 299 4458; e-mail: [email protected] Current Opinion in Critical Care: April 2020 - Volume 26 - Issue 2 - p 163-170 doi: 10.1097/MCC.0000000000000697 Buy Metrics Abstract Purpose of review The aim of this article is to provide the reader with an overview of established standards of care and to summarize important newer research findings in acute liver failure (ALF). Recent findings New international guidelines are now in place with recommendations for medical care and nutritional support. Large-scale retrospective studies have confirmed the low level of bleeding complications observed, despite apparently severe coagulopathy on standard laboratory testing, and the improved survival seen with continuous rather than intermittent forms of renal replacement therapy. Advances in neurologic support include confirmation of the efficacy of control of hyperammonaemia using continuous haemofiltration, and of the utility of transcranial Doppler ultrasound as a screening modality for detection of cerebral oedema. Improvements in outcomes with medical treatment for some causes of ALF have resulted in need for new means of identification of patients who will benefit from liver transplantation. Summary Best practice in the care of patients with ALF continues to evolve with ongoing improvement in survival. Survival in these patients is expected to improve further with refinement of medical supportive care and more accurate identification of transplant candidacy. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.