Evaluation and treatment of the critically ill cirrhotic patient

• Published in: Gastroenterología y hepatología Vol. 39; no. 9; p. 607
• Main Authors: Fernández, Javier, Aracil, Carles, Solà, Elsa, Soriano, Germán, Cinta Cardona, Maria, Coll, Susanna, Genescà, Joan, Hombrados, Manoli, Morillas, Rosa, Martín-Llahí, Marta, Pardo, Albert, Sánchez, Jordi, Vargas, Victor, Xiol, Xavier, Ginès, Pere
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.11.2016
• Subjects: Acute Kidney Injury - etiology; Anti-Bacterial Agents - therapeutic use; Blood Coagulation Disorders - etiology; Combined Modality Therapy; Critical Care - methods; Critical Illness; Disease Management; Early Diagnosis; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - therapy; Fluid Therapy; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hemostatic Techniques; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - therapy; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - therapy; Liver Failure - etiology; Liver Failure - therapy; Liver Transplantation; Respiration, Artificial; Shock, Septic - etiology; Shock, Septic - therapy; Sepsis grave; Prognosis; Pronóstico; Severe sepsis; Acute kidney injury; Variceal bleeding; Acute-on-chronic liver failure; Hemorragia variceal; Insuficiencia renal; Fracaso hepático agudo sobre crónico; Hepatic encephalopathy; Encefalopatía hepática
• ISSN: 0210-5705
• DOI: 10.1016/j.gastrohep.2015.09.019

Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions.