Download PDF
Semin Liver Dis 2008; 28(2): 188-200
DOI: 10.1055/s-2008-1073118
© Thieme Medical Publishers

Intensive Care Management of Acute Liver Failure

William Bernal1 , Georg Auzinger1 , Elizabeth Sizer1 , Julia Wendon1
  • 1Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, London, United Kingdom
Further Information

Publication History

Publication Date:
02 May 2008 (online)

    Permissions and Reprints

ABSTRACT

The care of patients with acute liver failure (ALF) presents unique clinical challenges to the practicing physician. It combines the management of rapidly progressive, severe multiple organ failure, unpredictable and often devastating complications, and a need for urgent decision-making in the application of emergency liver transplantation. However, outcomes for patients with this condition have shown progressive improvement over the last four decades. In this article, practical clinical approaches to the care of critically ill patients with ALF are discussed, taking an organ systems-based perspective and discussing the underlying pathophysiological processes and major areas of uncertainty as to what constitutes best practice.

KEYWORDS

Acute liver failure - fulminant hepatic failure - intensive care - multiple organ failure

REFERENCES

  • 1 Bihari D J, Gimson A E, Williams R. Cardiovascular, pulmonary and renal complications of fulminant hepatic failure.  Semin Liver Dis. 1986;  6 119-128
    PubMedGoogle Scholar
  • 2 Stravitz R T, Kramer A H, Davern T et al.. Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group.  Crit Care Med. 2007;  35 2498-2508
    CrossrefPubMedGoogle Scholar
  • 3 Rivers E, Nguyen B, Havstad S et al.. Goal-directed therapy for severe sepsis and septic shock.  N Engl J Med. 2001;  345 1368-1377
    CrossrefPubMedGoogle Scholar
  • 4 Harry R, Auzinger G, Wendon J. The clinical importance of adrenal insufficiency in acute hepatic dysfunction.  Hepatology. 2002;  36 395-402
    CrossrefPubMedGoogle Scholar
  • 5 Marik P E. Mechanisms and clinical consequences of critical illness associated adrenal insufficiency.  Curr Opin Crit Care. 2007;  13 363-369
    CrossrefPubMedGoogle Scholar
  • 6 Parekh N K, Hynan L S, De Lemos J, Lee W M. Elevated troponin I levels in acute liver failure: is myocardial injury an integral part of acute liver failure?.  Hepatology. 2007;  45 1489-1495
    CrossrefPubMedGoogle Scholar
  • 7 Bagshaw S M, Bellomo R. The influence of volume management on outcome.  Curr Opin Crit Care. 2007;  13 541-548
    CrossrefPubMedGoogle Scholar
  • 8 Harry R, Auzinger G, Wendon J. The effects of supraphysiological doses of corticosteroids in hypotensive liver failure.  Liver Int. 2003;  23 71-77
    CrossrefPubMedGoogle Scholar
  • 9 Eefsen M, Dethloff T, Frederiksen H-J, Hauerberg J, Hansen B A, Larsen F S. Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support.  J Hepatol. 2007;  47 381-386
    CrossrefPubMedGoogle Scholar
  • 10 Shawcross D L, Davies N A, Mookerjee R P et al.. Worsening of cerebral hyperemia by the administration of terlipressin in acute liver failure with severe encephalopathy.  Hepatology. 2004;  39 471-475
    CrossrefPubMedGoogle Scholar
  • 11 Rolando N, Philpott-Howard J, Williams R. Bacterial and fungal infection in acute liver failure.  Semin Liver Dis. 1996;  16 389-402
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Wade J, Rolando N, Philpott-Howard J, Wendon J. Timing and aetiology of bacterial infections in a liver intensive care unit.  J Hosp Infect. 2003;  53 144-146
    CrossrefPubMedGoogle Scholar
  • 13 Imawari M, Hughes R D, Gove C D, Williams R. Fibronectin and Kupffer cell function in fulminant hepatic failure.  Dig Dis Sci. 1985;  30 1028-1033
    CrossrefPubMedGoogle Scholar
  • 14 Wyke R J, Rajkovic I A, Eddleston A L, Williams R. Defective opsonisation and complement deficiency in serum from patients with fulminant hepatic failure.  Gut. 1980;  21 643-649
    PubMedGoogle Scholar
  • 15 Canalese J, Gove C D, Gimson A E, Wilkinson S P, Wardle E N, Williams R. Reticuloendothelial system and hepatocytic function in fulminant hepatic failure.  Gut. 1982;  23 265-269
    CrossrefPubMedGoogle Scholar
  • 16 Wigmore S J, Walsh T S, Lee A, Ross J A. Pro-inflammatory cytokine release and mediation of the acute phase protein response in fulminant hepatic failure.  Intensive Care Med. 1998;  24 224-229
    CrossrefPubMedGoogle Scholar
  • 17 Bailey R J, Woolf I L, Cullens H, Williams R. Metabolic inhibition of polymorphonuclear leucocytes in fulminant hepatic failure.  Lancet. 1976;  1 1162-1163
    PubMedGoogle Scholar
  • 18 Clapperton M, Rolando N, Sandoval L, Davies E, Williams R. Neutrophil superoxide and hydrogen peroxide production in patients with acute liver failure.  Eur J Clin Invest. 1997;  27 164-168
    CrossrefPubMedGoogle Scholar
  • 19 Antoniades C G, Berry P A, Davies E T et al.. Reduced monocyte HLA-DR expression: a novel biomarker of disease severity and outcome in acetaminophen-induced acute liver failure.  Hepatology. 2006;  44 34-43
    CrossrefPubMedGoogle Scholar
  • 20 Vaquero J, Polson J, Chung C et al.. Infection and the progression of hepatic encephalopathy in acute liver failure.  Gastroenterology. 2003;  125 755-764
    CrossrefPubMedGoogle Scholar
  • 21 Pahlavan P S, Feldmann Jr R E, Zavos C, Kountouras J. Prometheus' challenge: molecular, cellular and systemic aspects of liver regeneration.  J Surg Res. 2006;  134 238-251
    CrossrefPubMedGoogle Scholar
  • 22 Akita K, Okuno M, Enya M et al.. Impaired liver regeneration in mice by lipopolysaccharide via TNF-alpha/kallikrein-mediated activation of latent TGF-beta.  Gastroenterology. 2002;  123 352-364
    CrossrefPubMedGoogle Scholar
  • 23 Rolando N, Wade J, Davalos M, Wendon J, Philpott-Howard J, Williams R. The systemic inflammatory response syndrome in acute liver failure.  Hepatology. 2000;  32 734-739
    CrossrefPubMedGoogle Scholar
  • 24 Bearman G ML, Munro C, Sessler C N, Wenzel R P. Infection control and the prevention of nosocomial infections in the intensive care unit.  Semin Respir Crit Care Med. 2006;  27 310-324
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Cohen J, Brun-Buisson C, Torres A, Jorgensen J. Diagnosis of infection in sepsis: an evidence-based review.  Crit Care Med. 2004;  32(suppl) S466-S494
    CrossrefPubMedGoogle Scholar
  • 26 Rolando N, Gimson A, Wade J, Phillpot-Howard J, Casewell M, Williams R. Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure.  Hepatology. 1993;  17 196-201
    CrossrefPubMedGoogle Scholar
  • 27 Rolando N, Wade J J, Stangou A et al.. Prospective study comparing the efficacy of prophylactic parenteral antimicrobials, with or without enteral decontamination, in patients with acute liver failure.  Liver Transpl Surg. 1996;  2 8-13
    CrossrefPubMedGoogle Scholar
  • 28 Jain S, Pendyala P, Varma S, Sharma N, Joshi K, Chawla Y. Effect of renal dysfunction in fulminant hepatic failure.  Trop Gastroenterol. 2000;  21 118-120
    PubMedGoogle Scholar
  • 29 Wilkinson S P, Moodie H, Arroyo V A, Williams R. Frequency of renal impairment in paracetamol overdose compared with other causes of acute liver damage.  J Clin Pathol. 1977;  30 141-143
    CrossrefPubMedGoogle Scholar
  • 30 O'Grady J G, Alexander G J, Hayllar K M, Williams R. Early indicators of prognosis in fulminant hepatic failure.  Gastroenterology. 1989;  97 439-445
    PubMedGoogle Scholar
  • 31 Wilkinson S P, Arroyo V A, Moodie H, Blendis L M, Williams R. Abnormalities of sodium excretion and other disorders of renal function in fulminant hepatic failure.  Gut. 1976;  17 501-505
    CrossrefPubMedGoogle Scholar
  • 32 Moore K. Renal failure in acute liver failure.  Eur J Gastroenterol Hepatol. 1999;  11 967-975
    PubMedGoogle Scholar
  • 33 Jones A L, Prescott L F. Unusual complications of paracetamol poisoning.  QJM. 1997;  90 161-168
    CrossrefPubMedGoogle Scholar
  • 34 Davenport A, Will E J, Davison A M. Effect of renal replacement therapy on patients with combined acute renal and fulminant hepatic failure.  Kidney Int Suppl. 1993;  41 S245-S251
    PubMedGoogle Scholar
  • 35 Heering P, Ivens K, Thumer O et al.. The use of different buffers during continuous hemofiltration in critically ill patients with acute renal failure.  Intensive Care Med. 1999;  25 1244-1251
    CrossrefPubMedGoogle Scholar
  • 36 Ronco C, Bellomo R, Homel P et al.. Effects of different doses in continuous veno-venous hemofiltration on outcomes of acute renal failure: a prospective randomised trial.  Lancet. 2000;  356 26-30
    CrossrefPubMedGoogle Scholar
  • 37 Ratanarat R, Brendolan A, Ricci Z et al.. Pulse high-volume hemofiltration in critically ill patients: a new approach for patients with septic shock.  Semin Dial. 2006;  19 69-74
    CrossrefPubMedGoogle Scholar
  • 38 Cornejo R, Downey P, Castro R et al.. High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock.  Intensive Care Med. 2006;  32 713-722
    CrossrefPubMedGoogle Scholar
  • 39 Ratanarat R, Brendolan A, Piccinni P et al.. Pulse high-volume haemofiltration for treatment of severe sepsis: effects on hemodynamics and survival [see comment].  Crit Care. 2005;  9 R294-R302
    CrossrefPubMedGoogle Scholar
  • 40 Braun M C, Welch T R. Continuous venovenous hemodiafiltration in the treatment of acute hyperammonemia.  Am J Nephrol. 1998;  18 531-533
    CrossrefPubMedGoogle Scholar
  • 41 Wong K Y, Wong S N, Lam S Y, Tam S, Tsoi N S. Ammonia clearance by peritoneal dialysis and continuous arteriovenous hemodiafiltration.  Pediatr Nephrol. 1998;  12 589-591
    CrossrefPubMedGoogle Scholar
  • 42 Polderman K H. Application of therapeutic hypothermia in the intensive care unit: opportunities and pitfalls of a promising treatment modality. Part 2: practical aspects and side effects [see comment].  Intensive Care Med. 2004;  30 757-769
    CrossrefPubMedGoogle Scholar
  • 43 Rokyta Jr R, Matejovic M, Krouzecky A, Opatrny Jr K, Ruzicka J, Novak I. Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients.  Nephrol Dial Transplant. 2004;  19 623-630
    CrossrefPubMedGoogle Scholar
  • 44 Baudouin S V, Howdle P, O'Grady J G, Webster N R. Acute lung injury in fulminant hepatic failure following paracetamol poisoning.  Thorax. 1995;  50 399-402
    PubMedGoogle Scholar
  • 45 Fan E, Needham D M, Stewart T E. Ventilatory management of acute lung injury and acute respiratory distress syndrome.  JAMA. 2005;  294 2889-2896
    CrossrefPubMedGoogle Scholar
  • 46 Ede R J, Gimson A E, Bihari D, Williams R. Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure.  J Hepatol. 1986;  2 43-51
    CrossrefPubMedGoogle Scholar
  • 47 Auzinger G, O'Callaghan G P, Bernal W, Sizer E, Wendon J A. Percutaneous tracheostomy in patients with severe liver disease and a high incidence of refractory coagulopathy: a prospective trial.  Crit Care. 2007;  11 R110
    CrossrefPubMedGoogle Scholar
  • 48 Reilly P M, Sing R F, Giberson F A et al.. Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy [see comment].  Intensive Care Med. 1997;  23 859-864
    CrossrefPubMedGoogle Scholar
  • 49 Schutz T, Bechstein W-O, Neuhaus P, Lochs H, Plauth M. Clinical practice of nutrition in acute liver failure: a European survey [see comment].  Clin Nutr. 2004;  23 975-982
    CrossrefPubMedGoogle Scholar
  • 50 Samson R, Trey C, Timme A, Saunders S. Fulminating hepatitis with recurrent hypoglycaemia and hemorrhage.  Gastroenterology. 1967;  53 291-300
    PubMedGoogle Scholar
  • 51 Vilstrup H, Iversen J, Tygstrup N. Glucoregulation in acute liver failure.  Eur J Clin Invest. 1986;  16 193-197
    CrossrefPubMedGoogle Scholar
  • 52 Schneeweiss B, Pammer J, Ratheiser K et al.. Energy metabolism in acute hepatic failure.  Gastroenterology. 1993;  105 1515-1521
    CrossrefPubMedGoogle Scholar
  • 53 Grimble R F. Effect of antioxidative vitamins on immune function with clinical applications.  Int J Vitam Nutr Res. 1997;  67 312-320
    PubMedGoogle Scholar
  • 54 Labadarios D, Rossouw J E, McConnell J B, Davis M, Williams R. Thiamine deficiency in fulminant hepatic failure and effects of supplementation.  Int J Vitam Nutr Res. 1977;  47 17-22
    PubMedGoogle Scholar
  • 55 Rossouw J E, Labadarios D, Davis M, Williams R. Water-soluble vitamins in severe liver disease.  S Afr Med J. 1978;  54 183-186
    PubMedGoogle Scholar
  • 56 Marin A, Hardy G. Practical implications of nutritional support during continuous renal replacement therapy [see comment].  Curr Opin Clin Nutr Metab Care. 2001;  4 219-225
    CrossrefPubMedGoogle Scholar
  • 57 Quasim T, McMillan D C, Talwar D et al.. The relationship between plasma and red cell B-vitamin concentrations in critically-ill patients.  Clin Nutr. 2005;  24 956-960
    CrossrefPubMedGoogle Scholar
  • 58 Heyland D K, Dhaliwal R, Suchner U, Berger M M. Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient.  Intensive Care Med. 2005;  31 327-337
    CrossrefPubMedGoogle Scholar
  • 59 Walsh T S, Wigmore S J, Hopton P, Richardson R, Lee A. Energy expenditure in acetaminophen-induced fulminant hepatic failure.  Crit Care Med. 2000;  28 649-654
    CrossrefPubMedGoogle Scholar
  • 60 O'Keefe S J, Abraham R, El-Zayadi A, Marshall W, Davis M, Williams R. Increased plasma tyrosine concentrations in patients with cirrhosis and fulminant hepatic failure associated with increased plasma tyrosine flux and reduced hepatic oxidation capacity.  Gastroenterology. 1981;  81 1017-1024
    PubMedGoogle Scholar
  • 61 Clemmesen J O, Kondrup J, Ott P. Splanchnic and leg exchange of amino acids and ammonia in acute liver failure.  Gastroenterology. 2000;  118 1131-1139
    CrossrefPubMedGoogle Scholar
  • 62 Plauth M, Cabre E, Riggio O et al.. ESPEN Guidelines on Enteral Nutrition: liver disease.  Clin Nutr. 2006;  25 285-294
    CrossrefPubMedGoogle Scholar
  • 63 Charlton M. Branched-chain amino acid enriched supplements as therapy for liver disease.  J Nutr. 2006;  136(suppl) 295S-298S
    PubMedGoogle Scholar
  • 64 Trey C, Davidson C S. The management of fulminant hepatic failure.  Prog Liver Dis. 1970;  3 282-298
    PubMedGoogle Scholar
  • 65 O'Grady J G, Schalm S W, Williams R. Acute liver failure: redefining the syndromes.  Lancet. 1993;  342 273-275
    CrossrefPubMedGoogle Scholar
  • 66 Felipo V, Butterworth R F. Neurobiology of ammonia.  Prog Neurobiol. 2002;  67 259-279
    PubMedGoogle Scholar
  • 67 Vaquero J, Rose C, Butterworth R F. Keeping cool in acute liver failure: rationale for the use of mild hypothermia.  J Hepatol. 2005;  43 1067-1077
    CrossrefPubMedGoogle Scholar
  • 68 Albrecht J, Norenberg M. Glutamine: a trojan horse in ammonia neurotoxicity.  Hepatology. 2006;  44 788-794
    CrossrefPubMedGoogle Scholar
  • 69 Norenberg M D, Rao K V, Jayakumar A R. Mechanisms of ammonia-induced astrocyte swelling.  Metab Brain Dis. 2005;  20 303-318
    CrossrefPubMedGoogle Scholar
  • 70 Clemmesen J O, Larsen F S, Kondrup J, Hansen B A, Ott P. Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration.  Hepatology. 1999;  29 648-653
    CrossrefPubMedGoogle Scholar
  • 71 Bhatia V, Singh R, Acharya S K. Predictive value of arterial ammonia for complications and outcome in acute liver failure.  Gut. 2006;  55 98-104
    CrossrefPubMedGoogle Scholar
  • 72 Kundra A, Jain A, Banga A, Bajaj G, Kar P. Evaluation of plasma ammonia levels in patients with acute liver failure and chronic liver disease and its correlation with the severity of hepatic encephalopathy and clinical features of raised intracranial tension.  Clin Biochem. 2005;  38 696-699
    CrossrefPubMedGoogle Scholar
  • 73 Tofteng F, Hauerberg J, Hansen B A, Pedersen C B, Jorgensen L, Larsen F S. Persistent arterial hyperammonemia increases the concentration of glutamine and alanine in the brain and correlates with intracranial pressure in patients with fulminant hepatic failure.  J Cereb Blood Flow Metab. 2006;  26 21-27
    CrossrefPubMedGoogle Scholar
  • 74 Jalan R, Olde Damink S W, Hayes P C, Deutz N E, Lee A. Pathogenesis of intracranial hypertension in acute liver failure: inflammation, ammonia and cerebral blood flow.  J Hepatol. 2004;  41 613-620
    CrossrefPubMedGoogle Scholar
  • 75 Bernal W, Hall C, Karvellas C J, Auzinger G, Sizer E, Wendon J. Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure.  Hepatology. 2007;  46 1844-1852
    CrossrefPubMedGoogle Scholar
  • 76 Larsen F S, Adel Hansen B, Pott F et al.. Dissociated cerebral vasoparalysis in acute liver failure: a hypothesis of gradual cerebral hyperaemia.  J Hepatol. 1996;  25 145-151
    CrossrefPubMedGoogle Scholar
  • 77 Jalan R. Pathophysiological basis of therapy of raised intracranial pressure in acute liver failure.  Neurochem Int. 2005;  47 78-83
    CrossrefPubMedGoogle Scholar
  • 78 Vaquero J, Chung C, Blei A T. Cerebral blood flow in acute liver failure: a finding in search of a mechanism.  Metab Brain Dis. 2004;  19 177-194
    CrossrefPubMedGoogle Scholar
  • 79 Wendon J A, Harrison P M, Keays R, Williams R. Cerebral blood flow and metabolism in fulminant liver failure.  Hepatology. 1994;  19 1407-1413
    CrossrefPubMedGoogle Scholar
  • 80 Aggarwal S, Kramer D, Yonas H et al.. Cerebral hemodynamic and metabolic changes in fulminant hepatic failure: a retrospective study.  Hepatology. 1994;  19 80-87
    CrossrefPubMedGoogle Scholar
  • 81 Canalese J, Gimson A E, Davis C, Mellon P J, Davis M, Williams R. Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure.  Gut. 1982;  23 625-629
    PubMedGoogle Scholar
  • 82 Acharya S K, Dasarathy S, Kumer T L et al.. Fulminant hepatitis in a tropical population: clinical course, cause, and early predictors of outcome.  Hepatology. 1996;  23 1448-1455
    CrossrefPubMedGoogle Scholar
  • 83 Rose C, Michalak A, Rao K V, Quack G, Kircheis G, Butterworth R F. L-ornithine-L-aspartate lowers plasma and cerebrospinal fluid ammonia and prevents brain edema in rats with acute liver failure.  Hepatology. 1999;  30 636-640
    CrossrefPubMedGoogle Scholar
  • 84 Sen S, Williams R. New liver support devices in acute liver failure: a critical evaluation.  Semin Liver Dis. 2003;  23 283-294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 85 Adembri C, Venturi L, Pellegrini-Giampietro D E. Neuroprotective effects of propofol in acute cerebral injury.  CNS Drug Rev. 2007;  13 333-351
    CrossrefPubMedGoogle Scholar
  • 86 Fulton B, Sorkin E M. Propofol: an overview of its pharmacology and a review of its clinical efficacy in intensive care sedation.  Drugs. 1995;  50 636-657
    CrossrefPubMedGoogle Scholar
  • 87 Raghavan M, Marik P E. Therapy of intracranial hypertension in patients with fulminant hepatic failure.  Neurocrit Care. 2006;  4 179-189
    CrossrefPubMedGoogle Scholar
  • 88 Davenport A, Will E J, Davison A M. Effect of posture on intracranial pressure and cerebral perfusion pressure in patients with fulminant hepatic and renal failure after acetaminophen self-poisoning.  Crit Care Med. 1990;  18 286-289
    PubMedGoogle Scholar
  • 89 Ng I, Lim J, Wong H B. Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation.  Neurosurgery. 2004;  54 593-597 , discussion 598
    CrossrefPubMedGoogle Scholar
  • 90 Leighton H. Effect of endotracheal suctioning on the intracerebral haemodynamics of patients in fulminant hepatic failure.  Intensive Crit Care Nurs. 1997;  13 198-208
    CrossrefPubMedGoogle Scholar
  • 91 McGuinness A. Role of the nurse in managing patients with hepatic cerebral oedema.  Br J Nurs. 2007;  16 340-343
    PubMedGoogle Scholar
  • 92 Murphy N, Auzinger G, Bernal W, Wendon J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure.  Hepatology. 2004;  39 464-470
    CrossrefPubMedGoogle Scholar
  • 93 Himmelseher S. Hypertonic saline solutions for treatment of intracranial hypertension.  Curr Opin Anaesthesiol. 2007;  20 414-426
    CrossrefPubMedGoogle Scholar
  • 94 Axelrod Y K, Diringer M N. Temperature management in acute neurologic disorders.  Crit Care Clin. 2006;  22 767-785
    CrossrefPubMedGoogle Scholar
  • 95 Diringer M N, Reaven N L, Funk S E, Uman G C. Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients [see comment].  Crit Care Med. 2004;  32 1489-1495
    CrossrefPubMedGoogle Scholar
  • 96 Jalan R, Olde Damink S W, Deutz N E, Hayes P C, Lee A. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension.  Gastroenterology. 2004;  127 1338-1346
    CrossrefPubMedGoogle Scholar
  • 97 Munoz S J. Hypothermia may impair hepatic regeneration in acute liver failure [comment].  Gastroenterology. 2005;  128 1143-1144 , author reply 1144-1145
    CrossrefPubMedGoogle Scholar
  • 98 Vaquero J, Fontana R J, Larson A M et al.. Complications and use of intracranial pressure monitoring in patients with acute liver failure and severe encephalopathy.  Liver Transpl. 2005;  11 1581-1589
    CrossrefPubMedGoogle Scholar
  • 99 Nielsen H B, Tofteng F, Wang L P, Larsen F S. Cerebral oxygenation determined by near-infrared spectrophotometry in patients with fulminant hepatic failure.  J Hepatol. 2003;  38 188-192
    PubMedGoogle Scholar
  • 100 Abdo A, Lopez O, Fernandez A et al.. Transcranial Doppler sonography in fulminant hepatic failure.  Transplant Proc. 2003;  35 1859-1860
    CrossrefPubMedGoogle Scholar
  • 101 Ellis A J, Wendon J A, Williams R. Subclinical seizure activity and prophylactic phenytoin infusion in acute liver failure: a controlled clinical trial.  Hepatology. 2000;  32 536-541
    CrossrefPubMedGoogle Scholar
  • 102 Jalan R. Intracranial hypertension in acute liver failure: pathophysiologic basis of rational management.  Semin Liver Dis. 2003;  23 271-282
    Article in Thieme ConnectPubMedGoogle Scholar
  • 103 Shami V M, Caldwell S H, Hespenheide E E, Arseneau K O, Bickston S J, Macik B G. Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy.  Liver Transpl. 2003;  9 138-143
    CrossrefPubMedGoogle Scholar
  • 104 Donovan J P, Shaw Jr B W, Langnas A N, Sorrell M F. Brain water and acute liver failure: the emerging role of intracranial pressure monitoring.  Hepatology. 1992;  16 267-268
    PubMedGoogle Scholar
  • 105 McCashland T M, Shaw Jr B W, Tape E. The American experience with transplantation for acute liver failure.  Semin Liver Dis. 1996;  16 427-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 106 Davies M H, Mutimer D, Lowes J, Elias E, Neuberger J. Recovery despite impaired cerebral perfusion in fulminant hepatic failure.  Lancet. 1994;  343 1329-1330
    CrossrefPubMedGoogle Scholar
  • 107 Clemmesen J O, Hansen B A, Larsen F S. Indomethacin normalizes intracranial pressure in acute liver failure: a twenty-three-year-old woman treated with indomethacin.  Hepatology. 1997;  26 1423-1425
    PubMedGoogle Scholar
  • 108 Tofteng F, Larsen F S. The effect of indomethacin on intracranial pressure, cerebral perfusion and extracellular lactate and glutamate concentrations in patients with fulminant hepatic failure.  J Cereb Blood Flow Metab. 2004;  24 798-804
    PubMedGoogle Scholar
  • 109 Forbes A, Alexander G J, O'Grady J G et al.. Thiopental infusion in the treatment of intracranial hypertension complicating fulminant hepatic failure.  Hepatology. 1989;  10 306-310
    PubMedGoogle Scholar
  • 110 Ringe B, Lubbe N, Kuse E, Frei U, Pichlmayr R. Total hepatectomy and liver transplantation as two-stage procedure [see comments].  Ann Surg. 1993;  218 3-9
    CrossrefPubMedGoogle Scholar
  • 111 Keays R, Harrison P M, Wendon J A et al.. Intravenous acetylcysteine in paracetamol-induced fulminant hepatic failure: a prospective controlled trial.  BMJ. 1991;  303 1026-1029
    PubMedGoogle Scholar
  • 112 Tillmann H L, Hadem J, Leifeld L et al.. Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience.  J Viral Hepat. 2006;  13 256-263
    CrossrefPubMedGoogle Scholar
  • 113 Kessler W R, Cummings O W, Eckert G, Chalasani N, Lumeng L, Kwo P Y. Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis.  Clin Gastroenterol Hepatol. 2004;  2 625-631
    CrossrefPubMedGoogle Scholar
  • 114 Menon K VN, Shah V, Kamath P S. The Budd-Chiari syndrome [see comment].  N Engl J Med. 2004;  350 578-585
    CrossrefPubMedGoogle Scholar
  • 115 Enjalbert F, Rapior S, Nouguier-Soule J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis.  J Toxicol Clin Toxicol. 2002;  40 715-757
    CrossrefPubMedGoogle Scholar
  • 116 Mullen K D. Review of the final report of the 1998 Working Party on definition, nomenclature and diagnosis of hepatic encephalopathy.  Aliment Pharmacol Ther. 2007;  25(suppl 1) 11-16
    CrossrefPubMedGoogle Scholar

William BernalM.D. M.R.C.P. 

Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, Denmark Hill

London SE5 9RS, United Kingdom

Email: william.bernal@kcl.ac.uk

      >