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Semin Respir Crit Care Med 2018; 39(05): 538-545
DOI: 10.1055/s-0038-1672139
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Shock Etiologies and Fluid Management in Liver Failure

Emmanuel Weiss
1   Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Paris, France
,
Catherine Paugam-Burtz
1   Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Paris, France
,
Samir Jaber
2   Saint Eloi ICU, Montpellier University Hospital, Montpellier, France
› Author Affiliations
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Publication History

Publication Date:
28 November 2018 (online)

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Abstract

Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common. Septic shock is also particularly frequent in patients with ALF and can complicate the initial hypovolemic shock related to poor oral intake, vomiting, and encephalopathy prior to admission. Given the susceptibility of the liver to hypoxia and also the potential deleterious effects of fluid on liver function, the assessment of hemodynamic status and volume responsiveness is especially important in these patients. However, one should keep in mind that the hyperdynamic state and low systemic vascular resistance in liver failure may bias the accuracy of some hemodynamic monitoring devices. Fluid therapy should use crystalloids, and balanced salt solutions may limit the risk of hyperchloremic acidosis and subsequent adverse kidney events. Nevertheless, the beneficial effects of albumin resuscitation have been demonstrated in patients with cirrhosis and may reflect more than mere volume expansion.

Keywords

acute on chronic liver failure - acute liver failure - circulatory dysfunction - hemodynamic management - fluid therapy
 

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