Critical care of the end-stage liver disease patient awaiting liver transplantation.

Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Liver Transplantation (Impact Factor: 3.79). 05/2011; 17(5):496-510. DOI: 10.1002/lt.22269
Source: PubMed

ABSTRACT Patients with end-stage liver disease awaiting liver transplantation frequently require intensive care admission and management due to either complications of liver failure or to intercurrent illness, particularly infection. Mortality in such patients is high and the development of an illness necessitating intensive care unit management can influence transplant candidacy. Specialized support frequently requires hemodynamic support, mechanical ventilation, and renal support. In this review, areas of management of particular importance to patients with end-stage liver disease in the intensive care unit are discussed. These areas are hepatic encephalopathy, infectious diseases, cardiovascular support, mechanical ventilation, renal support and combined transplantation, and decisions regarding delisting. Current knowledge specific to these patients, when available, is discussed, current practice is described, and areas of uncertainty in the evidence are discussed.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: To prospectively compare norfloxacin (N) with trimethoprim-sulfamethoxazole (T-S) in preventing infection in cirrhotics. Cirrhotic patients at high risk of spontaneous bacterial peritonitis (SBP) were included and assigned N (400 mg daily) or T-S (160/800 mg daily). Patients were followed for 12 months. Primary endpoint was incidence of infection. Secondary endpoints included incidence of SBP, bacteraemia, extraperitoneal infection requiring antibiotic treatment, liver transplantation, death, side effects and rate of resistance to N or T-S. A total of 80 patients with mean age of 53.0 ± 9.3 years were prescribed N (n = 40) or T-S (n = 40). Child-Pugh, model for end-stage liver disease (MELD) and risk factors for SBP were similar between the groups. There were 10 infections occurred in N group and 9 in T-S group (P = 0.79). Two patients (5%) in N group and two (5%) in T-S group developed SBP (P = 0.6). There was a difference in the rate of transplantation favouring N (P = 0.03) but not death. The number of adverse events for (n = 7) and T-S (n = 10) were similar (P = 0.59), with T-S associated with an increased risk of developing a definite or probable adverse event compared to N (7 vs 0, P = 0.01). This study failed to demonstrate a difference between N and T-S in preventing infection in patients with advanced liver disease. T-S can be considered as an alternative first line therapy for infection prophylaxis particularly given its cheaper cost.
    Journal of Digestive Diseases 02/2014; DOI:10.1111/1751-2980.12132 · 1.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Increased number of patients with malignant disease as the cause of death requires a specific concept in the treatment and care those patients. The concept was launched in the UK today is important for patients in the terminal stage by a comprehensive approach to palliative care. Care for these patients is specific with regard of therapy, care and psychological support to patients and their family. Palliative care, effective and quality is reflected in the best possible provided techniques to improve the quality of life in patients in the terminal stage. Marked weakness, difficult movement or immobility, pains, nausea and vomiting, constipation, and decreased food intake of fluids, are just some problems which struggle patients, so that palliative care can be influenced to a greater conforms more dignified person. Patients in the terminal stage with the liver insufficiency and associated complications are the most complex with regard of palliative care. In this paper will demonstrate the principles of palliative care patients suffering from malignant disease in Gastroenterohepatology.
  • Source
    01/2013; 29(1):828-836. DOI:10.5937/matmed1301828V

Full-text (2 Sources)

Available from
Mar 16, 2015

Similar Publications