Guidelines for the management of adult acute and acute-on-chronic liver failure in the ICU: Cardiovascular, endocrine, hematologic, pulmonary, and renal considerations

Ahul RNanchal, Ram Subramanian, Constantine J. Karvellas, Steven M. Hollenberg, William J. Peppard, Kai Singbartl, Jonathon Truwit, Ali H. Al-Khafaji, Alley J. Killian, Mustafa Alquraini, Khalil Alshammari, Fayez Alshamsi, Emilie Belley-Cote, Rodrigo Cartin-Ceba, Joanna C. Dionne, Dragos M. Galusca, David T. Huang, Robert C. Hyzy, Mats Junek, Prem KandiahGagan Kumar, Rebecca L. Morgan, Peter E. Morris, Jody C. Olson, Rita Sieracki, Randolph Steadman, Beth Taylor, Waleed Alhazzani

Research output: Contribution to journalReview article

9 Scopus citations

Abstract

Objectives: To develop evidence-based recommendations for clinicians caring for adults with acute or acute on chronic liver failure in the ICU. Design: The guideline panel comprised 29 members with expertise in aspects of care of the critically ill patient with liver failure and/ or methodology. The Society of Critical Care Medicine standard operating procedures manual and conflict-of-interest policy were followed throughout. Teleconferences and electronic-based discussion among the panel, as well as within subgroups, served as an integral part of the guideline development. Setting: The panel was divided into nine subgroups: cardiovascular, hematology, pulmonary, renal, endocrine and nutrition, gastrointestinal, infection, perioperative, and neurology. Interventions: We developed and selected population, intervention, comparison, and outcomes questions according to importance to patients and practicing clinicians. For each population, intervention, comparison, and outcomes question, we conducted a systematic review aiming to identify the best available evidence, statistically summarized the evidence whenever applicable, and assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence to decision framework to facilitate recommendations formulation as strong or conditional. We followed strict criteria to formulate best practice statements. Measurements and Main Results: In this article, we report 29 recommendations (from 30 population, intervention, comparison, and outcomes questions) on the management acute or acute on chronic liver failure in the ICU, related to five groups (cardiovascular, hematology, pulmonary, renal, and endocrine). Overall, six were strong recommendations, 19 were conditional recommendations, four were best-practice statements, and in two instances, the panel did not issue a recommendation due to insufficient evidence. Conclusions: Multidisciplinary international experts were able to formulate evidence-based recommendations for the management acute or acute on chronic liver failure in the ICU, acknowledging that most recommendations were based on low-quality indirect evidence.

Original languageEnglish (US)
Pages (from-to)E173-E191
JournalCritical Care Medicine
Volume48
Issue number3
DOIs
StatePublished - 2020

Keywords

  • Acute liver failure
  • Acute on chronic liver failure
  • And Evaluation criteria
  • Clinical practice guidelines
  • Development
  • Evidence-based medicine
  • Grading of Recommendations Assessment

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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