Intensive care management of children with liver failure

Abstract

Liver disease may present as a severe life-threatening illness that requires care in the pediatric intensive care unit (PICU). Patients may present with acute liver failure (ALF) or due to complications of chronic liver disease. Because the liver plays a central role in metabolism, protein synthesis, and detoxification of many inherently toxic substances, severe liver disease can affect any organ, and patients may suffer impairment of multiple organs. Hepatic encephalopathy is the leading cause of death in patients awaiting liver transplantation. The goal of intensive liver care is to stabilize the child in order that transplantation may occur. Preoperative complications can complicate the postoperative course of children who are successfully transplanted. However, following the procedure, new issues arise because patients receive immunosuppressive agents or may have new organ involvement after the procedure. Additionally, the transplantation may be followed by vascular complications, biliary tree injury, or failure of the graft from primary nonfunction, rejection, or hemodynamic compromise. This chapter reviews the pre- and posttransplantation management of children with end-stage liver disease.