New guidelines for hepatic failure in the intensive care unit

February 14, 2020

February 14, 2020 - For critical care specialists, hepatic failure poses complex challenges unlike those of other critical illnesses. A new set of evidence-based recommendations for management of liver failure is presented in the March issue of Critical Care Medicine, the official journal of the Society of Critical Care Medicine (SCCM). The journal is published in the Lippincott portfolio by Wolters Kluwer. The guidelines are being presented at the SCCM 49th Critical Care Congress.

The new guidelines assemble recommendations for critical care specialists managing the wide range of conditions and complications posed by liver failure - a serious organ derangement that carries a high risk of death, and for which liver transplantation may be the only definitive treatment. Rahul Nanchal, MD, MS, FCCM, of Medical College of Wisconsin, Milwaukee, and Ram Subramanian, MD, FCCM, of Emory University Hospital were Co-Chairs of the Guidelines Committee.

Recommendations on Liver Failure in Five Key Areas

As for all SCCM guidelines, the multidisciplinary, international expert Committee followed a rigorous approach to reviewing the best available evidence and developing consensus guidelines to answer a defined set of clinical questions. Two forms of hepatic failure are addressed. Acute liver failure (ALF) is a life-threatening condition associated with rapid loss of liver function - over a period of days or weeks - in a previously healthy person. Acute- on -chronic liver failure (ACLF) develops in a patient with pre-existing chronic liver disease.

Critically ill patients with liver disease are at risk of unique manifestations affecting various organ systems. "Strategies used to manage organ complications in general critical illness are not always applicable to the care of the patient with liver failure," according to the guideline statement. Through a formal review and guideline development process, the Committee approved 29 evidence-based recommendations in five areas: Although the guidelines reflect the latest research on each topic, most of the recommendations are based on "low-quality indirect evidence" - for a few clinical questions, no evidence-based recommendation could be made. The Committee highlights areas in need of further research to better inform clinical practice. While acknowledging the limitations of the recommendations regarding the complex challenges in critically ill patients with ALF/ACLF, the Guideline authors conclude: "Our approach led to the generation of a contemporary document that can be used as a reference for clinicians."
Click here to read "Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Cardiovascular, Endocrine, Hematologic,Pulmonary, and Renal Considerations."

DOI: 10.1097/CCM.0000000000004193

Note to editors: For further information, contact Lauren Martin with Public Communications Inc. at +312 558-1770 or

About the Society of Critical Care Medicine

The Society of Critical Care Medicine (SCCM) is the largest nonprofit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The SCCM Critical Care Congress brings together intensivists and critical care experts from around the world to share the latest scientific research, develop solutions to common issues and improve the care of critically ill and injured patients. Visit for more information. Follow @SCCM or visit us on Facebook.

About Critical Care Medicine

Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the intensive care unit and critical care unit, including chest physicians, surgeons, pediatricians, pharmacists, pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques. Follow @CritCareMed.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2018 annual revenues of €4.3 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

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