Management of Acute-on-Chronic Liver Failure in the ICU

In this episode of Critical Matters, Dr. Sergio Zanotti interviews Dr. Rahul Nanchal about the recently released guidelines for managing adult acute and acute-on-chronic liver failure in the ICU. Dr. Nanchal, lead author of the guidelines, defines acute liver failure, chronic liver failure, and acute-on-chronic liver failure, highlighting the importance of early recognition and appropriate ICU support. The discussion covers antibiotic prophylaxis for GI bleeds, management of spontaneous bacterial peritonitis (SBP), including the timing and choice of antibiotics, the use of albumin, and the role of large-volume paracentesis. They also discuss the timing of endoscopy for portal hypertensive bleeding, the use of PPIs and other medications, and neurological considerations, particularly hepatic encephalopathy, differentiating between acute liver failure and acute-on-chronic liver failure. The episode concludes with book recommendations and a quote on the physician's prayer.