Coda Change Advanced support of Acute Liver Injury
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Aug 24, 2021 In this discussion, Alex Rowell, an intensive care specialist with a rich background at prominent hospitals, delves into the complexities of acute liver failure management. He highlights advanced liver support systems like CVVHDF, MARS, and SPAD, discussing their unique roles and limitations. Alex emphasizes the importance of early intervention with CVVHDF for ammonia clearance and shares insights on high-volume plasma exchange's benefits. Despite the lack of proven mortality advantages, these modalities serve as essential bridges to transplantation.
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Clinical Background Shapes Recommendations
- Alex Rowell practices in Perth at Princess Margaret Hospital and previously worked at King's College Hospital in London's liver ICU.
- His experience includes managing post-transplant and acute liver failure patients, informing his talk.
Start CRRT Early And At High Dose
- Start continuous renal replacement therapy early in acute liver failure to clear ammonia and correct metabolic derangements.
- Use high CRRT dose initially (eg. up to 60–90 mL/kg/h short-term) and taper as the patient improves.
Three Categories Of Liver Support
- Liver supports split into artificial (detox), bioartificial (synthetic/regulatory), and hybrid systems.
- Most clinical devices focus on detoxification, not replacing full liver synthetic function.