Coda Change Acute Liver Failure
Feb 28, 2024
Caleb Fisher, a dual-trained intensivist renowned for his work on acute liver failure, shares his insights from the CODA22 conference. He discusses the essential role of N-acetylcysteine and antibiotics in managing liver failure. Fisher emphasizes the dangers of ammonia buildup and introduces the Quad-H protocol to mitigate cerebral edema. He examines the lack of proven survival benefits of MARS/Prometheus therapies and critiques existing prognostic models, proposing a new dynamic prediction model for better outcomes.
AI Snips
Chapters
Transcript
Episode notes
Use NAC And Early Antimicrobials
- Give N-acetylcysteine intravenously to all acute liver failure patients, not just paracetamol cases.
- Start broad-spectrum antibiotics and antifungal coverage early because these patients mimic severe sepsis and later become immunoparalyzed.
Rebalanced Hemostasis Beats INR-Fixation
- Acute liver failure shows 'rebalanced hemostasis' where bleeding and clotting risks coexist and can flip quickly.
- Treat the patient, not the INR; use viscoelastic tests and reserve FFP for actual bleeding or procedures.
Lower Ammonia Early To Prevent Brain Swelling
- Aggressively lower ammonia to prevent cerebral edema using osmotherapy and targeted continuous renal replacement therapy.
- Aim serum sodium ~148–152 mmol/L, control PaCO2, avoid hypothermia, and start haemodiafiltration early to reduce ammonia within 48–72 hours.