Evaluation and treatment of the critically ill cirrhotic patient
Por:
Fernandez, J, Aracil, C, Sola, E, Soriano, G, Cardona, MC, Coll, S, Genesca, J, Hombrados, M, Morillas, R, Martin-Llahi, M, Pardo, A, Sanchez, J, Vargas, V, Xiol, X, Gines, P
Publicada:
1 nov 2016
Resumen:
Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions. (C) 2015 Elsevier Espana, S.L.U., AEEH y AEG. All rights reserved.
Filiaciones:
Fernandez, J:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Hosp Clin, Liver Unit,CIBERehd, Barcelona, Spain
Aracil, C:
Hosp Univ Arnau Villanova, Serv Digestiu, Lleida, Spain
Sola, E:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Hosp Clin, Liver Unit,CIBERehd, Barcelona, Spain
Soriano, G:
Hosp Santa Creu & Sant Pau, CIBERehd, Inst Salud Carlos III, Serv Patol Digest, Barcelona, Spain
Cardona, MC:
Hosp Tortosa Verge Cinta, Serv Digest, Tarragona, Spain
Coll, S:
Hosp Mar, Serv Digest, Barcelona, Spain
Genesca, J:
Univ Autonoma Barcelona CIBERehd, Serv Med Internahepatol, Inst Recerca Vall dHebron VHIR, Hosp Univ Vall dHebron, Barcelona, Spain
Hombrados, M:
Univ Girona, Fac Med, Hosp Dr Josep Trueta, Serv Aparato Digest, Girona, Spain
Morillas, R:
Hosp Badalona Germans Trias & Pujol, Serv Hepatol, Barcelona, Spain
Martin-Llahi, M:
Hosp St Joan Despi Moises Broggi, Serv Digestiu, Barcelona, Spain
Pardo, A:
Hosp Univ Tarragona Joan XXIII, Serv Aparato Digest, Barcelona, Spain
Sanchez, J:
Inst Salud Carlos Ill, CIBERehd, Corporacio Sanitaria Parc Tauli, Sabadell, Barcelona, Spain
Vargas, V:
Univ Autonoma Barcelona CIBERehd, Serv Med Internahepatol, Inst Recerca Vall dHebron VHIR, Hosp Univ Vall dHebron, Barcelona, Spain
Xiol, X:
Hosp Llobregat, Serv Aparato Digest, Hosp Univ Bellvitge, Barcelona, Spain
Gines, P:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Hosp Clin, Liver Unit,CIBERehd, Barcelona, Spain
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