Hepatic encephalopathy is a common cause of ICU admission, as well as a common complication of ICU admission for other indications (e.g. gastrointestinal hemorrhage). At first the intubated patient with hepatic encephalopathy may seem a bit bewildering (will they ever wake up??). However, an organized and aggressive strategy combined with some patience is generally sufficient to obtain an improved mental status and liberation from the ventilator.
-
The IBCC chapter is located here.
- The podcast & comments are below.
Follow us on iTunes
The Podcast Episode
Want to Download the Episode?
Right Click Here and Choose Save-As
- Pulmcrit wee: The cutoff razor - April 15, 2024
- PulmCrit Blogitorial – Use of ECGs for management of (sub)massive PE - March 24, 2024
- PulmCrit Wee: Propofol induced eyelid opening apraxia – the struggle is real - March 20, 2024
Hi doctor, long time reader first time commenter. What do you think about expanding this chapter in the future to include some topics about acute-on-chronic liver failure, and the importance to identify it as an entity with almost one exit and a very ominous prognosis for the early severe cases. I collected some vignetes on my own for a residency class. Feel free to check them out.: https://www.dropbox.com/s/53skdlfoyk2a4ir/ACLF.pptx?dl=0 Also, would you be ok with traslating the IBCC to spanish, with all the credits and for free. I just think your work is worth sharing and we could try to expand… Read more »
For sedation I think remifentanil is the best. Short acting and no liver dependent pharmocokinetics
On your yellow diagram showing the “vicious cycle of opioids or long-acting sedatives in severe hepatic encephalopathy,” you mentioned acetaminophen along with propofol and dex. I’m guessing the acetaminophen wasn’t meant to be included?
Awesome post as usual; any comments/thoughts on renal replacement therapy for refractory elevated ICP in the setting of HE and treatment in general for patients with increased ICP from acute/severe HE?