Practical management of acute liver failure in the intensive care unit

Purpose of review Acute liver failure is an uncommon condition affecting about 2500 patients each year in the United States. Optimal medical management in the ICU is one of the more important factors impacting survival with or without liver transplantation. This review focuses on the practical aspects of the management of patients with acute liver failure in the ICU. Recent findings The important topics of fluid disturbances, role of the liver biopsy, administration of N-acetylcysteine, role of hypothermic therapy and management of intracranial hypertension, coagulopathy and infection are discussed. Finally, the evaluation, management and recent outcomes of liver transplantation candidates are described. Summary The careful management of the patient in the ICU with acute liver failure improves the likelihood of survival.