Caring for Critically Ill Patients with Acute or Acute-on-Chronic Liver Failure

5 Jun 2023 • A recent Society for Critical Care Medicine Guideline focuses on recommendations for critically ill patients with gastrointestinal bleeding or spontaneous bacterial peritonitis. In 2020, the SCCM published recommendations focused on cardiovascular, hematologic, endocrine, renal, and pulmonary care of critically ill patients with acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). Now, the society has published a second installment, which is focused on gastrointestinal bleeding and spontaneous bacterial peritonitis (SBP) in these patients.


  • Critically ill patients with ACLF and any form of upper gastrointestinal bleeding should be treated with prophylactic antibiotics, usually third-generation cephalosporins.
  • Critically ill patients with ACLF and portal hypertensive bleeding should be treated with octreotide or a somatostatin analog (moderate-quality evidence) and a proton-pump inhibitor (low-quality evidence).
  • Critically ill patients with ACLF and SBP should receive broad-spectrum empirical antibiotics, including consideration of coverage for resistant organisms.
  • Patients with ACLF and SBP also should receive albumin, even if they are not clearly volume depleted, as moderate-quality evidence shows that albumin lowers risks for acute kidney injury and death.

Source: NEJM | Read full story

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