JLE

Hépato-Gastro & Oncologie Digestive

MENU

Management of critically-ill cirrhotic patients: transfer in intensive care unit or stop of care? Volume 20, issue 2, Février 2013

Figures

See all figures

Authors
CHRU Lille, hôpital Claude Huriez, maladies de l’appareil digestif et de la nutrition, 59037 Lille Cedex, France, CHRU Lille, hôpital Claude Huriez, pôle médico-chirurgical Huriez, service de réanimation chirurgicale, Lille, France, CHRU Lille, hôpital Claude Huriez, pôle médico-chirurgical Huriez, service d’anesthésie et transplantation hépatique, Lille, France

Cirrhosis is an independent prognostic factor for mortality in Intensive Care Unit (ICU). The improved management of acute complications of cirrhosis and a “fast tracking” access to liver transplantation are the keystones of reflection in the setting of invasive acute care. ICU admission is a multiparametric decision taking into account patient related factors, type of complications, intensive care scores and the existence of a therapeutical project. The decision between active resuscitation or withholding and withdrawal of life-sustaining treatment in critically-ill cirrhotic patient is difficult to make. In fact, the occurrence of a complication in these patients is often a turning point in the natural history and often leads to multi-organ failure. These procedures of withholding and withdrawal of life-sustaining treatment regulated by law have been developed to address these difficult ethical questions. The hepato-gastroenterologist plays a central role in this multidisciplinary reflection.