Liver: Hepatic Support and the Bioartificial Liver

Severe liver failure continues to be one of the most challenging admitting diagnoses to an intensive care unit (ICU). Most patients present with an acute complication of a preexisting chronic liver disease such as gastrointestinal (GI) bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, or renal failure. In a smaller group, liver failure develops acutely without preexisting Hver disease. These patients usually present with massive liver necrosis, profound coagulopathy, and encephalopathy often leading to deep coma and death. It is these patients who represent one of die most difficult therapeutic challenges in the ICU, This chapter outlines diagnostic and management issues in patients with acute liver failure.