TY - JOUR
T1 - Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU
T2 - Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations
AU - Nanchal, Rahul
AU - Subramanian, Ram
AU - Alhazzani, Waleed
AU - Dionne, Joanna C.
AU - Peppard, William J.
AU - Singbartl, Kai
AU - Truwit, Jonathon
AU - Al-Khafaji, Ali H.
AU - Killian, Alley J.
AU - Alquraini, Mustafa
AU - Alshammari, Khalil
AU - Alshamsi, Fayez
AU - Belley-Cote, Emilie
AU - Cartin-Ceba, Rodrigo
AU - Hollenberg, Steven M.
AU - Galusca, Dragos M.
AU - Huang, David T.
AU - Hyzy, Robert C.
AU - Junek, Mats
AU - Kandiah, Prem
AU - Kumar, Gagan
AU - Morgan, Rebecca L.
AU - Morris, Peter E.
AU - Olson, Jody C.
AU - Sieracki, Rita
AU - Steadman, Randolph
AU - Taylor, Beth
AU - Karvellas, Constantine J.
N1 - Copyright © 2023 by the Society of Critical Care Medicine.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - OBJECTIVES: To develop evidence-based recommendations for clinicians caring for adults with acute liver failure (ALF) or acute on chronic liver failure (ACLF) in the ICU. DESIGN: The guideline panel comprised 27 members with expertise in aspects of care of the critically ill patient with liver failure or methodology. We adhered to the Society of Critical Care Medicine standard operating procedures manual and conflict-of-interest policy. Teleconferences and electronic-based discussion among the panel, as well as within subgroups, served as an integral part of the guideline development. INTERVENTIONS: In part 2 of this guideline, the panel was divided into four subgroups: neurology, peri-transplant, infectious diseases, and gastrointestinal groups. We developed and selected Population, Intervention, Comparison, and Outcomes (PICO) questions according to importance to patients and practicing clinicians. For each PICO question, we conducted a systematic review and meta-analysis where applicable. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence to decision framework to facilitate recommendations formulation as strong or conditional. We followed strict criteria to formulate best practice statements. MEASUREMENTS AND MAIN RESULTS: We report 28 recommendations (from 31 PICO questions) on the management ALF and ACLF in the ICU. Overall, five were strong recommendations, 21 were conditional recommendations, two were best-practice statements, and we were unable to issue a recommendation for five questions due to insufficient evidence. CONCLUSIONS: Multidisciplinary, international experts formulated evidence-based recommendations for the management ALF and ACLF patients in the ICU, acknowledging that most recommendations were based on low quality and indirect evidence.
AB - OBJECTIVES: To develop evidence-based recommendations for clinicians caring for adults with acute liver failure (ALF) or acute on chronic liver failure (ACLF) in the ICU. DESIGN: The guideline panel comprised 27 members with expertise in aspects of care of the critically ill patient with liver failure or methodology. We adhered to the Society of Critical Care Medicine standard operating procedures manual and conflict-of-interest policy. Teleconferences and electronic-based discussion among the panel, as well as within subgroups, served as an integral part of the guideline development. INTERVENTIONS: In part 2 of this guideline, the panel was divided into four subgroups: neurology, peri-transplant, infectious diseases, and gastrointestinal groups. We developed and selected Population, Intervention, Comparison, and Outcomes (PICO) questions according to importance to patients and practicing clinicians. For each PICO question, we conducted a systematic review and meta-analysis where applicable. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence to decision framework to facilitate recommendations formulation as strong or conditional. We followed strict criteria to formulate best practice statements. MEASUREMENTS AND MAIN RESULTS: We report 28 recommendations (from 31 PICO questions) on the management ALF and ACLF in the ICU. Overall, five were strong recommendations, 21 were conditional recommendations, two were best-practice statements, and we were unable to issue a recommendation for five questions due to insufficient evidence. CONCLUSIONS: Multidisciplinary, international experts formulated evidence-based recommendations for the management ALF and ACLF patients in the ICU, acknowledging that most recommendations were based on low quality and indirect evidence.
KW - acute liver failure
KW - acute on chronic liver failure
KW - clinical practice guidelines
KW - Development, and Evaluation
KW - Grading of Recommendations Assessment
KW - Intensive Care Units
KW - Meta-Analysis as Topic
KW - Evidence-Based Practice
KW - Humans
KW - Acute-On-Chronic Liver Failure/therapy
KW - Systematic Reviews as Topic
KW - Adult
KW - Infectious Disease Medicine
UR - http://www.scopus.com/inward/record.url?scp=85152596459&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85152596459&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000005824
DO - 10.1097/CCM.0000000000005824
M3 - Article
C2 - 37052436
AN - SCOPUS:85152596459
SN - 0090-3493
VL - 51
SP - 657
EP - 676
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 5
ER -