Médecine

Paramédical

Autres domaines


S'abonner

Management of liver failure in general intensive care unit - 05/10/19

Doi : 10.1016/j.accpm.2019.06.014 
C. Paugam-Burtz 1, 2, E. Levesque 3, 4, A. Louvet 5, D. Thabut 6, R. Amathieu 7, 8, C. Bureau 9, 10, 11, C. Camus 12, G. Chanques 13, S. Faure 14, M. Ferrandière 15, C. Francoz 16, 17, A. Galbois 18, T. Gustot 19, 20, C. Ichai 21, P. Ichai 22, 23, 24, S. Jaber 25, T. Lescot 26, R. Moreau 27, 28, 29, 30, S. Roullet 31, 32, F. Saliba 33, T. Thévenot 34, L. Velly 35, 36, E. Weiss 37, 38,
1 Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP–HP Nord, Université de Paris, 92110 Clichy, France 
2 UMR_S1149, Centre de recherche sur l’inflammation, Inserm, Université de Paris, France 
3 Department of Anaesthesiology and Critical Care, Henri-Mondor Hospital, Assistance Publique–Hôpitaux de Paris, 94010 Créteil, France 
4 EA Dynamyc UPEC, ENVA Faculté de Médecine de Créteil, 94000 Créteil, France 
5 Department of Digestive Diseases, Claude Huriez Hospital, 59037 Lille, France 
6 Department of Hepathology, Pitié-Salpêtrière Hospital, Assistance publique–Hôpitaux de Paris, 75013 Paris, France 
7 Université Paris 13–UFR SMBH–CNRS UMR 7244, Paris, France 
8 Critical Care Department, Diaconesses Croix Saint Simon Hospital Group, 75020 Paris, France 
9 Department of Hepathology, Purpan Hospital, Toulouse University Hospital, 31300 ToulouseFrance 
10 Institut Cardiomet, Cardiovascular and Metabolic Department, Rangueil Hospital, TSA 50032, 31059 Toulouse cedex 9, France 
11 Paul Sabatier University, 31330 Toulouse, France 
12 Department of Infectious Diseases and Medical Resuscitation, Rennes University Hospital, 35000 Rennes, France 
13 Department of Anaesthesia and Intensive Care, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France 
14 Department of Hepathology, Saint Eloi Montpellier University Hospital, 34090 Montpellier, France 
15 Surgical Intensive Care Unit, Tours University Hospital, 37044 Tours cedex 9, France 
16 Department of Hepathology, Beaujon Hospital, AP–HP, 92110 Clichy, France 
17 UMR_S1149, Centre de recherche sur l’inflammation, INSERM and Paris Diderot University, 75013 Paris, France 
18 Ramsay Générale de Santé, Claude Galien Private Hospital, Department of Polyvalent Resuscitation, 91480 Quincy-sous-Sénart, France 
19 Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Route de Lennik, 808, 1070 Bruxelles, Belgium 
20 Laboratory of Experimental Gastroenterology, Faculté de Médecine, Université Libre de Bruxelles, avenue Franklin-Roosevelt, 50, 1050 Bruxelles, Belgium 
21 University of Côte D’Azur, Nice University Hospital, Department of Polyvalent Resuscitation, Pasteur 2 Hospital, 06000 Nice, France 
22 Hepato-Biliary Center, Paul-Brousse Hospital, AP–HP, Liver Intensive Care Unit, 94800 Villejuif, France 
23 INSERM, Unité 1193, Université Paris-Saclay, 94800 Villejuif, France 
24 DHU Hepatinov, 94800 Villejuif, France 
25 Department of Anaesthesia and Intensive Care, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France 
26 Sorbonne Université, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, ParisFrance 
27 Inserm, Université Paris Diderot, Centre de Recherche sur l’Inflammation (CRI), 75018 Paris, France 
28 Department of Hepatology, Beaujon Hospital, AP–HP, 92110 Clichy, France 
29 European Foundation for the study on chronic liver failure (EF Clif), Barcelona, Spain 
30 Institute for Liver and Biliary Sciences (ILBS), New Delhi, India 
31 Anaesthesiology and Critical Care Department 1, Bordeaux University Hospital, 33000 Bordeaux, France 
32 University of Bordeaux, INSERM U 1034, Biology of Cardiovascular Diseases, 33000 Bordeaux, France 
33 Hepato-Biliary Center, Paul Brousse Hospital, AP-HP, INSERM Unité 935 and Unité 1193, 94800 Villejuif, France 
34 Department of Hepatology and Digestive Critical Care, Department of Hepatology, Jean Minjoz University Hospital, 25030 BesançonFrance 
35 Aix Marseille University, CNRS, Institut de Neuroscience de la Timone (INT), 13005 Marseille, France 
36 Department of Anaesthesiology and Critical Care Medicine, University Hospital La Timone, 13005 Marseille, France 
37 Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP–HP Nord, University of Paris, France 
38 UMR_S1149, Centre de recherche sur l’inflammation, INSERM and University of Paris, Paris, France 

Corresponding author at: Service d’anesthésie-réanimation, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.Service d’anesthésie-réanimation, hôpital Beaujon100, boulevard du Général-LeclercClichy92110France
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 05 octobre 2019

Abstract

Objective

To produce French guidelines on Management of Liver failure in general Intensive Care Unit (ICU).

Design

A consensus committee of 23 experts from the French Society of Anesthesiology and Critical Care Medicine (Société française d’anesthésie et de réanimation, SFAR) and the French Association for the Study of the Liver (Association française pour l’étude du foie, AFEF) was convened. A formal conflict-of-interest (COI) policy was developed at the start of the process and enforced throughout. The entire guideline process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Some recommendations were ungraded.

Methods

Two fields were defined: acute liver failure (ALF) and cirrhotic patients in general ICU. The panel focused on three questions with respect to ALF: (1) Which etiological examinations should be performed to reduce morbidity and mortality? (2) Which specific treatments should be initiated rapidly to reduce morbidity and mortality? (3) Which symptomatic treatment should be initiated rapidly to reduce morbidity and mortality? Seven questions concerning cirrhotic patients were addressed: (1) Which criteria should be used to guide ICU admission of cirrhotic patients in order to improve their prognosis? (2) Which specific management of kidney injury should be implemented to reduce morbidity and mortality in cirrhotic ICU patients? (3) Which specific measures to manage sepsis in order to reduce morbidity and mortality in cirrhotic ICU patients? (4) In which circumstances, human serum albumin should be administered to reduce morbidity and mortality in cirrhotic ICU patients? (5) How should digestive haemorrhage be treated in order to reduce morbidity and mortality in cirrhotic ICU patients? (6) How should haemostasis be managed in order to reduce morbidity and mortality in cirrhotic ICU patients? And (7) When should advice be obtained from an expert centre in order to reduce morbidity and mortality in cirrhotic ICU patients? Population, intervention, comparison and outcome (PICO) issues were reviewed and updated as required, and evidence profiles were generated. An analysis of the literature and recommendations was then performed in accordance with the GRADE® methodology.

Results

The SFAR/AFEF Guidelines panel produced 18 statements on liver failure in general ICU. After two rounds of debate and various amendments, a strong agreement was reached on 100% of the recommendations: six had a high level of evidence (Grade 1 ±), seven had a low level of evidence (Grade 2 ±) and six were expert judgments. Finally, no recommendation was provided with respect to one question.

Conclusions

Substantial agreement exists among experts regarding numerous strong recommendations on the optimum care of patients with liver failure in general ICU.

Le texte complet de cet article est disponible en PDF.

Keywords : Acute liver failure, Acute-on-chronic liver failure, Guidelines, Cirrhosis, Intensive care unit


Plan


 Validated by the SFAR Council on June 21st, 2018.
☆☆ With the collaboration of the following societies: Société française d’anesthésie et de réanimation, Association française pour l’étude du foie.


© 2019  The Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement ou un achat à l’unité.

Déjà abonné à cette revue ?

;

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.