Kaya Eda, Nekarda Patrick, Traut Isabella, Aurich Philipp, Canbay Ali, Katsounas Antonios
Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland.
Med Klin Intensivmed Notfmed. 2024 Sep;119(6):470-477. doi: 10.1007/s00063-024-01160-w. Epub 2024 Jul 17.
Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.
肝脏疾病是全球发病和死亡的重要原因。肝硬化可导致严重并发症,如出血、肝性脑病(HE)和感染。实施明确的重症监护病房(ICU)入院管理策略可改善患者预后。血流动力学上显著的食管/胃静脉曲张出血(E/GVB)和4级HE,若伴有肾脏替代治疗(RRT)需求,是ICU入院的明确指征。E/GVB、自发性细菌性腹膜炎(SBP)和多重耐药菌(MDRO)感染需要密切且严格的评估。严重肝肾综合征(HRS)或呼吸衰竭患者的基线死亡率增加,早期ICU治疗最有可能使其获益。快速识别肝硬化患者的脓毒症是ICU入院的关键标准。根据死亡风险和临床紧迫性对病例进行优先级排序,可实现资源的有效利用并优化患者管理。此外,“肝病单元”为需要密切监测但无需立即重症监护的肝病患者提供中级护理(IMC)水平。