By Marco Dei Poli, Marco Resta (auth.), Biagio Allaria (eds.)
The contents of this publication are a range taken from fabrics which have been constructed in the course of the training of constant schooling classes (distance learning), whose clinical consultant is the quantity editor, Professor Allaria, and that experience by no means formerly been released. the subjects thought of are vast ranging; specific cognizance is dedicated to common subject matters of value to the practitioner, yet particular debatable concerns, reminiscent of the function of goal-directed hemodynamic remedy, also are addressed. all the authors are famous specialists at the topics they speak about. The booklet is a part of a much wider venture that goals to supply up-to-date details every year not just in anesthesiology but additionally in different fields, together with cardiology, ophthalmology, and nephrology.
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3 Causes of acute liver failure Conditions associated to ALF % Paracetamol 39 Undetermined causes 17 Idiosyncratic reactions 13 Ischaemic hepatitis 6 Hepatitis B 7 Hepatitis A 4 Autoimmune hepatitis 4 Wilson’s disease 3 Mushroom poisoning (Amanita Phalloides) 2 Budd-Chiari syndrome 2 HELPP syndrome 1 Pregnancy acute fatty liver 1 Metastatic disease 1 Other (incl. haemophagocytic syndrome) 2 4 Acute Liver Failure in Intensive Care 39 are classified as autoimmune by exclusion of evident causes, when seronegativity is present and when there is no documented toxicology.
12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. B. Allaria pulmonary artery catheter during repeat surgery for total hip replacement. Eur J Anestesial 24:1028-1033 Kern JW et al (2002) Meta analysis of hemodynamic optimization in high-risk patients. Crit Care Med 30:1686-1692 Lee GDJ (1994) The pulmonary circulation. In: Wagner WW, Weir EK, The pulmonary circulation and gas exchange, Futura, New York Lobo SM et al (2000) Effects of maximizing oxygen delivery on morbidity and mortality in high risk surgical patients.
Factor V levels of < 20% for patients aged < 30 or < 30% for people aged > 30 [3-10, 22-25] represent the criteria for indicating that a liver transplant is urgent in the presence of ALF. Intensive care management is optimal when linked to a Liver Transplant Centre and when it aims to support and to optimize vital functions [1, 4-7, 10] both in view of a liver transplant, if and when indicated, and with a view to combat or contain the onset of multiple organ failure (MOF) [1, 5, 6, 10]. In this context it is important to remember the role of N-acetyilcysteine (NAC) at high dose for the treatment of both paracetamol-induced ALF [1, 3-6, 10] and non-paracetamol-induced ALF [1, 26, 27]; early NAC treatment appears to be critical [1, 26, 27].