Intensive care management of children with liver disease

Children with liver disease almost invariably require an admission to pediatric intensive care unit (PICU) during their life. The most common causes are (1) an acute decompensation in a patient with a known chronic liver disease; (2) an episode of acute liver failure presenting with severe coagulopathy and encephalopathy; (3) complications of cirrhosis and portal hypertension, such as variceal bleeding; and (4) an admission following surgical operations such as hepatic resection or liver transplantation. Pediatric intensive care skills are of paramount importance in a pediatric liver transplantation center, since children with liver disease are fragile during anesthesia and the pathophysiology of their condition is often peculiar. Acute liver failure (ALF) is still a field of uncertainty as far as etiology, predictors of survival, and prevention and management of its complications. ALF should always be managed in PICUs of transplantation centers and remains a great challenge in terms of vital support, decision to list for transplantation, use of mechanical ventilation, and extracorporeal treatments. A tight liaison between the pediatric hepatologist and the pediatric intensivist offers the highest standards of care to children with liver disease and need for intensive care management.