Liver Intensive Care Unit

Acute liver failure is a life-threatening condition in children, often leading to multi-organ failure and mortality in the absence of liver transplantation. Similarly, children with chronic liver disease may develop acute decompensation (acute on chronic liver disease), stemming from secondary insults such as infections or drug toxicity, with catastrophic consequences. Keeping these children alive to liver transplantation and ensuring optimal post-operative outcomes remains an ongoing challenge.

The Liver Intensive Care Team, at Texas Children’s Hospital and Baylor College of Medicine was designed in February of 2014 to provide consistent, multidisciplinary, state-of-the-art peri-operative management, optimize collaboration between teams, enhance educational and research opportunities, to ultimately improve health care delivery in critically ill children with End Stage Liver Disease.

Intensive Care Support for the critically ill child with liver failure

We have implemented protocols for early continuous renal replacement therapy (CRRT) for fluid overload and hyperammonemia, extracorporeal liver support (ELS) in the form of Molecular Adsorbent Recirculating System (MARS) for hepatic encephalopathy and hemodynamic disturbance, Therapeutic Plasma Exchange (TPE) for coagulopathy, immunotherapy for ABO incompatible transplants and goal (ROTEM-rotational thromboelastometry) directed therapy for hemostasis.