Management of Decompensated Cirrhosis in the Surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Anupamaa Seshadri; Rachel Appelbaum; Samuel P Carmichael 2nd; Joseph Cuschieri; Jason Hoth; Krista L Kaups; Lisa Kodadek; Matthew E Kutcher; Abhijit Pathak; Joseph Rappold; Sean R Rudnick; Christopher P Michetti

doi:10.1136/tsaco-2022-000936

Management of Decompensated Cirrhosis in the Surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Trauma Surg Acute Care Open. 2022 Aug 1;7(1):e000936. doi: 10.1136/tsaco-2022-000936. eCollection 2022.

Authors

Affiliations

¹ Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
² Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
³ Department of Surgery, San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
⁴ Department of Surgery, UCSF Fresno, Fresno, California, USA.
⁵ Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
⁶ Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut, USA.
⁷ Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁸ Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
⁹ Department of Surgery, Maine Medical Center, Portland, Oregon, USA.
¹⁰ Department of Gastroenterology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
¹¹ Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA.

Abstract

Management of decompensated cirrhosis (DC) can be challenging for the surgical intensivist. Management of DC is often complicated by ascites, coagulopathy, hepatic encephalopathy, gastrointestinal bleeding, hepatorenal syndrome, and difficulty assessing volume status. This Clinical Consensus Document created by the American Association for the Surgery of Trauma Critical Care Committee reviews practical clinical questions about the critical care management of patients with DC to facilitate best practices by the bedside provider.

Keywords: cirrhosis; critical care; liver; practice guideline.