Liver Critical Care & ICU

Liver failure affects the whole body. Blood pressure may drop, kidneys may fail, the brain may swell, infections spread quickly and clotting is disturbed. General ICU protocols do not always fit these patients. The Liver Critical Care & ICU is built around this understanding, combining intensive care expertise with deep knowledge of liver physiology.

Who Is Admitted

• Acute liver failure caused by viruses, drugs, toxins or metabolic disease
• Acute-on-chronic liver failure with organ dysfunction
• Cirrhosis with variceal bleeding, sepsis, kidney failure or severe encephalopathy
• Severe alcoholic hepatitis
• Post-liver-transplant patients in the immediate recovery period
• Patients with complications after liver surgery or procedures
• Pregnancy-related liver failure, such as acute fatty liver

Specialised Team

The unit is run by intensivists and hepatologists who review patients together each day. They are supported by:

• Transplant surgeons and anaesthesiologists
• Nephrologists for dialysis and kidney management
• Infectious disease specialists
• Endoscopists and interventional radiologists
• ICU nurses trained in liver-specific monitoring
• Clinical dietitians, physiotherapists and pharmacists
• Counsellors who support families during difficult periods

Monitoring and Technology

• Continuous bedside monitoring: Heart rate, blood pressure, oxygen saturation, temperature and urine output
• Advanced haemodynamic monitoring: For guiding fluids and vasopressors in patients with unstable circulation
• Neurological assessment: Regular checks for encephalopathy and signs of raised brain pressure
• Point-of-care testing: Rapid measurement of blood gases, lactate, glucose and electrolytes
• Bedside imaging: Ultrasound and Doppler for liver vessels, heart and lungs
• Laboratory support: Frequent liver, kidney, coagulation and infection markers with round-the-clock lab access

Organ Support

• Respiratory support: Oxygen therapy, high-flow oxygen, non-invasive ventilation and mechanical ventilation
• Circulatory support: Vasopressors and carefully guided fluid and albumin therapy
• Renal support: Continuous renal replacement therapy for kidney failure
• Brain protection: Head elevation, sodium control, osmotic therapy and seizure prevention in acute liver failure
• Liver-support therapies: Plasma exchange and other extracorporeal treatments in selected patients
• Nutrition support: Early feeding, usually through the gut, to preserve muscle and immunity

Liver-Specific Principles of Care

• Identify and treat the trigger: Infection, bleeding, alcohol, drugs and viral flares are common causes of deterioration.
• Interpret clotting tests carefully: Abnormal numbers do not always mean high bleeding risk in liver disease, so blood products are given only when clinically necessary.
• Avoid harmful drugs: Sedatives, NSAIDs and certain antibiotics require caution.
• Protect kidneys and brain early
• Plan for transplant early: Patients unlikely to recover on their own are assessed for transplant within hours to days.

Rapid Access to Procedures

Critically ill liver patients often need urgent procedures. The unit works with the endoscopy suite for variceal banding, interventional radiology for TIPS, drainage and embolisation, and operation theatres for emergency surgery or transplantation. Close coordination reduces delays that can affect outcomes.

Infection Prevention

Patients with liver failure have weakened immunity. The unit follows strict infection control with hand hygiene, sterile line and catheter care, early device removal, antibiotic stewardship and regular microbiological surveillance. Visitor policies protect patients while still allowing families to be present as much as safely possible.

Communication With Families

Regular updates from the treating team explain the diagnosis, expected course, risks and choices. Families are encouraged to nominate a spokesperson to streamline communication. In situations where quick decisions are needed, doctors explain the options clearly so families can make informed choices.

Early Rehabilitation

Even in the ICU, physiotherapists begin passive and active exercises to prevent muscle wasting and stiffness. Dietitians plan nutrition to meet high protein and energy needs. Speech and swallow assessment, sleep promotion and delirium prevention are part of the recovery approach.

Transition Out of the ICU

When organ function stabilises, patients move to a step-down unit or ward. A structured handover ensures that medicines, monitoring plans and rehabilitation continue. Before discharge, patients and families learn about medicines, diet, warning signs and follow-up.

Post-Transplant Critical Care

Transplant recipients are monitored closely for graft function, blood flow, bleeding, kidney function and infection. Immunosuppressive drug levels are checked frequently, and complications such as hepatic artery thrombosis or bile leaks are detected early through Doppler ultrasound and other tools.

When to Seek ICU-Level Care

Patients with liver disease who experience vomiting blood, black stools, severe confusion, high fever, rapidly deepening jaundice, sharply reduced urine or breathing difficulty need urgent hospital care. Early transfer to a liver-capable centre can make a decisive difference.

Talk to Our Team

If your loved one has serious liver illness, contact LiverMitra to understand ICU options and referral pathways.