Update on treatment options for decompensated liver cirrhosis in the intensive care units

Liver cirrhosis is the end-stage consequence of chronic liver disease and is associated with typical life-threatening complications. The prognosis of decompensated liver cirrhosis and its complications can be substantially improved by optimal management in the intensive care unit (ICU). Identifying the etiology and presence of typical complications is of utmost importance on presentation at the ICU. Emergency measures for acute variceal bleeding include endoscopic intervention, vasoactive drugs, antibiotics, supportive intensive care treatment and, when necessary an urgent transjugular intrahepatic portosystemic shunt (TIPS) procedure. In cases of ascites, spontaneous bacterial peritonitis needs to be considered and immediately treated with antibiotics. First line therapy of hepatorenal syndrome consists of administration of albumin and terlipressin. Although data from controlled trials are limited, lactulose is still the standard therapy in patients with hepatic encephalopathy. In all patients with decompensated cirrhosis, liver transplantation should be discussed as an option. As a bridging procedure until potential transplant, artificial liver support devices may have clinical value.