When is intubation indicated during the treatment of fulminant hepatic failure (FHF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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As patients with fulminant hepatic failure drift deeper into coma, the ability to protect their airway from aspiration decreases. Patients who are in stage III coma should have a nasogastric tube (NGT) inserted for stomach decompression. When patients progress to stage III coma, intubation should be performed.

Short-acting benzodiazepines in low doses (eg, midazolam, 2-3 mg) may be used before intubation, or propofol (50 mcg/kg/min) may be initiated before intubation and continued as an infusion. Propofol is also known to decrease the cerebral blood flow and intracranial hypertension (ICH). It may be advisable to use endotracheal lidocaine before endotracheal suctioning.

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