Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Nida Qadir, MD; Tisha Wang, MD; Igor Barjaktarevic, MD, PhD; Steven Y. Chang, MD, PhD


Semin Respir Crit Care Med. 2018;39(5):546-555. 

In This Article

Prolonged Mechanical Ventilation

Many patients with ESLD are difficult to wean and require prolonged IMV. Higher severity of physiologic derangements at admission, frequently seen in ESLD patients, is associated with increased risk for prolonged IMV.[110–112] Patients requiring prolonged IMV are known to have poor outcomes, including a 1-year mortality of up to 68%.[113,114] Extra care should be taken to optimize these patients for ventilator weaning, including addressing nonpulmonary causes that may be contributing to persistent respiratory failure. Electrolyte derangements, such as hypocalcemia,[115] hypophosphatemia,[116] and hypomagnesemia,[117] are associated with respiratory muscle weakness and are easily correctible. Nutritional support should be optimized. Underfeeding can result in protein catabolism and decreased respiratory muscle strength,[118] while overfeeding can result in hypercapnea.[119,120] Physical therapy is also beneficial in these frequently deconditioned patients, as early mobilization has been shown to decrease the duration of IMV.[69] For patients who are unable to be weaned from IMV in a timely manner, tracheostomy should be considered. Tracheostomy may increase patient comfort, minimize the need for sedation, and facilitate participation in physical therapy.