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

Invasive Mechanical Ventilation

A substantial number of patients with ESLD and acute respiratory failure will require IMV. In general, principles guiding management of acute respiratory failure in the general ICU population should also be applied to ESLD patients. Delirium and deconditioning, known complications of IMV, frequently afflict ESLD patients even prior to the development of respiratory failure. Sedation should be minimized. If required, light rather than deep levels of sedation should be maintained whenever feasible, preferably with a nonbenzodiazepine, as these measures are associated with shorter lengths of IMV and ICU stay.[67,68] Similarly, early mobilization has been shown to decrease days of IMV and increase likelihood of ambulation upon discharge.[69] Particular care should also be taken to ensure that fluid status is optimized due to these patients' risk for volume overload, which may lead to or exacerbate respiratory failure.