[Intensive care treatment of post-traumatic liver failure].
Liver failure following trauma or surgery is associated with a mortality of between 15-->50%, depending on the extent of the operation, pre-operative functional impairment of the liver as well as the occurrence of concomitant infectious disease. The liver can be the source as well as the target of posttraumatic liver failure (PLF). PLF can be caused by a reduction of liver perfusion due to hypotension, catecholamines or increased intraabdominal pressure. Further contributing factors include prolonged parenteral nutrition, endotoxemia, and potentially hepatotoxic drugs (sedatives, anticonvulsive drugs, antibiotics etc.). PLF is mostly associated with MOF. The Child classification and the APACHE score may predict prognosis before surgery and serum bilirubin levels thereafter. Prevention and therapy is based on treatment of shock and tissue hypoxia. It should be accompanied by appropriate diagnostic measures and followed by an aggressive medical and surgical approach.
Bechstein
W O
WO
Chirurgische Universitätsklinik, Ruhr Universität Bochum, Knappschaftskrankenhaus Bochum-Langendreer, In der Schornau 23-25, 44892 Bochum. wolf.bechstein@ruhr-uni-bochum.de
Dette
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K
Wullstein
Ch
Ch
Golling
M
M
D018806:APACHE; D003422:Critical Care / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000145:classification / Q000209:etiology / Q000628:therapy*; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D009104:Multiple Trauma / Q000150:complications*; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors
Intensivmedizinische Behandlung des posttraumatischen Leberversagens.