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Liver Injury and Failure in Critically Ill Children

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Liver Diseases in the Pediatric Intensive Care Unit

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Abstract

Liver injury is frequent in the intensive care unit and its occurrence is associated with poorer outcomes. Multiple and interrelated mechanisms are involved. We review four major pathophysiological pathways of secondary liver injury in critically ill children: hypoxic liver injury, sepsis and the systemic inflammatory response syndrome, venous congestion, and treatment-associated liver injury including drug-induced liver injury and parenteral nutrition-associated liver disease. The diagnosis of liver injury in critically ill patients remains a challenge because of the lack of specificity of current markers and the presence of multiple confounders. We review the different patterns of liver injury and suggest an approach to abnormal liver test in the PICU. Central components of the treatment of critical illness-induced liver injury are detailed, mainly recognition of abnormal liver tests, prompt identification and treatment of the underlying illness, optimization of the hepatosplanchnic blood flow, removal of potentially hepatotoxic drugs, and treatment of the complications.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada

    Virginie Plante

  2. Pediatric Intensive Care Unit - Department of Pediatrics of Sainte Justine Hospital, University of Montreal, Montréal, QC, Canada

    Philippe Jouvet

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  1. Virginie Plante
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  2. Philippe Jouvet
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Correspondence to Philippe Jouvet .

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Editors and Affiliations

  1. Pediatric Intensive Care Unit - Department of Pediatrics of Sainte Justine Hospital, University of Montreal, Montréal, QC, Canada

    Philippe Jouvet

  2. Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics of Sainte Justine Hospital, University of Montreal, Montréal, QC, Canada

    Fernando Alvarez

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Plante, V., Jouvet, P. (2021). Liver Injury and Failure in Critically Ill Children. In: Jouvet, P., Alvarez, F. (eds) Liver Diseases in the Pediatric Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-030-79132-2_1

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