Intensive Care for Acute Liver Failure in Pediatric Practice (Review)

Acute liver failure (ALF) is a rare pathologic syndrome in pediatric practice with a high risk of multiple organ failure and death. Despite extensive research on risk factors and clinical manifestations, there are no standardized critical care protocols for ALF in children and adolescents. Anesthesiologists and intensivists face significant challenges in the diagnosis and prevention of ALF. The aim of this review is to analyze the main triggers, etiology, pathogenesis, clinical manifestations and both specific and supportive treatment approaches for ALF in pediatric intensive care units. The Cochrane Library, PubMed, Medscape and Library.ru databases were used to conduct a systematic search and analysis of the scientific literature using the keywords «acute liver failure, children and adolescents, hepatic encephalopathy, cerebral edema, extracorporeal methods, liver transplantation». A total of 81 sources were selected for review. Inclusion criteria were studies that described the pathogenesis, clinical manifestations, diagnosis and treatment of ALF in the pediatric intensive care unit. Exclusion criteria were studies that focused on the diagnosis and treatment of ALF in adult patients. This review summarizes the most common etiologic factors and clinical presentations of ALF based on the child's age, as well as the diagnostic tools used in the pediatric intensive care unit. It also focuses on the primary supportive and disease-specific management strategies for ALF in the ICU, taking into account the unique physiological characteristics of pediatric patients. Conclusion. Infectious and idiopathic causes are the most common etiologies of ALF, leading to hyperammonemia, inflammatory response, and hepatocyte death. The primary clinical manifestations of ALF in children vary with age and include jaundice, abdominal pain, nausea, vomiting, and encephalopathy. Specific treatment in the intensive care unit focuses on correcting fluid and electrolyte imbalances, administering antibacterial therapy, and providing enteral nutrition. Supportive therapy is aimed at stabilizing vital organ function, implementing extracorporeal treatment methods, and performing liver transplantation when indicated.