Blood purification in intensive care of liver failure

Along with standard conservative therapy, extracorporeal blood purification methods are important in the treatment of liver failure. Extracorporeal liver support methods are constantly developing and perspective strategies for liver failure, and their evolution is ongoing. Artificial methods with various mass transfer technologies are successfully used in clinical practice. These are filtration-convection, sorption, apheresis and combined methods combining several mass transfer technologies in a single circuit. Renal replacement therapy with diffusion-filtration-convection mass transfer (hemodialysis, hemofiltration, hemodiafiltration) is justified for complications caused by high serum ammonia even in the absence of kidney dysfunction. To eliminate lipophilic toxins, adsorption devices for hemosorption and plasmasorption have been introduced. The same is true for methods based on albumin dialysis. Searching for effective hemocorrection methods has led to combined extracorporeal methods with possible elimination of various pathophysiological substances through combination of different mass transfer technologies. This ensured high clearance of hydrophilic and hydrophobic substances (MARS therapy, Prometheus therapy, OPAL, DIALIVE, SPAD, ADVOS, CPFA). Apheresis technologies (plasma exchange, plasmapheresis) and their modifications combining filtration transfer (selective plasma filtration, plasma diafiltration) have not lost clinical significance. They are comparable in efficiency with other liver support technologies (albumin dialysis, hemosorption and plasma sorption), but are less expensive. All technologies are aimed primarily at reducing intoxication. Extracorporeal hemocorrection as a part of liver failure therapy in a cohort of critically ill patients should be adapted for widespread practice. When managing a patient with acute liver failure, one should assess clinical symptoms, trigger factors and pathophysiology of the organ.