This protocol addresses patients with acute liver failure who have received initial supportive management — including intravenous fluid resuscitation, glycaemic support, continuous renal replacement therapy, and enteral nutrition — but have not maintained the target blood glucose range, and in whom hypotension remains refractory to fluid resuscitation.
Initial supportive management (IV fluid resuscitation, continuous dextrose infusion, CRRT, and enteral nutrition) failed to sustain blood sugar within the 150–180 mg/dL target range. Hypotension also persisted despite adequate fluid resuscitation, meeting the threshold for escalation.
A specific first-line vasopressor agent is indicated for hypotension refractory to fluid resuscitation in this setting. The complete protocol defines the agent, monitoring approach, and the haemodynamic framework guiding its use.
The clinical goal is to maintain cerebral perfusion pressure in the range of 60–80 mm Hg.
DOI: 10.14309/ajg.0000000000002340
In patients with ALF, we recommend norepinephrine as the first-line vasopressor for hypotension refractory to fluid resuscitation.
The target range of MAP is to maintain a cerebral perfusion pressure of 60-80 mm Hg.
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