Physiotherapy - Case Reports Open access

Respiratory and physical therapy in the intensive care unit after liver transplantation for acute-on-chronic liver failure: a case report

Authors

Published
10 September 2024
Section
Physiotherapy - Case Reports

Abstract

Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation (LT) is the only curative option. Due to the recipients’ generally poor pre-operative clinical conditions and extensive surgery, post-LT respiratory disorders are very common and significantly contribute to related morbidity and mortality. We report the case of a 49-year-old patient with ACLF grade 3 who has been taken care of by the Respiratory Physiotherapy Team since hospital admission. After the extubation, the patient was supported with non-invasive ventilation and mechanical in-exsufflation; meanwhile, early resistance and functional training were started. No adverse events occurred during physiotherapy sessions, and the patient returned home without respiratory support. Respiratory and physical therapy in the intensive care unit after LT were safe and feasible interventions for this patient. Given the high incidence of postoperative pulmonary complications and the high rehabilitation needs, we suggest that physiotherapy should be provided for ACLF recipients.

References

  1. Perricone G, Artzner T, De Martin E, et al. Intensive care management of acute-on-chronic liver failure. Int Care Med 2023;49:903-21. DOI: https://doi.org/10.1007/s00134-023-07149-x
  2. Mezzano G, Juanola A, Cardenas A, et al. Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis. Gut 2022;71:148-55. DOI: https://doi.org/10.1136/gutjnl-2020-322161
  3. Belli LS, Duvoux C, Artzner T, et al. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: results of the ELITA/EF-CLIF collaborative study (ECLIS). J Hepatol 2021;75:610-22. DOI: https://doi.org/10.1016/j.jhep.2021.03.030
  4. Feltracco P, Carollo C, Barbieri S, et al. Early respiratory complications after liver transplantation. World J Gastroenterol 2013;19:9271-81. DOI: https://doi.org/10.3748/wjg.v19.i48.9271
  5. Laici C, Guizzardi C, Morelli MC, et al. Predictive factors of inhospital mortality for ICU patients with acute-on-chronic liver failure undergoing liver transplantation. Eur J Gastroenterol Hepatol 2022;34:967-74. DOI: https://doi.org/10.1097/MEG.0000000000002413
  6. Chen GH, Wu RL, Huang F, et al. Liver transplantation in acute-on-chronic liver failure: excellent outcome and difficult posttransplant course. Front Surg 2022;9:914611. DOI: https://doi.org/10.3389/fsurg.2022.914611
  7. Sundaram V, Lindenmeyer CC, Shetty K, et al. Patients with acute-on-chronic liver failure have greater healthcare resource utilization after liver transplantation. Clin Gastroenterol Hepatol 2023;21:704-12.e3. DOI: https://doi.org/10.1016/j.cgh.2022.03.014
  8. Riley DS, Barber MS, Kienle GS, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol 2017;89:218-35. DOI: https://doi.org/10.1016/j.jclinepi.2017.04.026
  9. Volpe MS, Guimarães FS, Morais CC. Airway clearance techniques for mechanically ventilated patients: insights for optimization. Respir Care 2020;65:1174-88. DOI: https://doi.org/10.4187/respcare.07904
  10. Hickmann CE, Montecinos-Munoz NR, Castanares-Zapatero D, et al. acute effects of sitting out of bed and exercise on lung aeration and oxygenation in critically ill subjects. Respir Care 2021;66:253-62. DOI: https://doi.org/10.4187/respcare.07487
  11. Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One 2019;14:e0223185. DOI: https://doi.org/10.1371/journal.pone.0223185
  12. Brustia R, Monsel A, Skurzak S, et al. Guidelines for perioperative care for liver transplantation: enhanced recovery after surgery (eras) recommendations. Transplantation 2022;106:552-61. DOI: https://doi.org/10.1097/TP.0000000000003808
  13. Cork G, Camporota L, Osman L, Shannon H. Physiotherapist prediction of extubation outcome in the adult intensive care unit. Physiother Res Int 2019;24:e1793. DOI: https://doi.org/10.1002/pri.1793
  14. Thille AW, Boissier F, Muller M, et al. Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation. Crit Care 2020;24:86. DOI: https://doi.org/10.1186/s13054-020-2807-9
  15. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50:1602426. DOI: https://doi.org/10.1183/13993003.02426-2016
  16. Oczkowski S, Ergan B, Bos L, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J 2022;59:2101574. DOI: https://doi.org/10.1183/13993003.01574-2021
  17. Bach JR, Gonçalves MR, Hamdani I, Winck JC. Extubation of patients with neuromuscular weakness: a new management paradigm. Chest 2010;137:1033-9. DOI: https://doi.org/10.1378/chest.09-2144
  18. Chatwin M, Toussaint M, Gonçalves MR, et al. Airway clearance techniques in neuromuscular disorders: a state of the art review. Respir Med 2018;136:98-110. DOI: https://doi.org/10.1016/j.rmed.2018.01.012
  19. Christensen M, Trapl M. Development of a modified swallowing screening tool to manage post-extubation dysphagia. Nurs Crit Care 2018;23:102-7. DOI: https://doi.org/10.1111/nicc.12333

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.