Thread by @yoncabulutmd

1/16 Fantastic talk by @aakashdeeparora 👏👏
So informative thank you🙏
#PedsICU management of #PediatricAcuteLiverFailure #PALF

@drarunbansal @p_khilnan @sidraishaque @iapindia

2/16What is new in #PALF management?
1. Change of paradigm
Instead of saying not stable to transplant for severely sick patients-
Consider CRRT and ECMO to optimize patient for tx or spontaneous recovery.

3/16Spontaneous regeneration is common 72%. 👇Can we wait? can we optimize support?
Which patients regenerate?

4/16 Role of intensivist

5/16 #PALF etiology is different according to age

6/16 What happens during #PALF? Systemic Inflammation is due to PAMPs, DAMPs, TGF IL-1...multifactorial

7/16 Supportive care for #PALF

8/16 How do you manage hemodynamic instability?

@threadreaderapp Unroll please

9/16 Where are you getting your Ammonia Levels? It matters

10/16 What is the ideal Extracorporeal Liver Assist Device (ELAD)?
45% of #PALF has acute kidney injury
CRRT improves outcome.

11/16 Plasma exchange in #PALF

12/16 Does CRRT bridge #PALF to LT? ANSWER IS YES @aakashdeeparora

13/16 Neuroprotection and monitoring in #PALF?
Utilize Reverse Jugular monitor, NIRS, ONSD, TCD @RobertCTasker @aakashdeeparora

14/16 Last effort Hepatectomy

15/16 What is future for #PALF ?
Hepatocyte transfusion may bridge to LT? Intriguing

16/16 THANK YOU this was a fantastic talk @aakashdeeparora