Pulmonary and Critical Care Considerations in Hepatic Disease

Liver disease remains a major cause of morbidity and mortality in the United States and worldwide. This issue outlines the major pulmonary and critical care complications of hepatic disease that often lead to the demise of patients with both acute and chronic liver disease. Many of these disease states also have important implications in selection and prioritization of patients for liver transplantation. Liver transplantation, the definitive cure for both acute and chronic liver disease, continues to be widely performed. More than five thousand transplants are performed annually in the United States, with overall favorable outcomes approaching 90% survival at 1 year and 60% survival at 10 years.

The three classic pulmonary complications specific to liver disease, hepatic hydrothorax, hepatopulmonary syndrome, and portopulmonary hypertension, are first discussed in detail with specific attention to candidacy and prioritization for liver transplantation. Next, sleep disorders in liver disease are discussed, a topic that has had increasing literature coverage in the last several years.

The subsequent articles in this issue detail the important acute critical care issues that frequently arise in the patient with liver disease admitted to an intensive care unit. The diagnosis and management of acute hepatic failure, acute variceal bleeding, hepatorenal syndrome, and acute respiratory failure in liver disease are discussed in detail. An article on liver replacement therapy provides insight into the limitations of this therapeutic option as a true bridge to liver transplantation. Finally, infectious complications of liver disease, before and after liver transplantation, are reviewed in detail. This is especially relevant given the high rates of a variety of infections, ranging from spontaneous bacterial peritonitis to septic shock, in patients with liver disease and in those post–liver transplantation.

We have endeavored to create an issue that is relevant to internists, pulmonologists, intensivists, gastroenterologists, hepatologists, and liver transplant surgeons alike, and we truly hope that you find it useful in your everyday clinical practice.

We sincerely thank all of our authors for their important and enlightening contributions to this issue of Seminars in Respiratory and Critical Care Medicine.