Management of Pediatric Acute Liver Failure (PALF) in the Absence of Liver Transplant in Pediatric Intensive Care Unit (PICU): About 5 Cases

Background: PALF is a rare and severe disease. The evolution of this complex and life-threatening illness is rapidly progressing with unknown etiology in the majority of cases and needed a challenging aspects of intensive management.

Objective: We aimed to describe, identify causal agent and intensive management of this PALF.

Methods: In this retrospective study conducted in our PICU in the university hospital center of Oran from 1 January 2019 to 30 November 2020 for PALF.

Results: In 5 children admitted with ALF with median age 5 (3-12) years, a sex ratio 4 (4/1). ALF was diagnosed in all patients using Biochemical evidence of liver injury in a child without evidence of chronic liver disease, Prothrombin Time < 50% not corrected by vitamin K Administration (5/5), International normalized ratio >1.5 (encephalopathy present in all patient). Patient presented: seizure (3/5), encephalopathy with median Glasgow Coma Score 10/15 (9-12/15), ARDS in one patient, shock with hypovolemia and vasoplegia in 3/5, cerebral perfusion was monitored in all patients using ultrasound doppler. Hepatitis A virus was the only etiology found in 3/5. Management consist on oxygenation, ventilation in (4/5) with sedation, analgesia, treatment of seizures, osmotherapy using SSH 3%, Maintain of natremia between 145 and 150 mmol/l, fluid loading 20 ml/kg, norepinephrine, the evolution was favorable in (2/5).

Conclusion: PALF represents one of the most life-threatening illness, intensive management is a challenge for the intensivist, but the need for urgent decision-making in regards to emergent liver transplantation seem to improve outcome.