Experience in Non-invasive Ventilation in Grade 3 Hepatic Encephalopathy

Abstract

Introduction:Hepatic encephalopathy (HE) is a common complication of acute and chronic liver failure, which can lead to significant morbidity and mortality. Grade 3-4 HE patients are typically managed with routine intubation and mechanical ventilation. However, recent research suggests that routine intubation may increase the risk of complications and death for the preservation of the airway. This study investigated the use of non-invasive ventilation (NIV) in patients with grade 3 encephalopathy associated with acute and chronic liver failure.Methods:This retrospective study included patients with grade 3 encephalopathy associated with liver failure who underwent NIV between January 2022 and March 2023 in a liver transplant intensive care unit. The patient demographic data, laboratory results, comorbidities, and outcomes were collected and analyzed. The results were compared to those of HE patients who were intubated as reported in the literature.Results:A total of 41 children and adults with grade 3 HE who received NIV were included in this study. Compared with HE patients who were intubated as reported in the literature, the NIV group had significantly lower rates of complications and mortality. Additionally, there were no additional complications observed in patients who received NIV without intubation, such as infections, cardiovascular disorders, or cognitive impairments.Conclusion:The use of NIV in grade 3 HE patients suggests that it is an effective alternative to intubation. These findings support the need for careful consideration when deciding to intubate HE patients and suggest that continuous support using NIV may provide potential benefits. Further studies are needed to investigate the optimal management of these patients to improve their outcomes.

Keywords

• hepatic encephalopathy
• hepatic failure
• non-invasive ventilation