Management of AFLP in the ICU is primarily supportive and includes:
- Prompt delivery of the foetus (if antenatal diagnosis)
- Intensive monitoring and support of vital organ functions
- Correction of hypoglycaemia
- Management of coagulopathy with blood products and recombinant factors
- Renal replacement therapy for acute kidney injury
- Mechanical ventilation for respiratory failure
- Vasopressor and inotropic support as needed for perfusion.
- Referral to tertiary Liver Unit and consideration of liver transplantation in severe cases
- Treatment of complications (e.g., sepsis, cerebral edema)
- Nutritional support
- Potential use of N-acetylcysteine to improve outcomes- This is considered as an adjunctive treatment alongside standard supportive care measures. There are no large-scale randomized controlled trials specifically evaluating NAC in AFLP. Most evidence comes from case reports and small studies.
- Plasmapheresis may be considered in cases where liver failure continues to worsen despite delivery. In severe cases, extracorporeal liver support systems like Molecular Adsorbent Recirculating System (MARS) may be considered, although evidence for their efficacy is limited.
