Liver Intensive Care

Department of Liver Intensive Care

The Liver Intensive Care Unit is an integral part of what is probably the largest comprehensive liver program in the world. It provides integrated investigation and treatment for all types of acute and chronic liver diseases as well as research into pathogenesis and future patient management.

The Liver Intensive Care at Global Hospital Mumbai is one of its kind Specialist Critical Care Unit in the whole of western India. It offers unique facility with a reputation of high-quality International standards for the Management of Complex Acute Liver Failure, Acute on Chronic Liver Failure and End Stage Liver Disease patients. 

The unit comprises of a dedicated team of Intensivists with vast experience in managing Liver Transplant and Liver Failure patients. Our Chief Liver Intensivist has an experience of managing complex Liver Failure patients associated with Multiorgan dysfunction, complicated Living-donor and Deceased-donor Liver Transplant patients and Post-operative care of various HPB Surgical cases.

She is ably assisted by a highly qualified, well-trained, and experienced team of dedicated doctors including a team of Pediatric Liver Intensivists to look after the precious pediatric category of patients. The Intensive care team works in tandem with senior Hepatologists and Liver Transplant Surgeons. 

The specialist team has been setting International standards for patient care for almost a decade now and is one of the leading centers in the country for the development and use of advanced and innovative therapies. Our Unit comprises of a 15 – bed critical care service   boasting facilities matching all International standards and has been specifically designed to cater  the need of both adult and pediatric liver patients.

The team takes care of the appropriate patient selection , ensuring fitness, preoperative optimization of Liver Transplant patients,  perioperative care and post-transplant recovery resulting in continuous high quality and safe care. The Liver ICU is well supported by allied department Consultants who are pioneers in their respective fields.

We have a dedicated Infectious Disease Consultant and Infection Control team to help us deal with and manage one of the commonest and most challenging issue of infections , not only in the management but also forming protocols to  control and avoid infections in this group of immunosuppressed patients.

The nursing staff play a vital role in the management of Liver Transplant and Liver ICU patients. The team consists of highly qualified nurses who are specially trained in handling high-risk patients. A 1:1 nursing ratio is maintained for critically ill patients in the liver ICU which helps improve care, safety and reduce infections.                          

Pediatric Liver Intensive Care

Apart from a highly efficient team of Adult Intensivist matching all the International standards of patient management, we also have a proficient team of Pediatric Liver Intensivist working under the umbrella of the Liver Critical Care department. 

Pediatric liver diseases are often genetically inherited and typically manifest themselves as soon as the child is born. These conditions require urgent and specialized care to ensure that the child receives appropriate treatment and can lead a normal healthy life. Children could be born with a varied number of liver conditions and a liver transplant is the only and most effective long-term solution to end-stage liver failure. The advancement to medical sciences allows us to employ liver transplant for the treatment of several liver-related conditions in children and infants. The Department of Pediatric Liver Intensive Care at Global Hospital, Mumbai provides comprehensive and advance liver care for children suffering from all types of liver ailments.

Why choose us for Liver Intensive Care & Services?

We are the proud innovators of state-of-the-Art specialist Liver Critical Care Unit, first of its kind in the whole of western India. The team follows up to date evidence-based protocols to treat all complex medical conditions. Protocols are drawn out in multidisciplinary meetings that are conducted periodically to help improve the consistency and safety in the care. All clinical pathways are updated, and compliance is monitored closely.

The Multidisciplinary team including Intensivists, Hepatologists, Transplant Surgeons, Infectious Disease Specialist, Cardiologist, Pulmonologist, Senior Critical Care Nurses, Physiotherapist and Dietitians visit patients daily. 

Global hospital, Mumbai is a referral center of the entire Western India for Acute Liver Failure and Acute On Chronic Liver Failure , End Stage Liver Disease  , Hepatobiliary and pancreatic disorders and liver trauma.

Infrastructure

Our facility is equipped with state-of-the-art technology. The ICU is specially designed to tailor the needs of this special category of Immunocompromised patients. Each bed in the ICU is an independent private room with Hepa filter and adherence to Strict Infection Control Practices are ensured to manage post-transplant as well as the medical liver patients.

Each patient is given a 1:1 nursing ratio to avoid any possible cross infection between patients. All post-transplant patients are kept in strict contact isolation with barrier nursing. 

Treatment for Liver Diseases and Conditions

The ICU provides

1. Management of Acute Liver Failure

   • Continuous Renal Replacement Therapy

   • Therapeutic Plasmapheresis/plasma exchange

   • Reverse jugular oxygen saturation monitoring

   • Management of Intracranial pressure

   • Therapeutic Plasmapheresis/plasma exchange

   • Emergency liver transplantation

2. Advanced Hemodynamic monitoring

3. Advanced ventilators for invasive and non-invasive artificial respiration,

4. All forms of Extra Corporeal Life support system required to manage and bridge liver failure patients to transplant, including cytokine removal filters.

5. Various modalities of dialysis – Conventional Hemodialysis, Slow low Efficiency Dialysis (SLED). 

6. Continuous Renal Replacement Therapy (CRRT) which is a specialized and advance form of dialysis, is managed independently by the ICU team, is available round the clock to ensure there is No Delay in treatment initiation of these critical patients when required. 

7. Crash cart with defibrillators, 

8. Round-the-clock bedside Ultrasonography (USG), 2 D Echo and all the intensive care doctors are trained for the bedside use of these.

9. Bronchoscopy and Broncho Alveolar Lavage – Which needs to be used for both diagnostic and Therapeutic purposes, available in the ICU for use anytime of the day or night.

10. Endoscopy – which can be a lifesaving procedure at times for massive gastrointestinal bleeds.

    • Endoscopic banding, glue injection

    • Esophageal stenting for refractory bleed

11.  Interventional Radiology 

    • Angiography/embolization

    • Trans jugular intrahepatic portosystemic shunt (TIPS procedure)

    • Trans Arterial embolization for ruptured tumors

    • Percutaneous Trans Hepatic Biliary Interventions

    • Trans jugular and Percutaneous Liver Biopsy

    • Portal Vein Embolization (PVE)

12.  Management of Acute Pancreatitis and complications of chronic pancreatitis

13.  Management of decompensated chronic liver disease and complications of portal hypertension

    • Hepatorenal syndrome/acute kidney injury

    • Ascites/spontaneous bacterial peritonitis

    • Variceal hemorrhage

    • Management of Acute on Chronic liver failure

14.  Management of complex hepatology patients

    • Viral Hepatitis

    • Acute alcoholic hepatitis

15.  Management of hepatobiliary surgical patients

    • Hepatobiliary and pancreatic tumor

    • Postop management of liver resection and Whipple’s procedure

Teaching and training

All Clinical Consultant staff participate in teaching which include didactic sessions, bedside teaching, journal club for junior faculty and nursing staff. 

We offer fellowship program in Liver Critical Care as well as for Liver transplant Anaesthesia and Critical Care.

Our Doctors – Liver Specialists

Dr Prashant Borade

MBBS , MD(Int.Med), MRCP(UK), MBA (IIM- K)

Director- Critical Care

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Dr Harish Chafle

MBBS, DTCD, DNB, IDCCM

Senior Consultant

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Dr Bhupinder Singh

MBBS, DA, DNB (Anaesthesiology), EDAIC (Belgium), FIPM (IPSC) (Intervenional pain management)

Consultant

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