Philippe Jouvet (editor) - Liver Diseases in the Pediatric Intensive Care Unit: A Clinical Guide

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For several years, we have observed an increase in liver damage in children hospitalized in the pediatric intensive care unit (PICU) of our institution. In many cases, this increase is due to the application and expansion of new technologies or therapeutic strategies, in others it is the consequence of intensive treatments administered in order to allow patients to have access to liver transplantation. Sometimes the liver suffers in silence, and in such circumstances, this can initiate a sequence of events leading to multi-organ failure. Early diagnosis of liver injury from many different causes could prevent further deterioration. In addition, precise control of the increase in the number of drugs prescribed in PICU could prevent permanent toxic damage or establish a close monitoring.

The main objective of this book is to gather as much experience as possible in one volume, and to identify gaps in our knowledge in order to motivate clinical studies and basic research, with the aim of implementing continuous improvement in the management of children with primary or secondary liver diseases in PICU. The high damage tolerance and regenerative capacities of the liver tissue must be protected and supported to allow full recovery from acute or more or less chronic damage. Assessing the possibility of restoration of normal liver function after severe liver injury is a difficult and, in some cases, impossible task, leading to organ replacement. We need new reliable markers to better avoid liver transplantation in case of possible recovery and to better select children who can benefit from liver regeneration treatments that may appear in the future. In most of the chapters of this book, we associated young with experienced physicians, trying to make them aware of the prevention and early treatment of liver complications, and encouraging their involvement in the analysis and research of new diagnostic tools and therapeutic options.

Another relevant feature of this book is related to the interdisciplinary effort necessary for the care of children in the PICU, and the involvement of many professionals and scientists in order to offer the best available options to our patients. In this sense, we are thinking of incorporating new chapters in the next edition, such as pharmacology and toxicity or nutrition and liver. Research is being developed on these topics in our institution. We also hope that this publication will expand collaborations and networks, thus accelerating new discoveries to improve quality of care.

We would like to thank all the colleagues who participated in this publication, for their openness during several fruitful discussions, and for their valuable support for this work. We would also like to acknowledge the invaluable trust conferred to us by the children and their families, which makes our daily task rewarding and motivates us to seek original alternatives to help them in such difficult situations.