Respiratory Failure in Cirrhotic Patients

Abstract

Acute respiratory failure is a common complication in cirrhotic patients and often necessitates intensive care. This condition is influenced by underlying respiratory changes observed even in compensated cirrhosis, including restrictive syndrome, small airway abnormalities, reduced DLCO, and compromised respiratory compliance and muscle function. Additionally, cirrhosis-associated immune dysfunction increases susceptibility to pneumonia, particularly bacterial, but also fungal and viral infections. Both respiratory and immunological alterations correlate with cirrhosis severity, predisposing these patients to episodes of acute respiratory failure. Pulmonary infections are the most frequent causes of acute respiratory failure, along with hydrothorax and ascites. Mechanical ventilation in cirrhotic patients appears to be a poor prognostic factor, with high reported mortality rates during critical care. For patients who are potential candidates for liver transplantation, severe respiratory impairment may contraindicate the procedure unless improvement is observed. Furthermore, pre-existing respiratory vulnerability can predispose patients to postoperative respiratory complications following liver transplantation.