Acute liver failure (ALF) is a rare condition characterized by new (no previous cirrhosis) and rapidly evolving (≤26 weeks) hepatic dysfunction associated with neurologic dysfunction (any grade of hepatic encephalopathy) and coagulopathy (INR ≥1.5). This disease may be due to several aetiologies (e.g. drug toxicity such as paracetamol and viruses such as hepatitis A, B or E), with great regional variability. The outcomes of patients with ALF have been improving throughout the decades largely because of optimized access and quality of intensive care and emergent liver transplantation.

We have developed the survey ALFinICU to try to characterize the current practice of European ICUs in treating patients with ALF. With this, we hope to contribute to generate debate and identify future educational points about this rare disease. This questionnaire is anonymous.

Thank you for you interest and participation.

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* 1. In which country do you work?

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* 2. How old are you?

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* 3. Which level of training do you have?

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* 4. In which kind of hospital do you work?

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* 5. In which kind of intensive care unit (ICU) do you work (1)?

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* 6. In which kind of ICU do you work (2)?

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* 7. How many beds your ICU has?

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* 8. How many patients with acute liver failure (ALF) average do you admit per year?

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* 9. Which percentage of ALF cases are due to paracetamol overdose?

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* 10. What are the common thresholds you use to admit patients with ALF in the ICU?

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* 11. What is the liver transplant rate amongst patients with ALF in your ICU ?
(if applicable)

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* 12. Which criteria do you use for liver transplant candidacy ?
(if applicable)

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* 13. What is the hospital mortality rate amongst patients with ALF in your ICU?

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* 14. For which etiologies of ALF do you prescribe N-acetyl-cysteine?

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* 15. Which triggers do you consider for endotracheal intubation in patients with ALF?

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* 16. How often do you measure serum ammonia in patients with ALF?

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* 17. How do you monitor the risk of cerebral edema/intracranial hypertension?

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* 18. How do you treat cerebral edema/intracranial hypertension?

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* 19. Which strategies do you use to control serum ammonia?

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* 20. Do you use plasma exchange in patients with ALF and if so in which circumstances?

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* 21. Do you use liver assisting devices to treat patients with ALF?

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* 22. When do you transfuse patients with ALF?

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* 23. Do you use prophylactic antibiotics and if so in which circumstances?

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* 24. When do you perform liver biopsy in patients with ALF?

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* 25. What markers of futility of care do you consider in patients with ALF?

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