Table 2.

High risk patient (high MELD Score > 30) and recommendations.

Condition	Scenario	Special recommendations
Airway protection in encephalopathy	General	(1) Avoidance of BIPAP.
		(2) Elective intubation for grade III and grade IV encephalopathy.
		(3) Low threshold for intubation.
		(4) Continue intubation if transplant likely soon.
		(5) Extubate only when convincingly awake for considerable duration.
		(6) Postpyloric feeding if intubated.
		(7) Avoidance/minimal use of sedatives and analgesics.
	Procedures (endoscopy, etc.)	Preprocedural preemptive intubation.
	Transportation	Low threshold for elective intubation for transportation to different centre.
Hepatorenal syndrome	Prolonged periods of physical inactivity form dialysis	Nighttime continuous venovenous hemodialysis keeping daytime free for mobilization
Cachexia		(1) No protein restriction.
		(2) Frequent small meals.
		(3) Nighttime meal supplement (postpyloric tube feeds or TPN if diarrhea from lactulose) to avoid triggering of muscle consuming gluconeogenesis.
		(4) Aggressive physical therapy.
		(5) Periodic visit by medical team member making patient perform simple range of motion exercises for all major joints throughout the day.
		(6) Frequent incentive spirometry in daytime.
Infections/sepsis	Ascites ± SBP, GI bleeding	(1) Aggressive screening, prophylaxis and treatment for infections.
		(2) Sparing and judicious use of steroids.