Standard Volume vs. High Volume Plasma Exchange in Pediatric Acute Liver Failure

Aim: To study the efficacy in terms of the native liver survival, of standard volume plasma exchange as compared to high volume plasma exchange in Pediatric ALF. Study Design: Open label pilot Randomized Control trial. Sample size: Time bound. All cases presenting during the study period will be included in the study. Standard Medical Therapy: * All patients are were managed by a multidisciplinary team at Live Coma ICU. * Intubation and ventilation were undertaken for standard indications in addition to the development of grade 3 encephalopathy or evidence of cerebral edema * Ventilation was managed by fentanyl and propofol along with the use of atracurium for paralysis wherever required. * Hemodynamics, ONSD and TCD are monitored routinely. * All patients received N-acetylcysteine. * Neuro-protective measures such as hypertonic saline, head end elevation, minimal stimulation, propofol and thiopentone infusion are followed as per protocol. * Anti-ammonia measures like sodium benzoate, CRRT as well started as per protocol. * CRRT is done for routine renal indications, hyperlactetmia, hyperammonemia.