lack of funds

Study Design- Randomized Controlled trial Duration of enrolment-Feb-2016 to December 2017 Sample size-120 patients Methodology We will include consecutive with advanced hepatic encephalopathy not responding to treatment of precipitants and on treatment with Lactulose and Rifaximin for 48 hours .

Two groups will be divided. One arm -Lactulose and Rifaximin will be continued Second Arm - Plasmapheresis will be added to the standard medical care therapy.(Maximum of 3 sessions once in 24 hours/or alternate days with an follow up for 5 days)

Inclusion Criteria:

• Cirrhotics
• Age between 18-70 years
• Hepatic encephalopathy -Grade 3-4
• Patients receiving Lactulose/Rifaximin for 48 hours and not showing improvement in Hepatic encephalopathy(Persistent Grade 3/4)

Exclusion Criteria:

• Concomitant participation in an other clinical trial
• Patient receiving sedatives(propofol,etc) 24 hours prior.
• Patients with severe cardiopulmonary disease
• Pregnancy
• Human Immunodeficiency Virus
• Hepatocellular Carcinoma or extrahepatic malignancy
• Active uncontrolled sepsis with hemodynamic instability
• Chronic renal insufficiency on treatment with haemodialysis
• Uncontrolled bleed or patients in DIC
• Extremely moribund patients with expected survival of less than 48 hours on high vasopressor support
• Patients with moderate-severe Acute Respiratory Distress Syndrome (ARDS).
• Patients with Non Hepatic Coma.