A Study to Evaluate Role of Inhaled Amikacin to Prevent Ventilator Associated Pneumonia in Patients With Cirrhosis

Inclusion Criteria: 1. Patients admitted to the liver ICU with hepatic encephalopathy (Grade 2 or higher), requiring intubation for at least 48 hours, without pneumonia. 2. Patient is aged ≥18 years. 3. Written informed consent of the patient or a proxy. Exclusion Criteria: 1. Suspected or confirmed Pneumonia at the day of inclusion. 2. Patients with Chronic kidney disease on maintenance hemodialysis 3. Stage 2 or 3 Kidney Disease Improving Global Outcome (KDIGO) classification AKI the day of inclusion. Patients undergoing renal replacement therapy or for whom decision has been made to initiate renal replacement therapy can be included whatever the KDIGO stage 4. Pregnancy or breast-feeding. 5. Clinical indication for systemic aminoglycoside therapy the day of inclusion: as deemed necessary by the clinician in charge. 6. Patients known to be allergic to aminoglycosides. 7. Patients who received intravenous Amikacin before 7 days of inclusion in this study.