liver function monitoring

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Presentation transcript:

liver function monitoring PULSION LiMON Non-invasive liver function monitoring

Setup Configuration PC5000 LiMON PICG0025 ICG-PULSION 25 mg PC50150 LiMON reusable sensor for adults and infants PV50100 LiMON disposable sensor for adults and infants PV50200 LiMON disposable sensor for neonates

Pulse Densitometry Based on Pulse Oximetry LEDs 805 nm & 905 nm pulsatile805 nm non pulsatile805 nm pulsatile905 nm Sensor non pulsatile905 nm [ s ] 1 2 3 4 5 CICG mg/l pulsatile905 nm non pulsatile905 nm CICG = pulsatile805 nm non pulsatile805 nm

dynamically determined range for back extrapolation ICG Dilution Curve Analysis CICG mg/l calculation of half life time and elimination rate of ICG-PULSION dynamically determined range for back extrapolation

Global liver function from elimination of ICG-PULSION: Parameters Global liver function from elimination of ICG-PULSION: Plasma Disappearance Rate of ICG PDR (%/min) ICG Retention Rate after 15 min R15 (%) ICG Clearance CB (ml/min) Circulating Blood Volume BV (ml) Pulse oximetry Oxygen Saturation SpO2 (%) Heart Rate HR (bpm)

Parameter Calculation Normal Range PDR (%/min) ln2/t1/2  100 18 – 25 Calculations and Normal Ranges Parameter Calculation Normal Range PDR (%/min) ln2/t1/2  100 18 – 25 R15 (%) CICG15m / CICG t=0  100 0 – 10 CBI (ml/min/m2) BV  PDR / BSA 500 – 750 BVI (ml/m2) [ICG]inj / CICG t=0 / BSA 2600 - 3200

Invasive COLD System vs non-invasive LiMON (16 pts, n=54) Validation Invasive COLD System vs non-invasive LiMON (16 pts, n=54) Sakka S, Meier-Hellmann A: International Journal of Intensive Care, 2002

Evaluation of liver function in organ donors and recipients Fields of Clinical Application All critically patients, especially those with sepsis, acute liver or multi-organ failure, and after multiple trauma Patients with chronically reduced hepatic function (hepatitis, liver cirrhosis) Evaluation of liver function in organ donors and recipients Monitoring of liver function during liver or abdominal surgery (resection, porto-caval shunt) Diagnosis and monitoring of congenital liver failure in children and neonates

Application in Intensive Care More than 50% of surgical ICU patients exhibit reduced PDR accompanied with a higher mortality normal range Sakka S, Meier-Hellmann A: International Journal of Intensive Care, 2002

* Prognosis of Survival in ICU Patients Significantly reduced liver function in non-survivors Non-survivors n= 168 Survivors 45 40 35 30 25 20 15 10 5 ICG-PDR [%/ min] (p< 0.001) * Sakka SG, Meier-Hellmann A: Yearbook of Intensive Care and Emergency Medicine, 2001

Prognosis of Survival in ICU Patients Clear indicator of probability of survival in septic shock (Survivors) (Non-survivors) Conclusion: Increase of reduced ICG elimination during the first 120 hours of septic shock predicts survival, whereas no change or even further decrease of ICG elimination predicts non-survival Kimura S et al: Crit Care Med 2001

Value as Liver Function Test in Intensive Care Higher sensitivity and specificity than bilirubin BILIRUBIN (>33.8) ICG-PDR 20 40 60 80 100 100-Specificity [%] Sensitivity [%] (>15.2) n= 336 p= 0.06 Sakka SG, Meier-Hellmann A: Yearbook of Intensive Care and Emergency Medicine, 2001

Liver Function in Organ Donors Clear borderline for transplantation suitability Wesslau C et al: Transplantology 1994

Application After Liver Transplantation Clear borderline for probability of graft function Jalan R et al: Transplantation 1994

Value as Liver Function Test in Liver Surgery Better correlation with prognosis than laboratory parameters in cirrhotic patients Hemming AW et al: Am J Surg 1992

Value as Liver Function Test in Liver Surgery Correlation between parenchymal cell volume and ICG elimination Hashimoto M and Watanabe G: J Surg Res 2000

Advantages Non-invasive measurement Uses a 4 wavelength near-infra red finger clip sensor and any peripheral or central venous access for injection of ICG-PULSION Quick information Bed-side results are obtained within a few minutes (approx. 6-8 min.). Specific parameters ICG-PULSION elimination is well established for quantification of liver function and has prognostic value Simple application Results not user dependent, up to 10 measurements per 24 hours Time and cost saving Reduces the numbers of laboratory blood/plasma samples