Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival

Kimura, Shinnichi; Yoshioka, Tomoki; Shibuya, Masabumi; Sakano, Tsutomu; Tanaka, Reiichiro; Matsuyama, Shogo

doi:10.1097/00003246-200106000-00014

Cited by 98 publications

(68 citation statements)

References 27 publications

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“…Therefore, ICG elimination has been used to evaluate hepatic blood flow and liver function in liver transplant recipients, after partial hepatectomy in rats, and in septic patients with hepatocellular dysfunction. [15][16][17][18] In addition, ICG is an intravascular marker because it binds to plasma proteins rapidly and completely, impeding its extravascular distribution. Thus, it can be used to estimate both blood volume and cardiac output (CO).…”

mentioning

confidence: 99%

Intraoperative hemodynamics and liver function in adult-to-adult living liver donors

Niemann

2002

Liver Transplantation

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Indocyanine green (ICG) can be used to measure cardiac output (CO), hepatic function, and blood volume. We used ICG to describe the effect of right hepatectomy for living liver donation on intraoperative hemodynamics and perioperative liver function. ICG disposition was determined in 12 healthy adult living liver donors during the dissection phase and immediately after removal of the right hepatic lobe. In addition, measurements were repeated postoperative day 5. After injecting ICG, plasma concentrations were obtained for approximately 10 minutes by noninvasive pulse dye densitometry. CO was significantly higher and systemic vascular resistance was significantly lower immediately after removal of the right lobe compared with those obtained before resection (6.02 f 1.12 v 10.28 f 3.84 L/min; P < .05; 639 f 254 v 1,007 f 264 dyn.~-cm-~; P < .OS). Heart rate also increased significantly after removal of the right lobe from 62 f 10 to 83 f 9 beats/min (P < intraoperative hemodynamic changes during living liver donation. In addition, we show that functional recovery of the liver is likely to be slower than morphological recovery, and such clinical parameters as coagulation profile may not be a good index of fully restored hepatic function..

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mentioning

confidence: 99%

Intraoperative hemodynamics and liver function in adult-to-adult living liver donors

Niemann

2002

Liver Transplantation

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“…22,25 Although the measurement of ICG-PDR was developed several years ago, a new transcutaneous pulse densitometry device that is less invasive and simpler to apply has recently been put to use in the clinical setting. 15 The only such device currently in use in Turkey is the LiMON.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical ventilation occurred in volume-or pressure-controlled modes during continuous sedation with midazolam and fentanyl. 22 Vasopressors were administered to maintain the mean arterial pressure at levels greater than 65-70 mm Hg. The vasopressor agents and corresponding dose ranges were norepinephrine (3-40 µg per min), epinephrine (2-100 µg per min) or dopamine (6-30 µg/kg per min).…”

Section: Researchmentioning

confidence: 99%

Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients

Memiş²,

Ya³

et al. 2011

Can J Surg

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Background: Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. Methods:We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. [SD 6.78]), and the twelfth-hour ICG-PDR values were decreased in all groups; the difference between groups was significant (p < 0.001). Results Conclusion:Our results suggest that measurement of ICG-PDR with the LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients.Contexte : L'élévation de la pression intra-abdominale (PIA) et l'hypertension intraabdominale sont associées à des taux importants de morbidité et de mortalité chez les patients en état critique. Nous voulions évaluer les effets de l'hypertension intraabdominale sur la fonction hépatique en utilisant le système de surveillance non effractif de la fonction lymphatique LiMON et évaluer la valeur de la PIA comme pronostic chez des patients en état critique.

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“…ICG-PDR correlates well with global hepato-splanchnic blood flow [83] and has been demonstrated to be an early indicator of hepatocellular injury [84]. In critically ill patients, ICG-PDR appears to reflect changes in hepatic perfusion associated with IAH [85,86] and correlates well with IAP and APP [67].…”

Section: Monitoring Regional Perfusionmentioning

confidence: 92%

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Regli

Keulenaer²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population. Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test. Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

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Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival

Abstract: The KICG can identify reversible liver injury in septic shock, suggesting good prognosis. Either failure to increase the KICG within 120 hrs or an extremely low KICG is a poor prognostic sign.

Cited by 98 publications

References 27 publications

Intraoperative hemodynamics and liver function in adult-to-adult living liver donors

Intraoperative hemodynamics and liver function in adult-to-adult living liver donors

Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

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