Estimation of indocyanine green concentration in blood from fluorescence emission: application to hemodynamic assessment during hemodialysis

Abstract

There is considerable interest in assessing cardiovascular function noninvasively in patients receiving hemodialysis. A possible approach is to measure the blood concentration of bolus-injected indocyanine green dye and to apply the dye-dilution method for estimating cardiac output and blood volume. Blood ICG concentration can be derived from a measurement of the ICG fluorescence through the dialysis tubing if a simple and unique calibration relationship can be established between transmural fluorescence intensity and blood ICG concentration. We investigated this relationship using Monte Carlo simulations of light transport in blood with varying hematocrit and ICG concentrations and performed empiric measurements of optical absorption and ICG fluorescence emission to confirm our findings. The ICG fluorescence intensity measured at the blood surface, as well as the light intensity remitted by the blood, varied as hematocrit changes modified the absorption and scattering characteristics of the blood. Calibration relationships were developed between fluorescence intensity and ICG concentration that accounted for hematocrit changes. Combining the backreflected fluorescence and the reflected light measured near the point of illumination provided optimal signal intensity, linearity, and robustness to hematocrit changes. These results provide a basis for developing a noninvasive approach to derive optically circulating blood ICG concentration in hemodialysis circuits.