Indocyanine Green Plasma Disappearance Research Articles

Application of Indocyanine Green Fluorescence as an Adjuvant to Laparoscopic Ultrasound in Minimally Invasive Liver Resection.

Background: Indocyanine green (ICG) fluorescence imaging has been extensively used in a variety of applications in visceral surgery. In minimally invasive liver resections, the detection of small superficial hepatic lesions using an intravenous injection of ICG before surgery represents a promising application. Methods: We analyzed 18 consecutive patients who underwent laparoscopic liver resection for superficial malignant tumors, namely 11 patients with hepatocellular carcinoma (HCC), 5 patients with colorectal liver metastases (CRLM), 1 patient with intrahepatic cholangiocarcinoma (ICC), and 1 patient with thyroid cancer metastasis, using ICG fluorescence as an adjuvant tool to intraoperative laparoscopic ultrasound (LUS). Results: An optimal ICG 15-minute clearance retention rate (R15 < 10%) and ICG plasma disappearance rate (<18%/minute) were present in 11 patients (61.1%) and in 14 patients (77.7%), respectively. Liver tumors were 29 in total, including 14 HCCs (48.3%), 13 CRLMs (44.8%), 1 ICC (3.4%), and 1 thyroid cancer metastasis (3.4%). Twenty-nine tumors (100%) were correctly visualized with ICG/fluorescence, as compared with 21 tumors identified with LUS (72.4%). After complete liver mobilization, ICG staining allowed to identify more superficial lesions (early HCC and small CRLM) in posterolateral segments (Segments 6 and 7) as compared with LUS (14 versus 10 lesions). In addition, in segments usually treated laparoscopically (e.g., left lateral segments), ICG was superior to LUS (10 versus 6 lesions) to identify superficial early HCC in patients with macronodular cirrhosis. Conclusions: ICG visual feedback might substitute the tactile feedback of the hand and might in some cases act as a "booster" of LUS for superficial hepatic lesions.

Assessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients.

Indocyanine green (ICG) is a water-soluble dye that is bound to plasma proteins when administered intravenously and nearly completely eliminated from the blood by the liver. ICG elimination depends on hepatic blood flow, hepatocellular function and biliary excretion. ICG elimination is considered as a useful dynamic test describing liver function and perfusion in the perioperative setting, i.e., in liver surgery and transplantation, as well as in critically ill patients. ICG plasma disappearance rate (ICG-PDR) which can be measured today by transcutaneous systems at the bedside is a valuable method for dynamic assessment of liver function and perfusion, and is regarded as a valuable prognostic tool in predicting survival of critically ill patients, presenting with sepsis, ARDS or acute liver failure.

Use of finger-piece method for indocyanine green clearance test.

The indocyanine green (ICG) finger-piece method (FPM), which allows measurement of the ICG concentration by mounting a light sensor onto a finger, is used to assess liver function. We compared the ICG FPM with the conventional ICG blood sampling method (BSM) in patients with liver disorders. Ninety consecutive patients simultaneously underwent the ICG BSM and ICG FPM. After ICG administration, blood samples were collected at 5, 10, and 15min for the ICG BSM. The ICG concentration was measured through the finger piece by an ICG clearance meter. Seventy-one patients (78.9%) had Child-Pugh class A liver disease, and 19 (21.1%) had class B or C. The FPM-measured ICG plasma disappearance rate was positively correlated with the BSM-measured values (r = 0.886, P <0.001). Bland-Altman analysis showed good agreement between the two methods (mean difference, 0.012 ± 0.018). The FPM-measured ICG plasma disappearance rate was positively correlated with the BSM-measured values both in patients with Child-Pugh class A liver disease (r = 0.821, P <0.001) and class B or C liver disease (r = 0.859, P <0.001). The ICG FPM may be an alternative to the ICG BSM for liver function assessment.

Perioperative Non-Invasive Indocyanine Green-Clearance Testing to Predict Postoperative Outcome after Liver Resection.

BackgroundPostoperative liver dysfunction may lead to morbidity and mortality after liver resection. Preoperative liver function assessment is critical to identify preexisting liver dysfunction in patients prior to resection. The aim of this study was to evaluate the predictive potential of perioperative indocyanine green (ICG)-clearance testing to prevent postoperative liver dysfunction and morbidity using standardized outcome parameters in a routine Western-clinical-setting.Study Design137 patients undergoing partial hepatectomy between 2011 and 2013, at the general hospital of Vienna, were included. ICG-clearance was recorded one day prior to surgery as well as on the first and fifth postoperative day. Postoperative liver dysfunction was defined according to the International Study Group of Liver Surgery and evaluation of morbidity was based on the Dindo-Clavien classification. Statistical analyses were based on non-parametric tests.ResultsPreoperative reduced ICG—plasma disappearance rate (PDR) as well as increased ICG—retention rate at 15 min (R15) were able to significantly predict postoperative liver dysfunction (Area under the curve = PDR: 0.716, P = 0.018; R15: 0.719, P = 0.016). Furthermore, PDR <17%/min. or R15 >8%, were able to accurately predict postoperative complications prior to surgery. In addition to this, ICG-clearance on postoperative day 1 comparably predicted postoperative liver dysfunction (Area under the curve = PDR: 0.895; R15: 0.893; both P <0.001), specifically, PDR <10%/min or R15 >20% on postoperative day 1 predicted poor postoperative outcome.ConclusionPDR and R15 may represent useful parameters to distinguish preoperative high and low risk patients in a Western collective as well as on postoperative day 1, to identify patients who require closer monitoring for potential complications.

Chronic liver disease: Correlation of CEUS-based microperfusion and indocyanine green clearance.

To evaluate whether changes of dynamic contrast-enhanced ultrasound (CEUS)-based liver microcirculation during chronic liver disease are correlated with the extent of impaired liver function, expressed by the indocyanine green (ICG) clearance. 19 patients underwent CEUS examinations with previous or consecutive ICG clearance test. The ICG plasma disappearance rate (ICG-PDR) was determined using the noninvasive pulse-densitometric LiMON system. Quantification of peak enhancement (PE), rise time (RT) and the wash-in rate (WiR) was performed in the liver parenchyma (ROIliver) as well as in the portal vein (ROIportal vein) using a novel quantification software (VueBoxTM). To compare quantification parameters, patients were classified in patients representing a healthy population (ICG-PDR >16, n = 8) and those representing patients with liver disease (ICG-PDR ≤16, n = 11). ROIportal vein showed significant differences comparing healthy patients and patients with liver disease for all perfusion parameters: PE and WiR were significantly higher in patients without liver disease (p = 0.048; p = 0.039). RT was significantly lower in healthy population (p = 0.039). Comparing perfusion parameters for ROIliver, PE was significantly higher in patients without liver disease (p = 0.039). There was no significant difference for RT (p = 0.804) and WiR (p = 0.058), respectively. Within the framework of this study CEUS derived estimation of microcirculation did not prove to be a reliable estimator of liver function. RT, PE and WiR measured in the portal vein were significant perfusion factors in predicting liver function.

Intraoperative simulation of remnant liver function during anatomic liver resection with indocyanine green clearance (LiMON) measurements

ObjectivePost-hepatectomy liver failure (PHLF) is the major cause of death following liver resection. The aim of this study was to evaluate the feasibility of an intraoperative simulation of post-resection liver function. MethodsIntraoperative liver function was measured by indocyanine green (ICG) clearance using the LiMON™ technology. In 20 patients undergoing anatomic liver resection, ICG plasma disappearance rate (PDR (%/min) and ICG retention at 15 min (R15) (%) were measured immediately after the induction of anaesthesia (t0), after selective arterial and portovenous inflow trial clamping (TC) of the resected liver segments (t1), after the completion of resection (t2) and before the closure of the abdominal cavity (t3). ResultsThe median baseline (t0) PDR was 16.5%/min. Trial clamping of the inflow (t1) resulted in a significant reduction in PDR to 10.5%/min. Results under TC were similar to those obtained after resection (t2) (median PDR: 10.5%/min). Linear regression modelling showed that post-resection liver volume could be accurately predicted by TC of liver inflow (P < 0.0001), but not by determining the resected liver volume. Simulated post-resection liver function under TC correlated well with PHLF and length of hospital stay. ConclusionsIntraoperative ICG clearance measurements allow real-time monitoring of intraoperative liver function during surgery. Trial clamping of arterial and portovenous inflow accurately predicts immediate post-resection liver function. The intraoperative measurement of liver function and simulation of post-resection liver function may help to avoid PHLF.

Indocyanine green plasma disappearance rate as dynamic liver function test in critically ill patients.

Indocyanine green (ICG) is a water-soluble fluorescent dye that is bound to plasma protein when administered intravenously. Removal of ICG from the blood depends on hepatic blood flow, function of the parenchymal cells and biliary excretion. ICG elimination is described as a useful dynamic liver function test. In this review, we looked at the most recent literature to clarify why ICG is useful in critically ill patients, the validity of the ICG plasma disappearance rate (ICG-PDR) measured transcutaneously and whether ICG-PDR has any prognostic value. In conclusion, measuring ICG-PDR is a valuable method for dynamic assessment of liver function, and is found to be a valuable prognostic tool in predicting survival for septic patients, patients presenting with acute liver failure and critically ill patients.

ICG-liver test versus new biomarkers as prognostic markers for prolonged length of stay in critically ill patients - a prospective study of accuracy for prediction of length of stay in the ICU.

BackgroundPrognostic abilities of medical parameters, which are scoring systems, measurements and biomarkers, are important for stratifying critically ill patients. Indocyanine green plasma disappearance (ICG-PDR) is an established clinical tool for the assessment of liver perfusion and function. Copeptin, MR-proANP and pro-ADM are biomarkers whose prognostic value is still unclear. The goal of this prospective study was to evaluate ICG-PDR, copeptin, MR-proANP and pro-ADM to predict prolonged length of stay (pLOS) in the ICU.MethodsThis study was conducted as a prospective single center study including 110 consecutively admitted ICU patients. Primary endpoint was prolonged length of stay (pLOS) in the ICU, defined as more than three days of stay there.ResultsROC analysis showed an AUC of 0.73 for ICG-PDR, 0.70 for SAPS II, 0.65 for MR-proANP, 0.64 for pro-ADM and 0.54 for copeptin for pLOS in the ICU.ConclusionsThe prediction of pLOS in the ICU might be better by means of ICG-PDR than with the new biomarkers copeptin, MR-proANP or pro-ADM. Nevertheless, there is more need for research to evaluate whether ICG-PDR is an overall prognostic marker for pLOS.Trial registration(ClinicalTrials.gov number, NCT01126554).

Prediction of 28-day mortality by indocyanine green disappearance rate, other markers of hepatic function and transpulmonary thermodilution parameters: a prospective study in 154 patients

Hepatic dysfunction has been associated with outcome of ICU patients. However, most scoring systems including APACHE II only marginally reflect acute liver dysfunction on admission. Indocyanine green (ICG) is eliminated by hepatobiliary excretion. Therefore, the ICG plasma disappearance rate (ICG-PDR) is used as a dynamic liver function test. ICG-PDR has been associated with mortality in several studies.

结合近红外光谱法的肝血流参数测量

A pulse spectroscopic scheme based on dye dilution and an excretion test was developed to overcome the shortcomings of conventional blood dye concentration measuring method in complex operation,invasive treatment and non-continuance.Firstly,Indocyanine Green(ICG) was intravenously injected and a finger clip sensor was used to extract spectral signals of fingertips for a sufferer.Then,by recording the dye dilution curve simultaneously,the algorithm to isolate ICG absorption spectrum from the disturbance of peripheral arterial blood was implemented.Finally,the ICG plasma disappearance rate K,15 min retention rate R15and other hepatic hemodynamic parameters were deduced by analyzing the semi-logarithmic dye concentration graph.Combining a lab-VIEW software platform with an adaptive differential threshold method,proposed scheme eliminates the interference come from the hemoglobin absorption spectrum and baseline drift,improves the measuring accuracy greatly,and the average measurement error of K is less than 0.008.This method is great value to not only the assessing hepatic functional reserve at pre-operation,intra-operation,post-operation,but also providing a way to monitor some middle variables for clinical research purposes.

Pulse Dye Densitometry and Indocyanine Green Plasma Disappearance

Pulse Dye Densitometry and Indocyanine Green Plasma Disappearance

Evaluation of indocyanine green clearance and model for end‐stage liver disease for estimation of short‐term prognosis in decompensated cirrhosis

Indocyanine green (ICG) clearance has been proposed as a quantitative liver function test several decades ago. Interest in this method has been renewed following the development of finger pulse densitometry for noninvasive estimation of the ICG plasma disappearance rate (PDR). On the other hand, the model for end-stage liver disease (MELD), which is based on routine laboratory parameters, is widely used for estimation of short-term survival in cirrhosis, but its prognostic value in critically ill cirrhotic patients is unclear. The aim of the present study was to compare the diagnostic accuracy of ICG PDR vs. MELD for estimation of short-term prognosis in cirrhotic patients. Ninety consecutive cirrhotic patients who were admitted for decompensated disease or were being evaluated for liver transplantation were screened. Patients who underwent liver transplantation within the following 90 days and those with hepatocellular carcinoma were excluded. In the remaining 70 patients, routine laboratory parameters and ICG clearance were analysed. Following an injection of ICG 0.25 mg/kg, PDR was measured by finger pulse densitometry. The diagnostic accuracy of ICG PDR and MELD for prediction of 90-day survival was assessed by receiver-operating characteristic (ROC) curve analysis. ROC curve analysis revealed superior diagnostic accuracy for MELD as compared with ICG PDR in predicting 90-day survival (area under the ROC curve 0.89 vs. 0.71). A MELD cut-off of 22 provided the best discrimination for prediction of 90-day survival. MELD is superior to ICG PDR for estimation of short-term survival in patients with decompensated cirrhosis.

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

Introduction A non-invasive liver function monitoring system, the LiMON ®, has been developed that measures indocyanine green (ICG) elimination by pulse spectrophotometry. The aim was to assess the relationship between pre and post-operative ICG plasma disappearance rate (ICG PDR %/min) values and the onset of post-hepatectomy liver dysfunction. Methods 37 patients scheduled for major liver resections were selected. None had chronic liver disease. IGC PDR was measured preoperatively and on days 1, five and 10 postoperatively. On the same day, serum liver function tests were measured. Results The median preoperative and post-operative day 1 ICG PDR for the patients who developed liver dysfunction was significantly lower compared to those who did not ( p = 0.044, p = 0.014). Significant correlation was found between ICG PDR measurement taken on postoperative day 1 and bilirubin level on day 1 ( p = 0.002), 5 ( p =<0.001) and 10 ( p = 0.001). The same was true for ICG PDR on post-operative day 1 and albumin level on day 5 and 10 ( p = 0.003, p < 0.001). Discussion LiMON ICG PDR measured by pulse spectophotometry is a quick, non-invasive and reliable liver function test in patients undergoing liver resection that aids in the prediction and early detection of post-hepatectomy liver dysfunction.

Effect of iloprost on the microcirculation and liver function after orthotopic liver transplantation

Iloprost, a prostacyclin analogon, can probably improve the microcirculation in various tissues. It may have a positive effect on perfusion and function of the liver, especially in patients after liver transplantation. We therefore estimated liver function with the indocyanine green (ICG) plasma disappearance rate (PDR). We also evaluated iloprost effects on microcirculation in the oral mucosal tissue.

Indocyanine Green Plasma Disappearance Rate During the Anhepatic Phase of Orthotopic Liver Transplantation

Non-invasive pulse spectrophotometry to measure indocyanine green (ICG) elimination correlates well with the conventional invasive ICG clearance test. Nevertheless, the precision of this method remains unclear for any application, including small-for-size liver remnants. We therefore measured ICG plasma disappearance rate (PDR) during the anhepatic phase of orthotopic liver transplantation using pulse spectrophotometry. Measurements were done in 24 patients. The median PDR after exclusion of two outliers and two patients with inconstant signal was 1.55%/min (95% confidence interval [CI] = 0.8–2.2). No correlation with patient age, gender, body mass, blood loss, administration of fresh frozen plasma, norepinephrine dose, postoperative albumin (serum), or difference in pre and post transplant body weight was detected. In conclusion, we found an ICG-PDR different from zero in the anhepatic phase, an overestimation that may arise in particular from a redistribution into the interstitial space. If ICG pulse spectrophotometry is used to measure functional hepatic reserve, the verified average difference from zero (1.55%/min) determined in our study needs to be taken into account.

Indozyaningrün-Plasmaverschwinderate

Indocyanine green (ICG) is nearly exclusively eliminated from the blood by the liver and the ICG plasma disappearance rate (ICG-PDR) enables assessment of liver blood flow and function. The ICG-PDR which nowadays can be measured non-invasively by a transcutaneous system enables bedside and "on-line" regional monitoring in critically ill patients. So far, only complete lack of ICG-PDR as a sign of non-existing perfusion during liver transplantation has been reported. We describe two patients who developed mesenteric ischemia accompanied by an inadequate increase after revascularisation and an acute drop in the ICG-PDR. In both cases, a computed tomography scan was performed and confirmed an acute abdominal ischemia as indicated by ICG-PDR. Both patients suffered from occlusion of the truncus coeliacus while hepato-splanchnic perfusion via the A. mesenterica superior and the V. portae was maintained. ICG-PDR may be helpful for early detection of hepato-splanchnic ischemia and enables rapid and sufficient initiation of diagnostic and therapeutic procedures. In conclusion, ICG-PDR may be regarded as a clinically attractive bedside monitoring tool for early and reliable detection of partial ischemia in the hepato-splanchnic tract.

Plasma disappearance of indocyanine green: a marker for excretory liver function?

To investigate whether the plasma disappearance rate of indocyanine green (ICG) assessed using a commercially available bedside monitor provides an accurate estimation of cumulative biliary ICG excretion in a clinically relevant model of long-term, hyperdynamic porcine endotoxemia. Prospective experimental study in the animal laboratory in a university hospital. Fifteen domestic pigs. Pigs were anesthetized, mechanically ventilated, and instrumented. Intravenous endotoxin was continuously infused over 12 h concomitant with fluid resuscitation. Measurements were performed before and 12 h after the start of endotoxin infusion. All animals developed hyperdynamic circulation characterized by a sustained increase in cardiac output. Despite well maintained portal venous and consequently total liver blood flow endotoxemia decreased hepatic lactate uptake, which was accompanied by a significant fall in portal and hepatic venous pH. Both the cumulative bile flow and biliary ICG and bicarbonate excretion measured during 1 h after intravenous bolus of 25 mg ICG fell significantly. By contrast, neither the plasma disappearance rate of ICG nor the rate corrected for liver blood flow exhibited any changes over time. In hyperdynamic porcine endotoxemia the plasma disappearance rate of ICG failed to accurately substitute for direct short-term measures of biliary ICG excretion. Hence normal values of plasma disappearance rate of ICG should be interpreted with caution in early, acute inflammatory conditions.

Measurement of Indocyanine Green Dye Concentration in the Extracorporeal Circulation

Indocyanine green (ICG) is a dye used to measure plasma volume and cardiac output and to assess hepatic function by monitoring the ICG plasma disappearance rate. A method for continuous and noninvasive measurement of ICG plasma concentration (c) in the extracorporeal circulation is presented using technology originally developed for on-line measurement of hematocrit. As expected from the ICG absorption maximum at 805 nm, the presence of ICG in blood leads to a pronounced increase in hematocrit (Hct) measured by optical means. This apparent change in hematocrit (Hct(rel) = Hct/ Hct(b) - 1) relative to the baseline hematocrit (Hct(b), where c = 0) showed a strong linear relationship (Hct(rel) = k.c) with respect to ICG concentration. The dependence of k on baseline hematocrit was best described by an exponential relationship (k = a*e(b*Hctb)). The constants a and b were determined in in vitro experiments using bovine blood. With the information on a and b, and when baseline hematocrit is known and can be assumed to remain constant throughout the observation phase, plasma ICG concentration can be noninvasively and continuously measured in the extracorporeal circulation by using available optical techniques without taking blood samples. This approach greatly simplifies the diagnostic use of ICG, which may be of importance in patients treated with extracorporeal blood purification techniques.

Room G, 10/16/2000 2: 00 PM - 4: 00 PM (PS) Comparison between Invasive and Non-Invasive Measurement of Indocyanine-Green Plasma Disappearance Rate in Critically Ill Patients

<b>Room G, 10/16/2000 2: 00 PM - 4: 00 PM (PS) Comparison between Invasive and Non-Invasive Measurement of Indocyanine-Green Plasma Disappearance Rate in Critically Ill Patients</b>

Increasing Splanchnic Blood Flow in the Critically III

To assess the effect of low dose dopexamine and dopamine on splanchnic blood flow as measured by gastric intramucosal pH, hepatic metabolism of lidocaine (lignocaine) to monoethylglycinexy-lidide (MEGX), and plasma disappearance rate of indocyanine green (ICG). Single-blind randomization of patients with a gastric intramucosal acidosis to receive dopexamine (ten patients), dopamine (ten patients), or saline solution (five control patients) for 2 h. All 25 patients were in the ICU of Guys' Hospital. All patients met the criteria for the diagnosis of the systemic inflammatory response syndrome, were mechanically ventilated, and had pulmonary artery catheters placed. All had a low gastric intramucosal pH and had a median first 24-h acute physiology and chronic health evaluation (II) score of 22 (range, 7 to 40). Baseline measurements of gastric intramucosal pH, MEGX formation from lidocaine, ICG plasma disappearance rate, heart rate, mean arterial pressure, pulmonary artery occlusion pressure, cardiac index, oxygen delivery index, oxygen uptake index, systemic vascular resistance, and arterial pH were taken. Dopexamine (1 mg.kg-1.min-1), dopamine (2.5 mg.kg-1.min-1), or 0.9% saline solution was then infused for 2 h, after which a repeated set of the measurements was taken. Dopexamine at a low dose had no effect on any of the systemic measurements. The median intramucosal pH rose from 7.23 to 7.35 (p < 0.005), the median ICG plasma disappearance rate from 7.6 to 11.3%.min-1 (p < 0.02), and the median MEGX concentration from 4 to 10.2 ng.mL-1 (p < 0.005). Dopamine had no effect on any of the measured variables. There were no changes in the control group. Low-dose dopexamine increases splanchnic blood flow as measured by gastric intramucosal pH, MEGX formation from lidocaine, and ICG clearance. The lack of any change in the systemic measurements suggests that these effects are the result of a selective vasodilatation of the splanchnic vessels. At the dose used in this study, dopamine had no effect on splanchnic blood flow. Dopexamine may be useful in the management of splanchnic ischemia in the critically ill.