LiMON_E_V02_03_02.PPT Page 1 Non-invasive liver function monitoring PULSION LiMON.

LiMON_E_V02_03_02.PPT

Non-invasive

liver function monitoring

PULSION LiMON


Setup Configuration

PC50150 LiMON reusable sensor for adults and infants

PV50100 LiMON disposable sensor for adults and infantsPV50200 LiMON disposable sensor for neonates

PICG0025 ICG-PULSION 25 mgPICG0050 ICG-PULSION 50 mg

PC5000 LiMON


Pulse Densitometry Based on Pulse Oximetry

pulsatile905 nm

non pulsatile805 nm

non pulsatile905 nm

pulsatile805 nmLEDs805 nm & 905 nm

Sensor

[s]0 10 20 30 40 50

0

10

20

30

40

CICG mg/l

pulsatile905 nm

non pulsatile905 nm

pulsatile805 nm

non pulsatile805 nm

CICG =


ICG Dilution Curve Analysis

dynamically determined range for back extrapolation

CICG mg/l

calculation of half life time and elimination rate of ICG-PULSION


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)

Parameters


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

Calculations and Normal Ranges


Invasive COLD System vs non-invasive LiMON (16 pts, n=54)

Validation

Sakka S, Meier-Hellmann A: International Journal of Intensive Care, 2002


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

Sakka SG, Meier-Hellmann A: Yearbook of Intensive Care and Emergency Medicine, 2001

Non-survivorsn= 168

Survivorsn= 168

45

40

35

30

25

20

15

10

5

0

ICG

-PD

R [ %

/ min

]

(p< 0.001)

*

*

Significantly reduced liver function in non-survivors


Kimura S et al: Crit Care Med 2001

Clear indicator of probability of survival in septic shock

Prognosis of Survival in ICU Patients

(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

(Non-survivors)


BILIRUBIN

(>33.8)

ICG-PDR

0 20 40 60 80 100

100-Specificity [%]

100

80

60

40

20

0

Sen

sitiv

ity [

%]

(>15.2)

n= 336p= 0.06

Sakka SG, Meier-Hellmann A: Yearbook of Intensive Care and Emergency Medicine, 2001

Value as Liver Function Test in Intensive Care

Higher sensitivity and specificity than bilirubin


Liver Function in Organ Donors

Wesslau C et al: Transplantology 1994

Clear borderline for transplantation suitability


Application After Liver Transplantation

Jalan R et al: Transplantation 1994

Clear borderline for probability of graft function


Value as Liver Function Test in Liver Surgery

Hemming AW et al: Am J Surg 1992

Better correlation with prognosis than laboratory parameters in cirrhotic patients


Hashimoto M and Watanabe G: J Surg Res 2000

Correlation between parenchymal cell volume and ICG elimination

Value as Liver Function Test in Liver Surgery


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 applicationResults not user dependent, up to 10 measurements per 24 hours

Time and cost savingReduces the numbers of laboratory blood/plasma samples

LiMON_E_V02_03_02.PPT Page 1 Non-invasive liver function monitoring PULSION LiMON.

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