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Puelz C, Danial Z, Raval JS, Marinaro JL, Griffith BE, Peskin CS. Models for plasma kinetics during simultaneous therapeutic plasma exchange and extracorporeal membrane oxygenation. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2021; 38:255-271. [PMID: 33626571 DOI: 10.1093/imammb/dqab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/17/2020] [Accepted: 01/24/2021] [Indexed: 11/13/2022]
Abstract
This paper focuses on the derivation and simulation of mathematical models describing new plasma fraction in blood for patients undergoing simultaneous extracorporeal membrane oxygenation and therapeutic plasma exchange. Models for plasma exchange with either veno-arterial or veno-venous extracorporeal membrane oxygenation are considered. Two classes of models are derived for each case, one in the form of an algebraic delay equation and another in the form of a system of delay differential equations. In special cases, our models reduce to single compartment ones for plasma exchange that have been validated with experimental data (Randerson et al., 1982, Artif. Organs, 6, 43-49). We also show that the algebraic differential equations are forward Euler discretizations of the delay differential equations, with timesteps equal to transit times through model compartments. Numerical simulations are performed to compare different model types, to investigate the impact of plasma device port switching on the efficiency of the exchange process, and to study the sensitivity of the models to their parameters.
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Affiliation(s)
- Charles Puelz
- Department of Pediatrics, Section of Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Zach Danial
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Jonathan L Marinaro
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Boyce E Griffith
- Departments of Mathematics, Applied Physical Sciences, and Biomedical Engineering, University of North Carolina; Carolina Center for Interdisciplinary Applied Mathematics, University of North Carolina; Computational Medicine Program, University of North Carolina, and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Charles S Peskin
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
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Froghi F, Koti R, Gurusamy K, Mallett S, Thorburn D, Selves L, James S, Singh J, Pinto M, Eastgate C, McNeil M, Filipe H, Jichi F, Schofield N, Martin D, Davidson B. Cardiac output Optimisation following Liver Transplant (COLT) trial: study protocol for a feasibility randomised controlled trial. Trials 2018. [PMID: 29514697 PMCID: PMC5842525 DOI: 10.1186/s13063-018-2488-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation. Methods The Cardiac output Optimisation following Liver Transplant (COLT) trial is designed as a prospective, single-centre, randomised controlled study to assess the feasibility and safety of GDFT in liver transplantation for patients with cirrhosis. Consenting adults (aged between 18 and 80 years) with biopsy-proven liver cirrhosis who have been selected to undergo a first liver transplantation will be included in the trial and randomised into GDFT or standard care starting immediately after surgery and continuing for the first 12 h thereafter. Both groups will have cardiac output and stroke volume monitored using the FloTrac (EV1000) device. The intervention will consist of a protocolised GDFT approach to patient management, using stroke volume optimisation. The control group will receive standard care, without stroke volume and cardiac output measurement. After 12 h the patient’s fluid management will revert to standard of care. The primary endpoint of this study is feasibility. Secondary endpoints will include a safety assessment of the intervention, graft and patient survival, liver function, postoperative complications graded by Clavien-Dindo criteria, length of intensive care and hospital stay and quality of life across the intervention and control groups. Discussion There is a growing body of evidence that the use of perioperative GDFT in surgical patients can improve outcomes; however, signals of harm have also been detected. Patients with liver cirrhosis undergoing liver transplantation have markedly different cardiovascular physiology than general surgical patients. If GDFT is proven to be feasible and safe in this patient group, then a multicentre trial to demonstrate efficacy and cost-effectiveness will be required. Trial registration International Standard Randomised Controlled Trial Registry, ID: ISRCTN10329248. Registered on 4 April 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2488-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farid Froghi
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rahul Koti
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Susan Mallett
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Linda Selves
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Sarah James
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Jeshika Singh
- Health Economic Research Group, Brunel University, London, UK
| | - Manuel Pinto
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | | | - Margaret McNeil
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Helder Filipe
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Fatima Jichi
- Biostatistics Group, Joint Research Office, University College London, London, UK
| | - Nick Schofield
- Royal Free Perioperative Research Group (RoFPoR), Royal Free Hospital, London, UK
| | - Daniel Martin
- Division of Surgery and Interventional Science, University College London, London, UK. .,Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK. .,Royal Free Perioperative Research Group (RoFPoR), Royal Free Hospital, London, UK.
| | - Brian Davidson
- Division of Surgery and Interventional Science, University College London, London, UK
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Du Z, Wei Y, Chen K, Chen X, Zhang Z, Li H, Ma Y, Li B. Risk factors and criteria predicting early graft loss after adult-to-adult living donor liver transplantation. J Surg Res 2014; 187:673-82. [DOI: 10.1016/j.jss.2013.10.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/08/2013] [Accepted: 10/24/2013] [Indexed: 12/11/2022]
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Weiss M, Krejcie TC, Avram MJ. A physiologically based model of hepatic ICG clearance: interplay between sinusoidal uptake and biliary excretion. Eur J Pharm Sci 2011; 44:359-65. [PMID: 21893195 DOI: 10.1016/j.ejps.2011.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 06/28/2011] [Accepted: 08/20/2011] [Indexed: 11/18/2022]
Abstract
Although indocyanine green (ICG) has long been used for the assessment of liver function, the respective roles of sinusoidal uptake and canalicular excretion in determining hepatic ICG clearance remain unclear. Here this issue was addressed by incorporating a liver model into a minimal physiological model of ICG disposition that accounts of the early distribution phase after bolus injection. Arterial ICG concentration-time data from awake dogs under control conditions and from the same dogs while anesthetized with 3.5% isoflurane were subjected to population analysis. The results suggest that ICG elimination in dogs is uptake limited since it depends on hepatocellular uptake capacity and on biliary excretion but not on hepatic blood flow. Isoflurane caused a 63% reduction in cardiac output and a 33% decrease in the ICG biliary excretion rate constant (resulting in a 26% reduction in elimination clearance) while leaving unchanged the sinusoidal uptake rate. The terminal slope of the concentration-time curve, K, correlated significantly with elimination clearance. The model could be useful for assessing the functions of sinusoidal and canalicular ICG transporters.
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Affiliation(s)
- Michael Weiss
- Section of Pharmacokinetics, Department of Pharmacology, Martin Luther University Halle-Wittenberg, Halle, Germany.
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Milesi-Hallé A, Abdel-Rahman SM, Brown A, McCullough SS, Letzig L, Hinson JA, James LP. Indocyanine green clearance varies as a function of N-acetylcysteine treatment in a murine model of acetaminophen toxicity. Chem Biol Interact 2010; 189:222-9. [PMID: 21145883 DOI: 10.1016/j.cbi.2010.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 01/05/2023]
Abstract
Standard assays to assess acetaminophen (APAP) toxicity in animal models include determination of ALT (alanine aminotransferase) levels and examination of histopathology of liver sections. However, these assays do not reflect the functional capacity of the injured liver. To examine a functional marker of liver injury, the pharmacokinetics of indocyanine green (ICG) were examined in mice treated with APAP, saline, or APAP followed by N-acetylcysteine (NAC) treatment.Male B6C3F1 mice were administered APAP (200 mg/kg IP) or saline. Two additional groups of mice received APAP followed by NAC at 1 or 4 h after APAP. At 24 h, mice were injected with ICG (10 mg/kg IV) and serial blood samples (0, 2, 10, 30, 50 and 75 min) were obtained for determination of serum ICG concentrations and ALT. Mouse livers were removed for measurement of APAP protein adducts and examination of histopathology. Toxicity (ALT values and histology) was significantly increased above saline treated mice in the APAP and APAP/NAC 4 h mice. Mice treated with APAP/NAC 1 h had complete protection from toxicity. APAP protein adducts were increased in all APAP treated groups and were highest in the APAP/NAC 1 h group. Pharmacokinetic analysis of ICG demonstrated that the total body clearance (Cl(T)) of ICG was significantly decreased and the mean residence time (MRT) was significantly increased in the APAP mice compared to the saline mice. Mice treated with NAC at 1 h had Cl(T) and MRT values similar to those of saline treated mice. Conversely, mice that received NAC at 4 h had a similar ICG pharmacokinetic profile to that of the APAP only mice. Prompt treatment with NAC prevented loss of functional activity while late treatment with NAC offered no improvement in ICG clearance at 24 h. ICG clearance in mice with APAP toxicity can be utilized in future studies testing the effects of novel treatments for APAP toxicity.
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Krejci V, Vannucci A, Abbas A, Chapman W, Kangrga IM. Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation. Liver Transpl 2010; 16:773-82. [PMID: 20517912 DOI: 10.1002/lt.22056] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI(L)) and the FloTrac-Vigileo monitor (CI(V)). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI(TD)). CI(V)-CI(TD) bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CI(L)-CI(TD) bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CI(TD) was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI(TD) was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI(TD). In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation.
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Affiliation(s)
- Vladimir Krejci
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Reekers M, Simon MJG, Boer F, Mooren RAG, van Kleef JW, Dahan A, Vuyk J. Pulse dye densitometry and indocyanine green plasma disappearance in ASA physical status I-II patients. Anesth Analg 2010; 110:466-72. [PMID: 20081133 DOI: 10.1213/ane.0b013e3181c92b09] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Indocyanine green plasma disappearance rate (ICG-PDR) is used to evaluate hepatic function. Although hepatic failure is generally said to occur with an ICG-PDR <18%/min, ICG disappearance rate is poorly defined in the healthy population, and a clear cutoff value of ICG-PDR that discriminates between normal hepatic function and hepatic failure has not yet been described. We therefore defined the ICG disappearance rate in an otherwise healthy patient population. In addition, we evaluated the noninvasive measurement of ICG-PDR (transcutaneously by pulse dye densitometry [PDD] at the finger and the nose) and compared these with the simultaneously performed invasive measurements of ICG-PDR (in arterial blood). METHODS In patients without signs of liver disease, scheduled for elective nonhepatic surgery, 10 mg ICG was administered IV and ICG-PDR measured by PDD (DDG-2001, Nihon Kohden, Tokyo, Japan). In a subset of patients, arterial blood samples were gathered to compare PDD with invasive ICG measurements. Methods were compared using Bland-Altman analysis. The results of our study and reported studies on discriminative use of ICG-PDR in assessing liver failure were used to construct receiver operating characteristic curves. RESULTS Forty-one patients were studied: 33 using the finger probe and 8 using the nose probe. The mean +/- SD noninvasive ICG-PDR in this patient population is 23.1% +/- 7.9%/min (n = 41) with a range of 9.7% to 43.2%/min. Bias (+/-2 sd, limits of agreement) for ICG-PDR measured by PDD compared with those measured in arterial blood were 1.6%/min (-5.2% to 8.3%/min) for the finger probe and -6.0%/min (-15.5% to 3.4%/min) for the nose probe. CONCLUSION ICG-PDR values in a population without liver failure ranged well below 18%/min, cited as the cutoff value for hepatic failure. This cutoff value needs reconsideration. In addition, we conclude that the ICG concentration is adequately determined noninvasively by PDD.
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Affiliation(s)
- Marije Reekers
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Weiss M. Cardiac output and systemic transit time dispersion as determinants of circulatory mixing time: a simulation study. J Appl Physiol (1985) 2009; 107:445-9. [PMID: 19498099 DOI: 10.1152/japplphysiol.00140.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A new approach to characterize the kinetics of intravascular mixing process is presented. The mixing time, defined as the time required for achieving 95% homogeneity, is calculated by numerical simulations using a circulatory model applied to the intravascular marker indocyanine green (ICG). The results suggest that the mixing time is determined by cardiac output and the relative dispersion of transit time distribution across the systemic circulation, whereby the rate of mixing increases with increasing cardiac output and decreasing transit time dispersion, and vice versa. The estimation of plasma volume from simulated ICG dilution data using the backextrapolation method shows that slow mixing is accompanied by an overestimation of blood volume. This error may be negligible for mixing times of less than approximately 3 min but high in disease states characterized by low cardiac output and/or high transit time dispersion. In view of the role of transit time dispersion as determinant of intravascular mixing, it would be interesting to know more about the effect of disease states on systemic transit time dispersion.
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Affiliation(s)
- Michael Weiss
- Section of Pharmacokinetics, Department of Pharmacology, Martin Luther University Halle-Wittenberg, D-06097 Halle, Germany.
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Hori T, Yagi S, Iida T, Taniguchi K, Yamagiwa K, Yamamoto C, Hasegawa T, Yamakado K, Kato T, Saito K, Wang L, Torii M, Hori Y, Takeda K, Maruyama K, Uemoto S. Optimal systemic hemodynamic stability for successful clinical outcomes after adult living-donor liver transplantation: prospective observational study. J Gastroenterol Hepatol 2008; 23:e170-e178. [PMID: 18422962 DOI: 10.1111/j.1440-1746.2008.05394.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Most living-donor liver transplantation (LDLT) recipients show characteristic systemic hemodynamics due to liver cirrhosis, and systemic hemodynamics after LDLT influenced postoperative graft function corresponding to outcomes. However, identities of optimal systemic hemodynamics for excellent outcomes and precise parameters for clinical strategy remain unclear. METHODS Therefore, we performed prospective study in adult LDLT recipients from 2003. Hemodynamic parameters were prospectively recorded, and were analyzed in 40 recipients classified into three groups: cirrhotic (group I-C) or non-cirrhotic recipients (group I-NC) with good outcomes, and cirrhotic recipients (group II-C) without good outcomes. RESULTS Group I-C retained characteristic hyperdynamics even after LDLT. However, absolute values of parameters revealed no significant differences between groups I-C and II-C, because group II-C also tended to show hyperdynamics. It is suggested that successful outcomes in cirrhotic recipients require maintenance of optimal hyperdynamic stability after LDLT, because cirrhotic vascular alterations still occurred. Because hemodynamic behaviors were different between groups I-C and I-NC, absolute values were also significantly different even in these successful two groups. Thus, absolute values themselves were not necessarily satisfactory for accurate evaluation of optimal hemodynamic stability. Cirrhotic hyperdynamics are symbolized in large blood volume (BV) circulated by high cardiac output (CO); therefore, we standardized CO against BV. CO/BV was significantly different between groups I-C and II-C, reflecting subtle variability of hyperdynamics in groups II-C, and was interestingly constant in the two successful groups. Therefore, CO/BV reliably evaluated optimal hemodynamic stability after LDLT, and accurately predicted outcomes. CONCLUSION Identification of inappropriate hemodynamics after LDLT is advantageous to further improve LDLT outcomes.
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Affiliation(s)
- Tomohide Hori
- Department of Hepato-pancreato-biliary Surgery and Transplantation, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
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Hori T, Yagi S, Iida T, Taniguchi K, Yamagiwa K, Yamamoto C, Hasegawa T, Yamakado K, Kato T, Saito K, Wang L, Torii M, Hori Y, Takeda K, Maruyama K, Uemoto S. Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis. World J Gastroenterol 2007; 13:5918-5925. [PMID: 17990357 PMCID: PMC4205438 DOI: 10.3748/wjg.v13.i44.5918] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 08/15/2007] [Accepted: 10/17/2007] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation (LDLT), and to clarify how systemic hemodynamics impact on local graft circulation after LDLT. METHODS Systemic hemodynamics, indocyanine green (ICG) elimination rate (K ICG) and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry (PDD) and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output (CO) to blood volume (BV) and mean transit time (MTT), defined as the time required for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function. RESULTS Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance (TPR) were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and MTT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased K ICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow. CONCLUSION We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.
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Marx G, Schuerholz T, Pedder S, Simon T, Grime S, Sümpelmann R, Leuwer M. Blood volume measurements using an integrated fiberoptic monitoring system in a porcine septic shock model. Crit Care Med 2006; 34:1483-8. [PMID: 16557156 DOI: 10.1097/01.ccm.0000216706.29242.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the accuracy of an integrated fiberoptic monitoring system using transpulmonary thermo-dye dilution technique to measure blood volume (BV) with standard method using chromium-51-tagged erythrocytes in septic shock. DESIGN Prospective blinded animal laboratory study. SETTING University department of anesthesiology. SUBJECTS Thirty-five anesthetized and mechanically ventilated pigs (21.4 +/- 2.2 kg) were investigated over a period of 6 hrs. INTERVENTIONS Septic shock was induced with fecal peritonitis (0.75 g . kg per body weight autologous feces). A central venous catheter was used for injection of the indicator dyes. MEASUREMENTS AND MAIN RESULTS BV was measured by detecting indocyanine green using a 4-Fr aortic catheter with an integrated fiberoptic and thermistor connected to a computer system for calculation of transpulmonary indicator dilution BV (BVTPID). Cr-tagged erythrocytes were used as standard method of BV measurement (BV-Cr). Hemodynamic treatment scheme was aimed at maintenance of a central venous pressure of 12 mm Hg. Data were analyzed using Bland-Altman analyses. One hundred and five data pairs of simultaneous BV measurements were yielded during hemodynamic stability with a mean BVTPID of 64.2 +/- 17.8 mL . kg. Mean BV-Cr was 83.1 +/- 17.0 mL . kg. Linear regression equation was BVTPID = 0.58 x BV-Cr + 15.8 (r = .56, p < .01). Mean bias was 18.9 mL . kg (95% confidence interval, 15.7-22.1 mL . kg), with limits of agreement of -13.9 to 51.7 mL . kg. CONCLUSIONS Transpulmonary indicator dilution for blood volume measurement agrees moderately with standard method using Cr-tagged erythrocytes in porcine septic shock.
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Affiliation(s)
- Gernot Marx
- Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena-Germany, Erlanger Allee 101, D-07747 Jena, Germany.
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Hori T, Iida T, Yagi S, Taniguchi K, Yamamoto C, Mizuno S, Yamagiwa K, Isaji S, Uemoto S. K(ICG) value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation. Liver Transpl 2006; 12:605-613. [PMID: 16555326 DOI: 10.1002/lt.20713] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Reliable monitoring enabling evaluation of graft function is crucial after living-donor liver transplantation (LDLT). A method to identify poor graft function at an early postoperative period would allow opportune intensive clinical management to bring about further improvements in LDLT outcomes. This study assessed the reliability of the indocyanine green (ICG) elimination rate constant (K(ICG)) value as an estimator of graft function and determined the actual temporal changes of K(ICG) after LDLT. K(ICG) values were measured using a noninvasive method in 30 adult recipients up to 28 days after LDLT. The receptor index (LHL15) based on liver scintigraphy, and graft parenchymal damage score based on histopathological findings were evaluated after LDLT and correlated well with simultaneous K(ICG). Thus, K(ICG) measured by noninvasive method was confirmed as accurately evaluating graft function. Changes of K(ICG) after LDLT in recipients with good graft function were maintained, after some falls in the early periods, and had a significant difference compared with those for recipients without good graft function; moreover, there were already significant differences in K(ICG) 24 hours after LDLT. Mean transit time reflecting systemic hemodynamics revealed that recipients without good outcomes fell into an unstable systemic hemodynamic state, and effective hepatic blood flow has a large influence on liver regeneration after LDLT. In conclusion, we suggested that K(ICG) values can predict clinical outcomes at the early postoperative period after LDLT by sharply reflecting the influence of systemic dynamics on splanchnic circulation.
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Affiliation(s)
- Tomohide Hori
- First Department of Surgery, School of Medicine, Mie University, Tsu City, Mie Prefecture, Japan.
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Kostopanagiotou G, Theodoraki K, Pandazi A, Arkadopoulos N, Kostopanagiotou K, Smyrniotis V. Changes in oxyhemoglobin dissociation curve in intrabdominal organs during pig experimental orthotopic liver transplantation. Liver Transpl 2005; 11:760-766. [PMID: 15973719 DOI: 10.1002/lt.20438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Liver transplantation has become a gold standard treatment for irreversible liver disease. Conventional measures of oxygenation are inadequate to understand the dynamics of regional oxygen metabolism during liver transplantation because they represent global markers of tissue dysoxia. Therefore, the addition of an assessment of the hemoglobin O(2) binding capacity can give a better insight into systemic and regional tissue oxygenation and can reflect a more accurate estimation of oxygen release to the tissues than can the hemoglobin, the PaO(2) and SaO(2) alone. This prospective study was designed to evaluate possible alterations in the oxyhemoglobin dissociation curve of vital end organs (small bowel, liver, and kidney) in an experimental liver transplantation model. Fifteen pigs with body weights ranging from 25 to 30 kg were used for the study. Five healthy pigs underwent a sham operation under general anesthesia (group A-control). Ten pigs underwent orthotopic liver transplantation (OLT). Five of them were healthy (group B), whereas the other five were in acute liver failure, which had been surgically induced (group C). Systemic arterial blood pressure, cardiac index, and pulmonary and systemic vascular resistance indexes were measured. Venous blood gas analysis was also performed from pulmonary artery, superior mesenteric, hepatic, and renal veins at well-defined timepoints during the course of the OLT. A statistically significant (P < 0.05) decrease of P(50) in groups B and C compared with group A was observed 30 minutes after reperfusion in the systemic circulation, hepatic, and renal veins. This coincided with a decrease in animal temperature 30 minutes after reperfusion. Regarding group C, after reperfusion of the newly transplanted liver there was a significant increase of P(50) in the small bowel in comparison to baseline values. In conclusion, these changes in P(50) may suggest the occurrence of abnormal tissue oxygenation after reperfusion.
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Affiliation(s)
- Georgia Kostopanagiotou
- Second Department of Anesthesiology, Attikon Hospital, University of Athens School of Medicine; Athens, Greece
| | - Kassiani Theodoraki
- First Department of Anesthesiology, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | - Ageliki Pandazi
- Second Department of Anesthesiology, Attikon Hospital, University of Athens School of Medicine; Athens, Greece
| | - Nikolaos Arkadopoulos
- Second Department of Surgery, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | | | - Vassilios Smyrniotis
- Second Department of Surgery, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
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Hsieh CB, Chen CJ, Chen TW, Yu JC, Shen KL, Chang TM, Liu YC. Accuracy of indocyanine green pulse spectrophotometry clearance test for liver function prediction in transplanted patients. World J Gastroenterol 2004; 10:2394-6. [PMID: 15285026 PMCID: PMC4576295 DOI: 10.3748/wjg.v10.i16.2394] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To investigate whether the non-invasive real-time Indocynine green (ICG) clearance is a sensitive index of liver viability in patients before, during, and after liver transplantation.
METHODS: Thirteen patients were studied, two before, three during, and eight following liver transplantation, with two patients suffering acute rejection. The conventional invasive ICG clearance test and ICG pulse spectrophotometry non-invasive real-time ICG clearance test were performed simultaneously. Using linear regression analysis we tested the correlation between these two methods. The transplantation condition of these patients and serum total bilirubin (T. Bil), alanine aminotransferase (ALT), and platelet count were also evaluated.
RESULTS: The correlation between these two methods was excellent (r2 = 0.977).
CONCLUSION: ICG pulse spectrophotometry clearance is a quick, non-invasive, and reliable liver function test in transplantation patients.
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Affiliation(s)
- Chung-Bao Hsieh
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, China.
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Mandell MS, Wachs M, Niemann CU, Henthorn TK. Elimination of indocyanine green in the perioperative evaluation of donor liver function. Anesth Analg 2002; 95:1182-4, table of contents. [PMID: 12401588 DOI: 10.1097/00000539-200211000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPLICATIONS The authors describe the intraoperative use of indocyanine green dye elimination to detect critical reductions in donor liver function.
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Affiliation(s)
- M Susan Mandell
- Department of Anesthesiology, Division of Transplantation, University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Denver, CO 80262, USA.
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