PiCCO2 PDR Flyer - PULSION Medical Systems SE
PiCCO2 PDR Flyer - PULSION Medical Systems SE
PiCCO2 PDR Flyer - PULSION Medical Systems SE
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Non-invasive measurement<br />
Non-invasive measurement<br />
via finger-sensor<br />
PiCCO 2 incorporates the<br />
<strong>PDR</strong> for liver function<br />
measurement<br />
Literature<br />
1. Tsubono T et al, Indocyanine Green Elimination Test in<br />
Orthotopic Liver Recipients, Hepatology 1996 Vol 24(5): 1165-71<br />
2. Jalan R et al, A pilot study of indocyanine green clearance as<br />
an early predictor of graft function, Transplantation 1994 Vol<br />
58(2): 196-200<br />
3. Scheingraber S et al, Indocyanine green disappearance rate is<br />
the most useful marker for liver resection<br />
Hepatogastroenterology 2008 Vol 55(85): 1394-9<br />
ICG dilution curve<br />
non-invasive<br />
<strong>PDR</strong> ICG Measurement<br />
The <strong>PDR</strong> ICG is measured<br />
during the second part<br />
of the ICG dilution curve<br />
4. Kortgen A et al Prospective assessment of hepatic function and<br />
mechanisms of dysfunction in the critically ill, Shock 2009 epub<br />
5. Sakka S et al, Prognostic value of the indocyanine green plasma<br />
disappearance rate in critically ill patients Chest 2002 Vol 122(5):<br />
1715-20<br />
<strong>PULSION</strong> <strong>Medical</strong> <strong>Systems</strong> AG • Joseph-Wild-Str. 20 • 81829 Munich, Germany<br />
Tel. +49-(0)89-45 99 14-0 • Fax +49-(0)89-45 99 14-18<br />
info@pulsion.com • www.<strong>PULSION</strong>.com 0124<br />
MPI500205_R01 © <strong>PULSION</strong> 11/2009<br />
• Reflects the actual liver function<br />
• Non-invasive measurement<br />
• Available at the bedside<br />
• Integrated into PiCCO 2<br />
BewARe!<br />
Liver dysfunction kills<br />
earliest detection with <strong>PDR</strong> ICG
<strong>PDR</strong> ICG - Plasma Disappearance Rate of Indocyanine Green<br />
<strong>PDR</strong> ICG is to the liver what creatinine clearance is to the kidneys<br />
• Dynamic liver function test (LFT)<br />
• Immediate profile of actual global liver function & perfusion<br />
F i e l d s o f a p p l i c a t i o n<br />
Liver<br />
Trans-<br />
plantation<br />
Liver<br />
Resection<br />
General<br />
Intensive<br />
Care<br />
• Best indicator of graft dysfunction post LTx<br />
• Peri-operative graft evaluation<br />
• Risk indicator pre liver resection<br />
• Estimation of safe resection volume<br />
• Post operative liver function indicator<br />
• Earliest indicator of liver dysfunction<br />
• Risk stratification of ICU patients<br />
• Low <strong>PDR</strong> ICG is associated with<br />
increased mortality<br />
• Significantly better specifity and sensitifity than standard LFTs<br />
• Changes detected instantly, unlike liver blood tests<br />
„The ICG elimination test ... is a<br />
reliable indicator of graft quality<br />
and subsequent graft outcome<br />
early after liver translantation“<br />
Tsubono, Hepatology 1996 1)<br />
„<strong>PDR</strong> ICG should be measured<br />
pre-operatively and daily after<br />
liver resection in patients at risk<br />
(underlying liver disease,<br />
resections > 30%)“<br />
Scheingraber, Hepato-Gastro 2008 3)<br />
Sensitifity<br />
ICG <strong>PDR</strong><br />
Bilirubin<br />
Reference line<br />
The <strong>PDR</strong> ICG is more specific and sensitive for detecting<br />
liver dysfunction than bilirubin<br />
Kortgen, Shock 2009 4)<br />
Specifity<br />
ICG clearance<br />
good<br />
graft function<br />
poor<br />
graft function<br />
ICG clearance in patients with good and poor graft function after<br />
transplantation Jalan Transplant, 1994 2)<br />
Sensitifity<br />
ICG <strong>PDR</strong><br />
PT values<br />
Reference line<br />
ICG <strong>PDR</strong><br />
Bilirubin<br />
Reference line<br />
Specifity<br />
ROC curves for postoperative <strong>PDR</strong> ICG and prothrombin (PT) values, and<br />
<strong>PDR</strong> ICG and bilirubin values in cases of postoperative liver dysfunction 4)<br />
33%<br />
<strong>PDR</strong><br />
> 16 %/min<br />
<strong>PDR</strong><br />
< 16 %/min<br />
67%<br />
36 %<br />
survivors<br />
64 %<br />
non-survivors<br />
> 60% of ICU patients requiring haemodynamic monitoring<br />
have liver dysfunction Sakka, Chest 2002 5)
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