Plasma disappearance of indocyanine green: a marker for excretory liver function?
- 227 Downloads
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.
Design and setting
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.
Measurements and results
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.
KeywordsEndotoxin Sepsis Indocyanine green Liver function Liver blood flow Biliary excretion
- 3.Kuntz HD, Schregel W (1990) Indocyanine green: evaluation of liver function—application in intensive care medicine. In: Lewis FR, Pfeiffer UJ (eds) Fiberoptics in critical care monitoring. Springer, Berlin Heidelberg New York, pp 57–62Google Scholar
- 6.Ott P (1998) Hepatic elimination of indocyanine green with special reference to distribution kinetics and the influence of plasma protein binding. Pharmacol Toxicol 83 Suppl 2:1–48Google Scholar
- 9.Theisen M, Träger K, Tugtekin I, Stehr A, Ploner F, Georgieff M, Radermacher P, Matejovic M (2001) Effects of nicotinamide, an inhibitor of PARS activity, on gut and liver O2 exchange and energy metabolism during hyperdynamic porcine endotoxemia. Intensive Care Med 27:586–592CrossRefPubMedGoogle Scholar
- 10.Nickel N, Schummer A, Seifferle E (1967) Lehrbuch der Anatomie der Haustiere, vol II. Parey, BerlinGoogle Scholar
- 14.Kisor DF, Frye RF, Kudsk KA (1993) Estimation of the hepatic extraction ratio of indocyanine green in swine. Clin Sci (Lond) 84:681–685Google Scholar
- 15.Burns E, Ball CE, Christie JP, Broadhead GD, Tucker GT, Bax ND (1989) Direct, indirect measurement of the hepatic extraction ratio of indocyanine green in the rat (1989) Clin Sci (Lond) 76:503–508Google Scholar
- 17.Grainger SL, Keeling PW, Brown IM, Marigold JH, Thompson RP (1983) Clearance and non-invasive determination of the hepatic extraction of indocyanine green in baboons and man. Clin Sci (Lond) 64:207–212Google Scholar
- 18.Burns E, Triger DR, Tucker GT, Bax ND (1991) Indocyanine green elimination inpatients with liver disease and in normal subjects. Clin Sci (Lond) 80:155–160Google Scholar
- 19.Burczynski FJ, Pushka KL, Sitar DS, Greenway CV (1987) Hepatic plasma flow: accuracy of estimation from bolus injections of indocyanine green. Am J Physiol 252:H935–H962Google Scholar