The validation of auricular densitometry for indocyanine green clearance measurement of hepatic blood flow during and after cardiopulmonary bypass in children

Abstract

The clinical measurement of hepatic perfusion is complicated by a dual blood supply and the invasive nature of the majority of techniques available. The aim of this study was to validate indocyanine green clearance and noninvasive auricular densitometry as a measure of hepatic perfusion in the context of paediatric cardiac surgery.

The effects of different dye concentrations on densitometer recording were assessed in vitro and found to have a linear relationship. Similarly, variations in haematocrit, within the range 21-47%, also had little effect on accuracy.

Comparison of densitometry and direct blood sampling with plasma spectrophotometry in six postoperative, normothermic children showed no significant difference between the noninvasive and invasive techniques (r = 0.968; p > 0.05, t-test). Comparison in 10 hypothermic children during cardiopulmonary bypass also showed no significant difference between the two methods, provided that no further cooling or rewarming took place (r = 0.83; p > 0.05, Wilcoxon test). Noninvasive auricular densitometry can, therefore, provide a reliable assessment of hepatic perfusion in children undergoing cardiac surgery.

Get full access to this article

View all access options for this article.

References

Bradley SE , Ingelfinger FJ , Bradley GP , Curry JJ The estimation of hepatic blood flow in man. J Clin Invest 1945; 24: 890-97.

Rudy LW , Heymann MA, Edmunds, LH Jr. Distribution of systemic blood flow during total cardiopulmonary bypass in rhesus monkeys. Surg Forum 1970; 21: 149-51.

Rudolph AM , Heymann MA Measurement of flow in perfused organs, using microsphere techniques. Acta Endocrinol 1972; suppl 158: 112-27.

Heymann MA , Payne BD , Hoffman Jie , Rudolph AM Blood flow measurements with radionuclidelabeled particles. Prog Cardiovasc Dis 1977; 20: 55-79.

Dobson EL , Jones HB The behaviour of intravenously injected particulate matter: its rate of disappearance from the blood stream as a measure of liver blood flow. Acta Med Scand 1952; 144 (suppl 273): 1-71.

Tygstrup N. , Winkler K. Galactose blood clearance as a measure of hepatic blood flow. Clin Sci 1958; 17: 1-9.

Schirmer WJ , Townsend MC , Schirmer JM , Hampton WW , Fry DE Galactose clearance as an estimate of effective hepatic blood flow: validation and limitations. J Surg Res 1986; 41: 543-56.

Keiding S. Hepatic clearance and liver blood flow. J Hepatol 1987; 4: 393-98.

Cooksley WG Anaphylaxis to bromosulphthalein. Med J Aust 1971; 2: 257-58.

10.

Leevy CM , Smith F. , Longeuville J. , Paumgartner G. , Howard MM Indocyanine green clearance as a test for hepatic function. Evaluation by dichromatic ear densitometry. JAMA 1967; 200: 148-52.

11.

Reed JH Jr , Wood EH Use of dichromatic earpiece densitometry for determination of cardiac output. J Appl Physiol 1967; 23: 373-80.

12.

Grainger SL , Keeling Pwn , Brown Imh , Marigold JH , Thompson Rph. Clearance and non-invasive determination of the hepatic extraction of indocyanine green in baboons and man. Clin Sci 1983; 64: 207-12.

13.

Rowell LB , Blackmon JR , Bruce RA Indocyanine green clearance and estimated hepatic blood flow during mild to maximal exercise in upright man. J Clin Invest 1964; 43: 1677-90.

14.

Preisig R. Clinical evaluation of liver function. In: Thomas HC , Jones EA eds. Recent advances in hepatology. Number 2. Edinburgh: Churchill Livingstone, 1986: 1-12.

15.

Cherrick GR , Stein SW , Leevy CM , Davidson CS Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. J Clin Invest 1960 ; 39: 592-600.

16.

Leevy CM , Bender J. , Silverberg M. , Naylor J. Physiology of dye extraction by the liver: comparative studies of sulfobromophthalein and indocyanine green. Ann NYAcad Sci 1963 ; 111: 161-76.

17.

Paumgartner G. The handling of indocyanine green by the liver . Reprinted from the Schweizerische Medizinische Wochenschrift . Schwabe & Co. Basel: Verlag, 1975: 1-30.

18.

Sherlock S. The liver in heart failure. Relation of anatomical, functional and circulatory changes. Br Heart J 1951 ; 13: 273-93.

19.

Ware AJ The liver when the heart fails. Gastroenterology 1978; 74: 627-28.

20.

Bynum TE , Boitnott JK , Maddrey WC Ischemic hepatitis. Dig Dis Sci 1979; 24: 129-35.

21.

Lockey E. , McIntyre N. , Ross DN , Brookes E. , Sturridge MF Early jaundice after open-heart surgery. Thorax 1967; 22: 165-69.

22.

Robinson JS , Cole FR , Gibson P. , Simpson JA Jaundice following cardiopulmonary bypass . Thorax 1967;22:232-37.

23.

Olsson R. , Hermodsson S. , Roberts D. , Waldenström J. Hepatic dysfunction after open-heart surgery. Scand J Thorac Cardiovasc Surg 1984; 18: 217-22.

24.

Sanderson RG , Ellison JH , Benson JA , Starr A. Jaundice following open-heart surgery. Ann Surg 1967; 165: 217-24.

25.

Hill DM , Warren SE , Mitas JA II, Swerdlin AHR. Hepatic coma after open heart surgery. South Med J 1980; 73: 906-11.

26.

Jenkins JG , Lynn AM , Wood AE , Trusler GA , Barker GA Acute hepatic failure following cardiac operation in children. J Thorac Cardiovasc Surg 1982; 84: 865-71.

27.

Collins JD , Bassendine MF , Ferner R. et al. Incidence and prognostic importance of jaundice after cardiopulmonary bypass surgery. Lancet 1983; i: 1119-23.

28.

Chu C-M., Chang C-H. , Liaw Y-F., Hsieh M-J. Jaundice after open heart surgery: a prospective study. Thorax 1984; 39: 52-56.

29.

Chenoweth DE , Cooper SW , Hugli TE , Stewart RW , Blackstone EH , Kirklin JW Complement activation during cardiopulmonary bypass. Evidence for generation of C3a and C5a anaphylatoxins. N Engl J Med 1981; 304: 497-503.

30.

Kirklin JK , Westaby S. , Blackstone EH , Kirklin JW , Chenoweth DE , Pacifico AD Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86: 845-57.

31.

Bonser RS , Dave JR , Davies ET et al. Reduction of complement activation during bypass by prime manipulation . Ann Thorac Surg 1990; 49: 279-83.

32.

Lees MH , Herr RH , Hill JD et al. Distribution of systemic blood flow of the rhesus monkey during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1971; 61: 570-86.

33.

Rudy LW Jr , Heymann MA , Edmunds LH Jr. Distribution of systemic blood flow during cardiopulmonary bypass. J Appl Physiol 1973 ; 34: 194-200.

34.

Mundth ED , Keller AR , Austen WG Progressive hepatic and renal failure associated with low cardiac output following open-heart surgery. J Thorac Cardiovasc Surg 1967; 53: 275-84.

35.

Matsuda H. , Covino E. , Hirose H. et al. Acute liver dysfunction after modified Fontan operation for complex cardiac lesions. Analysis of the contributing factors and its relation to the early prognosis. J Thorac Cardiovasc Surg 1988; 96: 219-26.

36.

Hampton WW , Townsend MC , Schirmer WJ , Haybron DM , Fry DE Effective hepatic blood flow during cardiopulmonary bypass. Arch Surg 1989; 124: 458-59.

37.

Mathie RT Hepatic blood flow during cardiopulmonary bypass. Crit Care Med 1993; 21: S72-S76.

38.

Waldhausen JA , Lombardo CR , McFarland JA , Cornell WP , Morrow AG Studies of hepatic blood flow and oxygen consumption during total cardiopulmonary bypass. Surgery 1959; 46: 1118-27.

39.

Mathie RT , Desai JB , Taylor KM The effect of normothermic cardiopulmonary bypass on hepatic blood flow in the dog. Perfusion 1986 ; 1: 245-53.

40.

Mori A. , Watanabe K. , Onoe M. et al. Regional blood flow in the liver, pancreas and kidney during pulsatile and nonpulsatile perfusion under profound hypothermia. Jpn Circ J 1988; 52: 219-27.

41.

Shimokawa S. Portal and hepatic circulation during cardiopulmonary bypass in chronic congestive liver. An experimental study. Nippon Geka Gakkai Zasshi 1989;90:695-704.

42.

Sutterer WF , Wood EH A compensated dichromatic densitometer for indocyanine green. IRE Trans Biomed Electronics 1962; 9: 133-37.

43.

Wheeler HO , Cranston WI , Meltzer JI Hepatic uptake and biliary excretion of indocyanine green in the dog. Proc Soc Exp Biol Med 1958; 99: 11-14.

44.

Caesar J. , Shaldon S. , Chiandussi L. , Guevara L. , Sherlock S. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci 1961 ; 21: 43-57.

45.

Pau gartner G. , Vasella DL , Herz R. , Reichenj , Preisig R. Hepatische extraktion von Taurocholat und Indocyaningrün bei Patienten mit Lebererkrankungen. Z Gastroenterol 1979; 17: 753-61.

46.

George WS , Leevy CM Abnormal BSP extraction induced by glucagon and prevented by oxygen inhalation . Clin Res 1961; 9: 152 (Abstract).

47.

Teranaka M. , Schenk WG Hepatic blood flow measurement. A comparison of the indocyanine green and electromagnetic techniques in normal and abnormal flow states in the dog. Ann Surg 1977; 185: 58-63.

48.

Baker KJ Binding of sulfobromophthalein (BSP) sodium and indocyanine green (ICG) by plasma alpha1-lipoproteins. Proc Soc Exp Biol 1966; 122: 957-63.

49.

Nakagawa S. , Nagata K. , Nagashima H.

Investigation of the hepatic excretion mechanisms of indocyanine green in patients with liver disease. III. Binding of indocyanine green to plasma proteins, with particular reference to the clinical evaluation. Kumamoto

Med J 1977; 30: 9-15.

50.

Cropp Gja. Effect of hematocrit on response characteristics of indocyanine green densitometers . J Appl Physiol 1969; 27: 132-36.

51.

Knutson Jrb , Taylor BE , Ellis EJ , Wood EH Studies on circulation time with the aid of the oximeter. Proc Staff Meet Mayo Clin 1950 ; 25: 405-12.

52.

Beard EF , Wood EH Estimation of cardiac output by the dye dilution method with an ear oximeter . J Appl Physiol 1951; 4: 177-87.

53.

Nicholson JW III , Wood EH Estimation of cardiac output and Evans blue space in man, using an oximeter. J Lab Clin Med 1951; 38: 588-603.

54.

Warner HR , Wood EH Simplified calculation of cardiac output from dye dilution curves recorded by oximeter. J Appl Physiol 1952; 5: 111-16.

55.

Gilmore HR , Hamilton M. , Kopelman H. , Sommer LS The ear oximeter: its use clinically and in the determination of cardiac output . Br Heart J 1954; 16: 301-10.

56.

Gabe I. , Shillingford J. The photo-electric earpiece technique for recording dye dilution curves. Br Heart J 1961; 23: 271-80.

57.

McGregor M. , Sekelj P. , Adam W. Measurement of cardiac output in man by dye dilution curves using simultaneous ear oximeter and whole blood cuvette techniques . Circulation Res 1961; 9: 1083-88.

58.

Wood EH , Swan Hjc , Helmholz JF Jr. Recording and basic patterns of dilution curves: normal and abnormal. Proc Staff Meet Mayo Clin 1957 ; 32: 464-77.