1. liver function monitoring
PULSION LiMON
Non-invasive
liver function monitoring

2. Setup Configuration PC5000 LiMON PICG0025 ICG-PULSION 25 mg
PC50150 LiMON reusable sensor for adults and infants
PV50100 LiMON disposable sensor for adults and infants
PV50200 LiMON disposable sensor for neonates

3. Pulse Densitometry Based on Pulse Oximetry
LEDs
805 nm & 905 nm
pulsatile805 nm
non pulsatile805 nm
pulsatile905 nm
Sensor
non pulsatile905 nm [ s ] 1 2 3 4 5
CICG mg/l
pulsatile905 nm
non pulsatile905 nm
CICG =
pulsatile805 nm
non pulsatile805 nm

4. dynamically determined range for back extrapolation
ICG Dilution Curve Analysis
CICG mg/l
calculation of half life time and elimination rate of ICG-PULSION
dynamically determined range for back extrapolation

5. Global liver function from elimination of ICG-PULSION:
Parameters
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)

6. Parameter Calculation Normal Range PDR (%/min) ln2/t1/2  100 18 – 25
Calculations and Normal Ranges
Parameter Calculation Normal Range
PDR (%/min) ln2/t1/2  – 25
R15 (%) CICG15m / CICG t=0  – 10
CBI (ml/min/m2) BV  PDR / BSA 500 – 750
BVI (ml/m2) [ICG]inj / CICG t=0 / BSA

7. Invasive COLD System vs non-invasive LiMON (16 pts, n=54)
Validation
Invasive COLD System vs non-invasive LiMON (16 pts, n=54)
Sakka S, Meier-Hellmann A: International Journal of Intensive Care, 2002

8. Evaluation of liver function in organ donors and recipients
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

9. 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

10. * Prognosis of Survival in ICU Patients
Significantly reduced liver function in non-survivors
Non-survivors
n= 168
Survivors 45 40 35 30 25 20 15 10 5
ICG-PDR [%/ min]
(p< 0.001) *
Sakka SG, Meier-Hellmann A: Yearbook of Intensive Care and Emergency Medicine, 2001

11. Prognosis of Survival in ICU Patients
Clear indicator of probability of survival in septic shock
(Survivors)
(Non-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
Kimura S et al: Crit Care Med 2001

12. Value as Liver Function Test in Intensive Care
Higher sensitivity and specificity than bilirubin
BILIRUBIN
(>33.8)
ICG-PDR 20 40 60 80
100
100-Specificity [%]
Sensitivity [%]
(>15.2)
n= 336
p= 0.06
Sakka SG, Meier-Hellmann A: Yearbook of Intensive Care and Emergency Medicine, 2001

13. Liver Function in Organ Donors
Clear borderline for transplantation suitability
Wesslau C et al: Transplantology 1994

14. Application After Liver Transplantation
Clear borderline for probability of graft function
Jalan R et al: Transplantation 1994

15. Value as Liver Function Test in Liver Surgery
Better correlation with prognosis than laboratory parameters in cirrhotic patients
Hemming AW et al: Am J Surg 1992

16. Value as Liver Function Test in Liver Surgery
Correlation between parenchymal cell volume and ICG elimination
Hashimoto M and Watanabe G: J Surg Res 2000

17. 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 application
Results not user dependent, up to 10 measurements per 24 hours
Time and cost saving
Reduces the numbers of laboratory blood/plasma samples