Clinical assessment of plasma volume and hepatic perfusion by using indocyanine green during hemorrhagic shock.
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[Objective] To validate the determination of plasma volume (PV) and hepatic perfusion as assessed by the indicator dilution technique with indocyanine green (ICG) during hemorrhagic shock. [Subjects] Fourteen patients with hemorrhagic shock. The cause of hemorrhagic shock was trauma in 12 patients and a gastric ulcer in 2. Twelve patients were successfully resuscitated from shock (resuscitated cases) and 2 patients died from uncontrollable shock (non-resuscitated cases). [Methods] The volume of distribution of ICG as PV and the elimination rate constant (KICG) as hepatic perfusion were sequentially evaluated in each case during the period from 2 to 72 hours after the onset of hypotension. The curve of disappearance of ICG from plasma at 3, 5, 7, and 9 minutes after a single injection was extrapolated to the time of injection (zero time) and thereby the concentration at zero time (C0) was determined. PV (ml/kg) was calculated as 25/C0/body weight. KICG equals the slope of the ln-concentration versus the time curve. [Results] For 9 of the resuscitated cases, PV was maintained at higer than 40ml/kg and KICG remained normal throughout the study period. For the other 3 resuscitated cases, both values were decreased at 6 hours and were concomitantly improved within 12 to 48 hours. The changes in PV did not parallel those in blood pressure or urinary output. For the non-resuscitated cases, the decrease in KICG was more pronounced and separate from the change in PV. PVs were significantly correlated with KICG (r=0.445, p<0.05). [Conclusion] 1) This study indicates a correlation between KICG and PV in hemorrhagic shock. 2) The concomitant decrease in KICG and PV suggests hepatic hypoperfusion, which can require prompt improvement. 3) When the decrease in KICG is more pronounced than that in PV, those changes are probably due to hepatocellular damage, which may lead to a poor outcome.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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