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Tecnología LiMON

product illustration limon

Tecnología LiMON

Monitorización no invasiva de la función hepática o la perfusión esplácnica

Visión general

LiMON es una tecnología para la medición no invasiva de la función hepática y la monitorización de la perfusión esplácnica que se basa en la eliminación del verde de indocianina (ICG). El ICG es un colorante fluorescente diseñado para utilizarse en forma de inyección intravenosa. El espectro de absorción y emisión del ICG se encuentra dentro del rango de los infrarrojos y los semiinfrarrojos, gracias a los cuales se puede detectar y cuantificar mediante procedimientos ópticos. 

La medición se puede llevar a cabo de forma no invasiva a través de la piel. Dado que el ICG solo se elimina a través del hígado, el índice de detección es un valioso indicador del funcionamiento general del hígado. Establecida desde hace ya más de 30 años, la importancia diagnóstica de la detección del ICG como indicador de la función hepática ha sido confirmada en numerosas publicaciones científicas.

  • Detección temprana de la disfunción hepática
  • Indica el rendimiento de la función hepática
  • Medición no invasiva
  • Disponibilidad a pie de cama
  • LiMON® detecta de inmediato la hipoperfusión hepática
  • Predice mucho mejor la probabilidad de supervivencia1
  • Un PDRICG menor que 16 %/min requiere intervención2
  • Terapia de fluidos optimizada mediante LiMON® en combinación con PiCCO3
  • Sirve de indicador de perfusión regional
  • Evaluación perioperativa de calidad y función del injerto de piel para reducir la probabilidad de necesitar un nuevo trasplante4
  • Es un indicador fiable de los resultados del injerto de forma temprana tras la cirugía5
  • Permite detectar las complicaciones de forma temprana6
  • LiMON® proporciona unos parámetros decisivos en la evaluación de riesgos preoperativa
  • Un PDRICG bajo excluye a los pacientes con resección mayor7
  • Detección temprana de disfunción hepática postoperativa
  • Ofrece una capacidad predictiva significativamente mayor que los marcadores convencionales7
  • Las mediciones preoperatorias, perioperatorias y postoperatorias tempranas del PDRICG pueden servir de predictor de tratamiento prolongado en la UCI8
  • Permite considerar la aplicación de estrategias por objetivos dirigidas a mejorar el nivel de PDRICG en pacientes sometidos a cirugía cardíaca en peligro con el fin de mejorar los resultados8
  • Valioso medio de evaluación del pronóstico en cirrosis hepática1
  • Permite predecir la supervivencia en enfermedad hepática intermedia avanzada1
  • Estimación de masa celular hepática funcional

Reutilizables

Sensor y módulo LiMON

Módulo LiMON

  • Tasa de desaparición en plasma del verde de indocianina (PDR/ICG)
  • Medición continua del SpO2*
  • No invasivo
  • Fácil de aplicar
  • Reutilizable

Sensor LiMON: sensor de dedo reutilizable

  • Monitorización no invasiva de la función hepática
  • Monitorización constante del SpO2*

Consumibles: verde de indocianina

* Este parámetro no está disponible en el monitor PulsioFlex con la versión de software 5.0 o posteriores

Metodología

La medición de la tecnología LiMON se basa en la eliminación del fármaco de diagnóstico verde de indocianina (ICG). El ICG se inyecta en vena, donde se enlaza inmediata y completamente a las proteínas de plasma, y solo se elimina de la sangre a través del hígado. Esta eliminación tiene lugar de una forma bastante rápida, y su vida útil no suele superar los 3,5-4 minutos.

Referencias

Sakka, S. G. 
Assessing Liver Function 
Curr. Opin. Crit. Care, 2007; 13(2):207-14

Bauer, M., Winning, J. y Kortgen, A. 
Liver Failure 
Curr. Opin. Anaest., 2005; 18:111-6

Sakka, S. G. y Meier-Hellmann, A. 
Non-invasive liver function monitoring by indocyanine green plasma disappearance rate in critically ill patients 
Int. J. Intensive Care, 2002; 9(2):66-72

Cuidados intensivos

  • Inal, M. T., Memis, D., Kargi, M. y Sut, N.
    Prognostic value of indocyanine green elimination assessed with LiMON in septic patients
    J. Crit. Care, 2009; 24(3): 329-34

Trasplante hepático

  • Olmedilla, L., Pérez Peña, J. M., Ripoll, C., Garutti, I., de Diego, R., Salcedo. M., Jiménez, C. y Banares, R.
    Early noninvasive measurement of the indocyanine green plasma disappearance rate accurately predicts early graft dysfunction and mortality after deceased donor liver transplantation
    Liver Transpl., 2009; 15(10): 1247-53

Resección hepática

  • Scheingraber, S., Richter Sn Igna, D., Flesch, S., Kopp, B. y Schilling, M. K.
    Indocyanine green disappearance rate is the most useful marker for liver resection
    Hepatogastroenterology, 2008; 55(85): 1394-9

Purcell, P., Kruger, P. y Jones, M.  
Indocyanine green elimination: a comparison of the LiMON and serial blood sampling methods  
ANZ J. Surg., 2006; 76: 75-7 

Sakka, S. G. y van Hout, N.  
Relation between indocyanine green (ICG) plasma disappearance rate and ICG blood clearance in critically ill patients
Intensive Care Med., 2006; 32(5):766-9 

Sakka, S. G., Koeck, H. y Meier-Hellmann, A.  
Measurement of indocyanine green plasma disappearance rate by two different dosages  
Intensive Care Med., 2004; 30(3):506-9 

Faybik, P., Krenn, C. G., Baker, A., Lahner, D., Berlakovich, G., Steltzer, H. y Hetz, H.  
Comparison of invasive and noninvasive measurement of plasma disappearance rate of indocyanine green in patients undergoing liver transplantation: a prospective investigator-blinded study  
Liver Transpl., 2004; 10(8):1060-4 

Sakka, S. G., Reinhart, K. y Meier-Hellmann, A.  
Comparison of invasive and noninvasive measurements of indocyanine green plasma disappearance rate in critically ill patients with mechanical ventilation and stable hemodynamics 
Intensive Care Med., 2000; 26(10): 1553-6 

verde de indocianina 

Leevy, C. M., Leevy, C. B. y Howard, M. M.  
Indocyanine green and the liver  
En Davidson, C. S. (ed.), Problems in Liver Diseases, 1979, Georg Thieme Publishers, Stuttgart - Nueva York; 42-52 

Paumgartner, G., Probst, P., Kraines, R. y Leevy, C. M.  
Kinetics of Indocyanine green removal from the blood  
NY Acad. Sci., 1970; 170:134-47 

Cirugía del corazón

Weis, F., Kilger, E., Beiras-Fernandez, A., Hinske, C. L., Nassau, K., Adnan, L., Vicol, C., Kur, F. y Mohnle, P.
Indocyanine green clearance as an outcome prediction tool in cardiac surgery: A prospective study
J. Crit. Care, 2013; publicación online

Sander, M., Spies, C. D., Berger, K., Schroder, T., Grubitzsch, H., Wernecke, K. D. y von Heymann, C.
Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting - an observational study
Crit. Care., 2009; 13(5): R149

Sander, M., Spies, C. D., Foer, A., Syn, D. Y., Grubitzsch, H. y Von Heymann, C.
Peri-operative plasma disappearance rate of indocyanine green after coronary artery bypass surgery
Cardiovasc. J. Afr., 2007; 18(6): 375-9

Sakka, S., Hofmann, D., Thuemer, O., Schelenz, C. y Van Hout, N.
Increasing cardiac output by epinephrine after cardiac surgery: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation
J. Cardiothorac. Vasc. Anesth., 2007; 21(3):351-6

Hofmann, D., Thuemer, O., Schelenz, C., van Hout, N. y Sakka, S. G.
Increasing cardiac output by fluid loading: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation
Acta Anaesthesiol. Scand., 2005; 49: 1280-6

Sepsis y shock séptico

Hernández, G., Bruhn, A., Luengo, C., Regueira, T., Kattan, E., Fuentealba, A., Flórez, J., Castro, R., Aquevedo, A.,Pairumani, R., McNab, P. e Ince, C.
Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: a randomized, placebo-controlled, double-blind, crossover study
Intensive Care Med., 2013; 39(8): 1435-43

Hernández, G., Regueira, T., Bruhn, A., Castro, R., Rovegno, M., Fuentealba, A., Veas, E., Berrutti, D., Kattan, E., Martín, C. e Ince, C.
Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study
Ann. Intensive Care, 2012; 2(1): 44

Memis, D., Inal, M. T. y Sut, N.
The effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock
J. Crit. Care, 2012; 27(3): 318.e1-6

Inal, M. T., Memis, D., Kargi, M. y Sut, N.
Prognostic value of indocyanine green elimination assessed with LiMON in septic patients
J. Crit. Care, 2009; 24(3): 329-34

Kortgen, A., Paxian, M., Werth, M., Recknagel, P., Rauchfu, F., Lupp, A., Krenn, C. G., Muller, D., Claus, R. A., Reinhart, K., Settmacher, U. y Bauer, M.
Prospective assessment of hepatic function and mechanisms of dysfunction in the critically ill
Shock, 2009; 32(4): 358-65

Poeze, M., Solberg, B. C., Greve, J. W. y Ramsay, G.
Monitoring global volume-related hemodynamic or regional variables after initial resuscitation: What is a better predictor of outcome in critically ill septic patients?
Crit. Care Med., 2005; 33(11):2494-2500

Sakka, S. G., Reinhart, K. y Meier-Hellmann, A.
Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients
Chest, 2002; 122(5):1715-20

Quirúrgico

Eryilmaz, H. B., Memis, D., Sezer, A. e Inal, M.
The Effects of Different Insufflation Pressures on Liver Functions Assessed with LiMON on Patients Undergoing Laparoscopic Cholecystectomy
Scientific World Journal, 2012: 172575

Sakka, S. G.
Indocyanine green plasma disappearance rate as an indicator of hepato-splanchnic ischemia during abdominal compartment syndrome
Anesth. Analg., 2007; 104(4):1003-4

Poeze, M., Ramsay, G., Buuman, W. A., Greve, J. W., Dentener, M. y Takala, J.
Increased hepatosplanchnic inflammation precedes the development of organ dysfunction after elective high-risk surgery
Shock, 2002; 17:451-8

Aspectos médicos

Quintero, J., Miserachs, M., Ortega, J., Bueno, J., Dopazo, C., Bilbao, I., Castells, L. y Charco, R.
Indocyanine green plasma disappearance rate: a new tool for the classification of paediatric patients with acute liver failure
Liver Int., 2013; publicación online

Ameloot, K., Meersseman, P., Wilmer, A., Hermans, G., Gerits, A., Spriet, I. y Wauters, J.
The influence of continuous venovenous renal replacement therapy on the plasma disappearance rate of indocyanine green
Intensive Care Med., 2013; 39(12): 2231-2232

Malbrain, M. L., Viaene, D., Kortgen, A., De Laet, I., Dits, H., Van Regenmortel, N., Schoonheydt, K. y Bauer, M.
Relationship between intra-abdominal pressure and indocyanine green plasma disappearance rate: hepatic perfusion may be impaired in critically ill patients with intra-abdominal hypertension
Ann. Intensive Care, 2012; 2 supl. 1: S19

Steinvall, I., Fredrikson, M., Bak, Z. y Sjoberg, J.
Incidence of early burn-induced effects on liver function as reflected by the plasma disappearance rate of indocyanine green: A prospective descriptive cohort study
Burns, 2012; 38(2): 214-24

Inal, M. T., Memis, D., Sezer, Y. A., Atalay, M., Karakoc, A. y Sut, N.
Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients
Can. J. Surg., 2011; 54(2): 42709.

Seibel, A., Muller, M. y Sakka, S.
Indocyanine green plasma disappearance rate for monitoring hepatosplanchnic blood flow
Intensive Care Med., 2011; 37(2): 357-9

Sakka, S. G., Reinhart, K. y Meier-Hellmann, A.
Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients
Chest, 2002; 122(5):1715-20

Trasplante hepático

Vos, J. J., Scheeren, T. W., Lukes, D. J., de Boer, M. T., Hendriks, H. G. y Wietasch, J. K.
Intraoperative ICG plasma disappearance rate helps to predict absence of early postoperative complications after orthotopic liver transplantation
J. Clin. Monit. Comput., 2013; 27(5): 591-8

Levesque, E., Hoti, E., Azoulay, D., Adam, R., Samuel, D., Castaing, D. y Saliba, F.
Non-invasive ICG-clearance: a useful tool for the management of hepatic artery thrombosis following liver transplantation
Clin. Transplant., 2011; 25(2): 297-301

Levesque, E., Saliba, F., Benhamida, S., Ichai, P., Azoulay, D., Adam, R., Castaing, D. y Samuel, D.
Plasma disappearance rate of indocyanine green: a tool to evaluate early graft outcome after liver transplantation
Liver Transpl., 2009; 15(10): 1358-64

Olmedilla, L., Pérez Peña, J. M., Ripoll, C., Garutti, I., de Diego, R., Salcedo, M., Jiménez, C. y Banares, R.
Early noninvasive measurement of the indocyanine green plasma disappearance rate accurately predicts early graft dysfunction and mortality after deceased donor liver transplantation
Liver Transpl., 2009; 15(10): 1247-53

Parker, B. M., Cywinski, J. B., Alster, J. M., Irefin, S. A., Popovich, M., Beven, M. y Fung, J. J.
Predicting immunosuppressant dosing in the early postoperative period with noninvasive indocyanine green elimination following orthotopic liver transplantation
Liver Transpl., 2008; 14(1): 46-52

Scheingraber, S., Richter, S., Igna, D., Girndt, M., Flesch, S., Kleinschmidt, S. y Schilling, M. K.
Indocyanine green elimination but not bilirubin indicates improvement of graft function during MARS therapy
Clin. Transplant., 2007; 21(6): p. 689-95

Hori, T., Iida, T., Yagi, S., Taniguchi, K., Yamamoto, C., Mizuno, S., Yamagiwa, K., Isaji, S. y Uemoto, S.
K(ICG) value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation
Liver Tranpl., 2006; 12: 605-13

Faybik, P., Krenn, C. G., Baker, A., Lahner, D., Berlakovich, G., Steltzer, H. y Hetz, H.
Comparison of invasive and noninvasive measurement of plasma disappearance rate of indocyanine green in patients undergoing liver transplantation: a prospective investigator-blinded study
Liver Transpl., 2004; 10(8):1060-4

von Spiegel, T., Scholz, M., Wietasch, G., Hering, R., Allen, S. J., Wood, P. y Hoeft, A.
Perioperative monitoring of indocyanine green clearance and plasma disappearance rate in patients undergoing liver transplantation
Anaesthesist, 2002; 51(5):359-66

Mandell, M. S., Wachs, M., Niemann, C. U. y Henthorn, T. K.
Elimination of indocyanine green in the perioperative evaluation of donor liver function
Anesth. Analg., 2002; 95(5):1182-4

Niemann, C. U., Roberts, J. P., Ascher, N. L. y Yost, C. S.
Intraoperative hemodynamics and liver function in adult-to-adult living liver donors
Liver Transpl., 2002; 8(12):1126-32

Krenn, C. G., Schafer, B., Berlakovich, G. A., Steininger, R., Steltzer, H. y Spiss, C. K.
Detection of graft nonfunction after liver transplantation by assessment of indocyanine green kinetics
Anesth. Analg., julio 1998; 87(1):34-6

Wesslau, C., Krüger, R. y May, G.
Clinical investigations using indocyanine green clearance for evaluation of liver function in organ donors
Transplantology, 1994; 5(1):7-9

Resección/cirugía hepática

Tralhao, J. G., Hoti, E., Oliveiros, B., Botelho, M. F. y Sousa, F. C.
Study of perioperative liver function by dynamic monitoring of ICG-clearance
Hepatogastroenterology, 2012; 59(116): 1179-83

de Liguori Carino, N., O'Reilly, D. A., Dajani, K., Ghaneh, P., Poston, G. J. y Wu, A. V.
Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure
Eur. J. Surg. Oncol., 2009; 35(9):957-62

Szijarto, A., Hargitai, B., Fischer, S., Darvas, K. y Kupcsulik, P.
Two-staged procedure of portal ligation and hepatectomy monitored by ICG clearance
J. Invest. Surg., 2009; 22(1): 63-8

Scheingraber, S., Richter, S., Igna, D., Flesch, S., Kopp, B. y Schilling, M. K.
Indocyanine green disappearance rate is the most useful marker for liver resection
Hepatogastroenterology, 2008; 55(85): 1394-9

Akita, H., Sasaki, Y., Yamada, T., Gotoh, K., Ohigashi, H., Eguchi, H., Yano, M., Ishikawa, O. e Imaoka, S.
Real-Time Intraoperative Assessment of Residual Liver Functional Reserve Using Pulse Dye Densitometry
World J. Surg., 2008; 32(21): 2668-74

Sato, S., Miyake, T., Mishiro, T., Furuta, K., Azumi, T., Oshima, N., Takahashi, Y., Rumi, M. A., Ishihara, S., Adachi, K., Amano, Y. y Kinoshita, Y.
Kinetics of indocyanine green removal from blood can be used to predict the size of the area removed by radiofrequency ablation of hepatic nodules
J. Gastroenterol. Hepatol., 2006; 21:1714-9

Imamura, H., Sano, K., Sugawara, Y., Kokudo, N. y Makuuchi, M.
Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test
J. Hepatobiliary Pancreat. Surg., 2005; 12: 16-22

Lee, S. G. y Hwang, S.
How I do it: assessment of hepatic functional reserve for indication of hepatic resection
J. Hepatobiliary Pancreat. Surg., 2005; 12: 38-43

Imamura, H., Seyama, Y., Kokudo, N., Maema, A., Sugawara, Y., Sano, K., Takayama, T. y Makuuchi, M.
One thousand fifty-six hepatectomies without mortality in 8 years
Arch. Surg., 2003; 138: 1198-1206

Thasler, W. E., Bein, T. y Jauch, K. W.
Perioperative effects of hepatic resection surgery on hemodynamics, pulmonary fluid balance, and indocyanine green clearance
Langenbecks Arch. Surg., 2002; 387: 271-5

Ishikawa, M., Yogita, S., Miyake, H., Fukuda, Y., Harada, M., Wada, D. y Tashiro, S.
Clarification of risk factors for hepatectomy in patients with hepatocellular carcinoma
Hepatogastroenterology, 2002; 49: 1625-31

Eguchi, H., Umeshita, K., Sakon, M., Nagano, H., Ito, Y., Kishimoto, S. I., Dono, K., Nakamori, S., Takeda, T., Gotoh, M., Wakasa, K., Matsuura, N. y Monden, M.
Presence of active hepatitis associated with liver cirrhosis is a risk factor for mortality caused by posthepatectomy liver failure
Dig. Dis. Sci., 2000; 45: 1383-8

Hsia, C. Y., Lui, W. Y., Chau, G. Y., King, K. L., Loong, C. C. y Wu, C. W.
Perioperative safety and prognosis in hepatocellular carcinoma patients with impaired liver function
J. Am. Coll. Surg., 2000; 190: 574-9

Hanazaki, K., Kajikawa, S., Shimozawa, N., Mihara, M., Shimada, K., Hiraguri, M., Koide, N., Adachi, W. y Amano, J.
Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma
J. Am. Coll. Surg., 2000; 191: 381-8

Hepatología/gastroenterología

Zipprich, A., Kuss, O., Rogowski, S., Kleber, G., Lotterer, E., Seufferlein, T., Fleig, W. E. y Dollinger, M. M.
Incorporating indocyanin green clearance into the Model for End Stage Liver Disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis
Gut, 2010; 59(7): 963-8

Merle, U., Sieg, O., Stremmel, W., Encke, J. y Eisenbach, C.
Sensitivity and specificity of plasma disappearance rate of indocyanine green as a prognostic indicator in acute liver failure
BMC Gastroenterol., 2009; 9: 91

Herold, C., Heinz, R., Radespiel-Tröger, M., Schneider, H. T., Schuppan, D. y Hahn, E. G. 
Quantitative testing of liver function in patients with cirrhosis due to chronic hepatitis C to assess disease severity
Liver, 2001; 21(1):26-30

Shock hipovolémico

Kisch, H., Leucht, S., Lichtwarck-Aschoff, M. y Pfeiffer, U. J.
Accuracy and reproducibility of the measurement of actively circulating blood volume with an integrated fiberoptic monitoring system
Crit. Care Med., 1995; 23(5):885-93

Monitorización de efectos terapéuticos
Farmacoterapias
Shock séptico

Lehmann, C., Taymoorian, K., Wauer, H., Krausch, D., Birnbaum, J. y Kox, W. J.
Effects of the stable prostacyclin analogue iloprost on the plasma disappearance rate of indocyanine green in human septic shock
Intensive Care Med., 2000; 26(10):1557-60

Meier-Hellmann, A., Bredle, D. L., Specht, M., Hannemann, L. y Reinhart, K.
Dopexamine increases splanchnic blood flow but decreases gastric mucosal pH in severe septic patients treated with dobutamine
Crit. Care Med., 1999; 27: 2166-71

Joly, L. M., Monchi, M., Cariou, A., Chiche, J. D., Bellenfant, F., Brunet, F. y Dhainaut, J. F.
Effects of dobutamine on gastric mucosal perfusion and hepatic metabolism in patients with septic shock
Am. J. Respir. Crit. Care Med., 1999; 160; 1983-6

Cirugía/disfunción hepática

Sheng, Q. S., Lang, R., He, Q., Yang, Y. J., Zhao, D. F. y Chen, D. Z.
Indocyanine green clearance test and model for end-stage liver disease score of patients with liver cirrhosis
Hepatobiliary Pancreat. Dis. Int., 2009; 8(1): 46-9

Orii, R., Sugawara, Y., Hayashida, M., Yamada, Y., Chang, K., Takayama, T., Makuuchi, M. y Hanaoka, K.
Effects of amrinone on ischaemia-reperfusion injury in cirrhotic patients undergoing hepatectomy: a comparative study with prostaglandin E1
Br. J. Anaesth., 2000; 85(3):389-95

Devlin, J., Ellis, A. E., McPeake, J., Heaton, N., Wendon, J. A. y Williams, R.
N-acetylcysteine improves indocyanine green extraction and oxygen transport during hepatic dysfunction
Crit. Care Med., 1997; 25(2):236-42

Tratamientos adyuvantes

Memis, D., Inal, M. T. y Sut, N.
The effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock
J. Crit. Care, 2012; 27(3): 318.e1-6

Abraldes, J., Albillos, A., Banares, R., Turnes, J., González, R., García Pagán, J. y Bosch, J.
Simvastatin Lowers Portal Pressure in Patients with Cirrhosis and Portal Hypertension: a Randomized Controlled Trial
Gastroenterology, 2009; 136(5): 1651-8

Link, A., Girndt, M., Selejan, S., Mathes, A., Bohm, M. y Rensing, H.
Argatroban for anticoagulation in continuous renal replacement therapy

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Todas las referencias

  1. 1. Zipprich, A. et al.: Incorporating indocyanin green clearance into the Model for End Stage Liver Disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut, 2010; 59(7): 963-968.

  2. 2. Sakka, S. G. et al.: Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients. Chest, 2002; 122(5): 1715-1720.

  3. 3. Sakka, S. G. et al.: Non-invasive liver function monitoring by indocyanine green plasma disappearance rate in critically ill patients. Int. J. Intensive Care, 2002; 9(2):66-72.

  4. 4. Mandel, M. S. et al.: Elimination of indocyanine green in the perioperative evaluation of donor liver function. Anesth. Analg., 2002; 95(5): 1182-1184.

  5. 5. Tsubono, T. et al.: Indocyanine green elimination test in orthotopic liver recipients. Hepatology, 1996; 24(5): 1165-1171.

  6. 6. Levesque, E. et al.: Plasma disappearance rate of indocyanine green: a tool to evaluate early graft outcome after liver transplantation. Liver Transpl., 2009; 15(10):1358-1364.

  7. 7. Scheingraber, S. et al.: Indocyanine green disappearance rate is the most useful marker for liver resection. Hepatogastroenterology, 2008; 55(85): 1394-1399.

  8. 8. Sander, M. et al.: Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting - an observational study. Crit. Care, 2009; 13(5): R149.