WO2006039731A1 - Procede et dispositif pour mesurer la concentration d'indicateur et le degagement des appareils pour des procedes de traitement extracorporel du sang - Google Patents

Procede et dispositif pour mesurer la concentration d'indicateur et le degagement des appareils pour des procedes de traitement extracorporel du sang Download PDF

Info

Publication number
WO2006039731A1
WO2006039731A1 PCT/AT2005/000397 AT2005000397W WO2006039731A1 WO 2006039731 A1 WO2006039731 A1 WO 2006039731A1 AT 2005000397 W AT2005000397 W AT 2005000397W WO 2006039731 A1 WO2006039731 A1 WO 2006039731A1
Authority
WO
WIPO (PCT)
Prior art keywords
indicator
measuring
blood
concentration
measured
Prior art date
Application number
PCT/AT2005/000397
Other languages
German (de)
English (en)
Inventor
Daniel Schneditz
Bernd Haditsch
Original Assignee
Medizinische Universität Graz
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Medizinische Universität Graz filed Critical Medizinische Universität Graz
Publication of WO2006039731A1 publication Critical patent/WO2006039731A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/14535—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring haematocrit
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
    • A61B5/14551—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters for measuring blood gases
    • A61B5/14557—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters for measuring blood gases specially adapted to extracorporeal circuits
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3607—Regulation parameters
    • A61M1/3609—Physical characteristics of the blood, e.g. haematocrit, urea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621—Extra-corporeal blood circuits
    • A61M1/367—Circuit parts not covered by the preceding subgroups of group A61M1/3621
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A61B5/0275—Measuring blood flow using tracers, e.g. dye dilution
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/42—Detecting, measuring or recording for evaluating the gastrointestinal, the endocrine or the exocrine systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
    • A61B5/7207—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal of noise induced by motion artifacts

Definitions

  • the invention relates to a device for measuring the concentration of an indicator, in particular a dye, such as indocyanine green (ICG), in the blood of patients in an extracorporeal blood circulation, especially in extracorporeal blood treatments, such as liver support therapy or hemodialysis, with a device for introducing the indicator into the bloodstream and a device for measuring the indicator concentration.
  • an indicator in particular a dye, such as indocyanine green (ICG)
  • ICG indocyanine green
  • the invention further relates to a method for measuring the concentration of an indicator, in particular a dye such as indocyanine green (ICG), in the blood of patients in an extracorporeal blood circulation, especially in extra ⁇ corporeal blood treatments, such as liver support or hemodialysis, the indicator into the blood of the patient is introduced, and the indicator concentration is measured in the blood ge.
  • an indicator in particular a dye such as indocyanine green (ICG)
  • ICG indocyanine green
  • the invention further relates to a method for measuring liver clearance and apparatus clearance in extracorporeal blood purification methods.
  • ICG indocyanine green
  • ICG is a well-tolerated drug which binds to plasma proteins after intravenous administration, remains predominantly in the blood space and is taken up by the liver with a normal half-life of three to four minutes from the blood and excreted into the bile. Due to these properties, ICG is not only suitable for measuring circulatory variables such as, for example, cardiac output, plasma and blood volume, as is the case with many other indicators, but also for measuring the rate of elimination by the liver, the so-called liver clearance Represents the measure of liver function or liver perfusion.
  • the measurement of the indicator concentration in the blood takes place most accurately by taking blood samples at defined time points and subsequent sample analysis.
  • this method is time-consuming and represents a burden on the patient due to the required vascular puncture and blood collections.
  • the number of possible measuring points is also severely limited.
  • the measurement of the concentration of an indicator should therefore be carried out as far as possible without vascular puncture and without blood consumption.
  • ICG absorbs and fluoresces in the visible and infrared wavelengths, maximally at a wavelength of about 805 nm.
  • the measurement of the ICG concentration is therefore carried out consistently with optical methods as an optical measurement can be done in principle without destruction and without consumption of sample material.
  • the special optical properties of a microscopically anisotropic suspension with changing adsorption properties of the adsorbing molecules must be taken into account. These properties require optical measurement at several wavelengths, in transmitted light, scattered light, and / or reflected light.
  • EP 1 402 917 A2 describes a catheter system for the simultaneous and continuous measurement of central venous oxygen saturation and local ICG concentration, wherein the intravenous part of the catheter system can be applied in a simple and gentle manner for the patient.
  • the invasive measuring methods have advantages, but because of their invasiveness are more burdensome for the patient and more complicated than simple blood samples.
  • a non-invasive optical measurement method of various sizes such as the water content in the blood or tissue of a patient is described in US 6,687,519 B2.
  • light with specific wavelengths is radiated through the skin on the finger or earlobe.
  • the intensity of the reflected light can be used to deduce the concentration of the respective blood component.
  • the ICG concentration can be measured selectively and specifically with the device and the method is not apparent from the publication.
  • EP 505 918 B1 describes a device and a method for determining cardiac output by means of Indicator dilution methods, whereby the burden and risks for the patient are reduced by the fact that the measurement by means of optical methods is non-invasive. Only the injection of the indicator dye into the bloodstream requires intervention.
  • the invention at best describes an indirect measurement of the ICG concentration, since the measurement takes place via the inclusion of a reference dye, preferably the red blood dye (hemoglobin).
  • the indicator concentration must be known in absolute units. For this purpose, the concentration of the reference dye in a blood sample is determined before the dilution measurement with standard laboratory methods.
  • the hemoglobin concentration in the microcirculation is systematically lowered to the hemoglobin concentration of a venous blood sample (Gaehtgens P, Pries AR, Walzog B: Blood, in Physiology, edited by Deetjen P, Speckman EJ, 3 ed, Kunststoff, Urban & Fischer, 1999 , pp 257-295).
  • the difference is based on the microscopic inhomogeneity of the blood, which in the microcirculation can lead to a reduction of the hematocrit to up to 15% of the hematocrit measured centrally and by laboratory methods.
  • the local hematocrit or hemoglobin content is systematically overestimated by a central measurement. For this reason, the absolute indicator concentration is also overestimated and, as a consequence, the cardiac output is underestimated.
  • the hemoglobin concentration is not constant due to removal of water by ultrafiltration and resulting hemoconcentration. The course of the hemoglobin concentration is at best predictable for a short duration and the routinely determined laboratory value is only of limited relevance for the hemoglobin concentration at the time of the dilution measurement. Therefore, in this case, a separate blood measurement immediately before the dilution measurement is necessary.
  • a liver function test by means of ICG measurement is, for example, in No. 6,640,129 Bl using a non-invasive method for determining the relative plasma elimination rate (k) of ICG.
  • the method does not require absolute concentration measurement, it does in principle yield unreliable results if the volume of distribution (plasma, blood volume) of the dye is disregarded.
  • an absolute concentration measurement of ICG is required.
  • the measurement of the absolute ICG concentration is unavoidable for accurate liver function measurement.
  • Non-invasive liver function measurement by means of ICG elimination is carried out, for example, with the LiMON device from Pulsion or the DDG 2001 device from Nihon Kohden. These methods require a good circulation of circulation peripheral and a stable microcirculation at the site. For hemodialysis patients and intensive care patients who require extracorporeal therapy, these conditions are usually not met.
  • the transcutaneous measurements are also very sensitive to motion artifacts so that plausible measurement results are almost only possible during anesthesia. To measure the absolute indi ⁇ katorkonzentration also a hemoglobin value is necessary.
  • US Pat. No. 6,090,061 A describes a measuring cuvette for the transillumination of a relatively thin blood layer with simultaneously high blood flow, the layer thickness being controlled by particularly pronounced spacers.
  • the continuous measurement of certain blood properties in these measuring cells subsequently also permits the indirect determination of physiological variables according to the known principles of indicator dilution.
  • US 5,453,576 and US 5,595,182 A describe devices and methods for measuring various blood and circulation sizes using an indicator that primarily affects the acoustic properties of the blood, such as isotonic saline.
  • an indicator that primarily affects the acoustic properties of the blood
  • the functions and extraction performance of the dialyzer in hemodialysis can be determined by means of a clearance measurement with these devices.
  • the method is limited to the introduction of an indicator which primarily influences the acoustic properties of the blood, which brings certain advantages in terms of measurement, but restricts the possibilities of application.
  • the clearance of strongly protein-bound substances which plays a role especially for extracorporeal liver support, can not be determined therewith.
  • No. 6,061,590 A describes a method for determining the central blood volume, the mean transit time and the heart minute volume according to the principles of indicator dilution using an extracorporeal system for introducing and measuring an indicator.
  • the patent US Pat. No. 5,601,080 A likewise describes a device and a method for the continuous measurement and control of blood components by optical methods.
  • the device is used to measure hemoglobin, hematocrit, and oxygen saturation in extracorporeal systems such as those used in hemodialysis. From the description of the device and the calibration, in which ICG is used for the simulation of the blood properties, it is apparent that the measurement of the blood constituents is strongly influenced by ICG. It can also be seen that the exogenous addition of an indicator such as ICG during blood measurement falsifies the measurement of blood components and the device is not suitable for ICG measurements without the improvement of the present invention. The same applies to US Pat. No. 6,144,444, since ICG absorbs strongly in the specified wavelength range from 666 to 999 nm.
  • clearance has the dimension of a flow [volume / time] and denotes that (hypothetical) flow which is completely purified by a substance.
  • hemodialysis the knowledge of the clearance by the artificial kidney is important for the dosage of the treatment and for the control of the treatment effect. Similar considerations apply to the assessment of the efficacy of extracorporeal liver support therapy.
  • the elimination of ICG during extracorporeal liver support therapy can serve to measure the treatment clearance.
  • liver support therapy can be achieved by measuring the concentration of endogenous substances, such as bilirubin or exogenous substances, using the principle of indicator dilution.
  • ICG or, as described in US Pat. No. 6,030,841 A, labeled bile acid may be added to the blood as an exogenous substance, and the change with time of the concentration may be recorded as a measure of the elimination of these substances.
  • the object of the present invention is to provide a device and a method for measuring the concentration of an injected indicator, in particular a dye, such as ICG in the blood of patients in an extracorporeal blood circulation, which is as simple as possible and without stress the patient is able to provide accurate and reproducible readings as quickly as possible and as little as possible prone to movement artifacts and interference by other Blut ⁇ ingredients, such as hematocrit or hemoglobin concentration. Disadvantages of known systems and methods should be reduced or avoided as far as possible.
  • the object of the present invention is to provide a device and a method for measuring the elimination of an injected indicator, in particular a dye, such as ICG from the blood of patients in an extra ⁇ corporal blood circulation, irrespective of the size of the Vechi ⁇ supply volume and as a measure of the separately assessed physiological function (or residual function) and extracorporeal function, wherein the physiological elimination of the indicator takes place in the patient's circulation and the treatment-related elimination in the extracorporeal circulation takes place.
  • an injected indicator in particular a dye, such as ICG from the blood of patients in an extra ⁇ corporal blood circulation
  • the object of the invention is achieved by an above-mentioned device for introducing the indicator and the measurement of the absolute indicator concentration, wherein the device for measuring the indicator concentration and at least one sensor for measuring the blood composition in the extracorpora ⁇ len blood circulation is arranged.
  • the sensor for measuring the blood composition is designed in particular for measuring the hematocrit, hemoglobin, plasma or water content or the content of red blood cells. Incorporation of the indicator via the extracorporeal circulation avoids the otherwise necessary venipuncture and is therefore in itself non-invasive. With the high extracorporeal blood flow, the indicator is quickly introduced into the patient circulation in the course of the blood treatment.
  • the extracorporeal measurement has the advantage that it is stress-free for the patient, that the measuring conditions are well defined by the known geometry and the reproducible flow conditions of the measuring point, that the measuring point is quickly reached via the measurable and controllable extracorporeal blood flow, and the concentration at the measurement site corresponds to the systemic indicator concentration.
  • the advantage of the present invention is that it is possible to measure blood quantities in the extracorporeal blood circulation without significant additional measurement effort, which hitherto had to be performed with unreliable, non-invasive, or expensive invasive measurements.
  • a further advantage of the device according to the invention is that it allows the indicator concentrations to be determined independently of the variable concentration of the other blood constituents, for example hemoglobin, hematocrit, plasma content, water content or the content of red blood cells.
  • transcutaneous measurements on the finger, nose wings or earlobes of the patient according to the prior art require the patient to remain at rest, which is the case for longer treatments and the respective clinical situation often is not possible.
  • the patient is freed from transcutaneous sensors on the earlobe, nasal wing, or fingers, which on the one hand is more pleasant for the patient, and on the other hand frees these excellent measuring sites for other transcutaneous measurements.
  • the device for measuring the indicator concentration is advantageously an optical sensor.
  • ICG as an indicator
  • the use of optical measurement methods is indicated.
  • the optical sensor for measuring the indicator concentration preferably utilizes two different wavelengths or two sensors at different positions of the incident light beam. As a result, influences of other blood properties can be compensated in a manner known per se.
  • the device for measuring the indicator concentration and / or a sensor for measuring the blood composition is preferably arranged on or in a measuring cell present in the extracorporeal blood circulation.
  • the device for measuring the indicator concentration in the arterial line of the extracorporeal blood circulation is arranged between the patient and the extracorporeal blood treatment device.
  • At least one further device for measuring the indicator concentration is arranged at at least one further point in the extracorporeal blood circulation.
  • a further sensor for measuring the indicator concentration in the extracorporeal blood circulation By additionally arranging a further sensor for measuring the indicator concentration in the extracorporeal blood circulation, further information, for example about the success of the treatment, can be obtained.
  • At least one further device for measuring the indicator concentration preferably in the venous line of the extracorporeal blood circulation between the patient and the patient, is provided Extracorporeal blood treatment device arranged.
  • the senor for measuring the blood composition is arranged substantially directly next to the device or integrated therein as a built-in part for measuring the indicator concentration, so that the effect of blood properties which influence the indicator concentration can be included in the measurement result.
  • a device for processing the measured indicator concentrations is preferably provided.
  • This device can be formed by a computer, microcomputer or microcontroller, which processes the dye concentration values on the basis of tables, calculation rules or the like.
  • the device for introducing the indicator into the blood circulation is advantageously provided in the venous line of the extracorporeal blood circulation.
  • the device for introducing the indicator can only be formed by a valve, via which the indicator is introduced, for example, with an infusion syringe, or can be realized by an automated device.
  • the introduction is conveniently carried out in the venous drip chamber, which is usually equipped with appropriate hose connections.
  • the direct injection of indicator into the venous blood line is as particularly advantageous as close to the patient as possible.
  • the ve ⁇ nbaum line is aus ⁇ conveniently equipped with a piercing septum. Comparable puncture septa are normally found in the arterial line for the removal of untreated patient blood.
  • a sensor for measuring the amount and optionally the time of the introduced indicator is arranged between the means for introducing the indicator and the extracorporeal blood circulation. This sensor can be designed in various ways. When using ICG, an optical sensor proves its worth. Another possibility for measuring the indicator injection is the use of a sensor on the infusion line and / or by input to the analysis and evaluation.
  • At least one further sensor for measuring the blood composition in the extracorporeal blood circulation is provided.
  • sensors which measure these physical properties are particularly suitable for measuring the blood composition.
  • at least one further wavelength must be measured for the already existing wavelengths for analysis of the blood, or a further sensor in scattered or reflection light must be used for the separate analysis of the blood composition and dye concentration.
  • a Regelvor ⁇ direction is provided, which is connected to at least one means for measuring the indicator concentration and the means for introducing the indicator into the bloodstream and possibly with the sensor for measuring the blood composition. Due to the measured indicator concentrations and possibly the measured blood composition, regulation of the device for introduction of the indicator into the bloodstream or another device can therefore be effected by this control device.
  • control device with a blood pump in the extracorporeal blood circulation or a flow sensor in extracorporeal blood circulation for measuring or regulating the Blood flow connected.
  • control device for measuring or regulating the ultrafiltration rate can be connected to an ultrafiltration pump.
  • control device is advantageously connected to an input / output unit in order to be able to set different values of the measurement and to be able to display determined values or settings.
  • the further object of providing a device and a method for measuring the elimination of an injected indicator from the blood of patients is achieved by processing the measured indicator concentrations as a function of time.
  • the calculation of clearance will be described below by way of example.
  • the extracorporeal blood circulation 1 shown schematically in the figure is connected to the patient 3 via an arterial line 2.
  • a blood pump 4 conveys the blood from the patient 3 into the corresponding device 5 for the purification of the blood, for example the dialyzer during hemodialysis.
  • the dialysate pump 19 regulates the flow of fresh dialysate via the dialysate lines 20 and 21 to the dialyzer 5 and thus also the efficiency of the blood purification process.
  • Volume balancing takes place through the balancing device 22. Excess liquid is removed by the ultrafiltration pump 23 from the dialysate outflow through the line 21. Via the venous line 6, the blood is returned to the patient 3.
  • a device 8 for measuring the indicator concentration is preferably provided in the arterial line 2 of the extracorporeal blood circuit 1.
  • This device 8 for measuring the indicator concentration which is preferably formed by an optical sensor, can be arranged in a measuring cell 9 already present in the extracorporeal blood circuit 1.
  • a sensor 10 for measuring the blood composition in the extracorporeal blood circulation 1 is advantageously provided substantially next to the device 8 for measuring the indicator concentration.
  • the indicator in particular a dye, such as ICG, for example, is introduced via a syringe 12 into the venous line 6 of the extracorporeal blood circulation 1 in desired amounts and at desired times.
  • a sensor 13 may be disposed between the syringe 12 and the extracorporeal circuit 1. The syringe 12 preferably enables an automated introduction of the indicator into the external blood circulation system 1.
  • the indicator is applied via the puncture septum 25 provided in the venous line 6.
  • the determination of the injection time and the injection amount is conveniently carried out by the venous sensors 17 or 18.
  • the device 8 for measuring the indicator concentration is advantageously connected to a control device 14, which may be formed for example by a computer, microcomputer or microcontroller. In this control device 14, processing of the measured indicator concentration can also take place.
  • the regulating device 14 also includes the sensor 10 for measuring the blood composition and / or the sensor 13 for measuring the quantity and the point in time of the indicator introduced by the syringe 12 and possibly the syringe 12 itself.
  • the blood pump 4 or a sensor 24 for measuring the blood flow in the arterial 2 or venous limb 6 of the extracorporeal circuit 1, and the ultrafiltration pump 23 either directly or indirectly via the evaluation and control device of the dialysis machine are also connected to the control device 14 , Consequently On the basis of the measured values of the indicator concentration in the blood but also of other variables determined therefrom, such as clearance, regulation of the syringe 12 or other devices, such as, for example, the dialysate pump 19 or the ultrafiltration pump 23, can take place.
  • the regulating device 14 is connected to an input / output device 15.
  • a further measuring chamber 16 is provided at a second location of the extracorporeal blood circuit 1, in the example shown in the venous line 6 of the extracorporeal blood circuit 1, which further means 17 for measuring the indicator concentration in the blood and possibly another sensor 18 for measuring the blood composition.
  • the blood composition at the measuring chamber 16 can optionally be calculated from the measurement of the blood composition at the measuring chamber 9 by the sensor 10 as well as from the change in the blood composition known by the pump 23 and the baffle device 22.
  • the present invention describes a device and a method by means of which a simple and rapid determination of important blood properties, of physiological variables determined therefrom, and of the performance of blood treatment in an extracorporeal blood circulation, in particular in liver support therapy or hemodialysis, is made possible.
  • the measurement of the indicator, in particular of ICG by means of optical methods by known optical extracorporeal sensors such as these are used in the continuous hemoglobin or hematocrit measurement, which, however, requires reliable detection of the indicator, as well as a Method for the registration of the indicator injection or the appearance of indicator at the measuring point in the course of a dilution measurement where the indicator is usually injected as bolus in a relatively high concentration into the venous line.
  • known optical sensors which are not primarily designed for the measurement of exogenous indicators such as ICG, the time of the first appearance of indicator at the measuring point must be determined as accurately as possible, since the determination of the (subsequent) indicator concentration refers to the optical properties measured at this time or the blood properties calculated therefrom.
  • the determination of the required reference concentration is carried out from the continuous analysis of the continuously measured optical signals or from values derived therefrom until the time of appearance of indicator at the measuring point according to the principles of time series analysis, such as by measurement the variance of hemoglobin concentration by optical measurements at different wavelengths.
  • the indicator appears, for example, the variance of certain optical signals and subsequently also the variance of the hematocrit or hemoglobin values calculated therefrom increases in a characteristic manner.
  • the detection of the jump in the variance indicates a completed indicator injection and the arrival of the indicator at the measuring location.
  • the total clearance Cl tot of the system results from the plasma disappearance rate k, which is determined by linear regression of the time-concentration curve shown in half-logarithmic fashion, preferably at the arterial measurement path.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Vascular Medicine (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Cardiology (AREA)
  • Optics & Photonics (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Spectroscopy & Molecular Physics (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • External Artificial Organs (AREA)

Abstract

L'invention concerne un dispositif et un procédé pour mesurer la concentration d'un indicateur tel que, par exemple, le vert d'indocyanine (ICG), dans le sang de patients (3) dans un circuit de sang (1) extracorporel, notamment lors de traitements extracorporels du sang tels que la thérapie de soutien hépatique ou l'hémodialyse, au moyen d'un dispositif (12) qui permet de mettre l'indicateur dans le circuit de sang (1) et d'au moins un dispositif (8, 17) pour mesurer la concentration de l'indicateur. L'invention vise à créer un dispositif et un procédé de ce type, lequel est d'application la plus simple possible et la plus conviviale possible pour les patients, ce procédé fournissant des valeurs de mesure reproductibles et précises le plus rapidement possible et étant le moins sensible possible aux mouvements et aux autres facteurs de perturbation. A cet effet, l'indicateur est introduit directement dans le circuit de sang (1) extracorporel, dans lequel sont disposés le dispositif (8, 17) pour mesurer la concentration de l'indicateur et au moins un capteur (10, 18) pour mesurer la composition du sang.
PCT/AT2005/000397 2004-10-15 2005-10-06 Procede et dispositif pour mesurer la concentration d'indicateur et le degagement des appareils pour des procedes de traitement extracorporel du sang WO2006039731A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AT0173604A AT501013B1 (de) 2004-10-15 2004-10-15 Vorrichtung und verfahren zur messung der indikatorkonzentration und apparateclearance bei extrakorporalen blutbehandlungsverfahren
ATA1736/2004 2004-10-15

Publications (1)

Publication Number Publication Date
WO2006039731A1 true WO2006039731A1 (fr) 2006-04-20

Family

ID=35447944

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AT2005/000397 WO2006039731A1 (fr) 2004-10-15 2005-10-06 Procede et dispositif pour mesurer la concentration d'indicateur et le degagement des appareils pour des procedes de traitement extracorporel du sang

Country Status (2)

Country Link
AT (1) AT501013B1 (fr)
WO (1) WO2006039731A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7474906B2 (en) 2001-05-22 2009-01-06 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Method for dye injection for the transcutaneous measurement of cardiac output
US8082016B2 (en) 2001-05-22 2011-12-20 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Measurement of cardiac output and blood volume by non-invasive detection of indicator dilution
US8337444B2 (en) 2001-05-22 2012-12-25 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Measurement of cardiac output and blood volume by non-invasive detection of indicator dilution for hemodialysis
US8449470B2 (en) 2002-05-21 2013-05-28 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California System for repetitive measurements of cardiac output in freely moving individuals
CN103165010A (zh) * 2013-02-27 2013-06-19 泰山医学院 体外模拟血压波动性增高的装置及其使用方法和应用
WO2021138601A1 (fr) * 2019-12-31 2021-07-08 Chf Solutions, Inc. Système de filtration du sang et surveillance de volume de plasma

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0403683A1 (fr) * 1989-06-23 1990-12-27 Siemens Aktiengesellschaft Appareil d'examen d'un milieu fluide
US20040204634A1 (en) * 2003-04-09 2004-10-14 Womble M. Edward Raman spectroscopic monitoring of hemodialysis

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5308320A (en) * 1990-12-28 1994-05-03 University Of Pittsburgh Of The Commonwealth System Of Higher Education Portable and modular cardiopulmonary bypass apparatus and associated aortic balloon catheter and associated method
US5817042A (en) * 1992-03-04 1998-10-06 Cobe Laboratories, Inc. Method and apparatus for controlling concentrations in vivos and in tubing systems
FR2702962B1 (fr) * 1993-03-22 1995-04-28 Hospal Ind Dispositif et procédé de contrôle de la balance des fluides sur un circuit extracorporel de sang.

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0403683A1 (fr) * 1989-06-23 1990-12-27 Siemens Aktiengesellschaft Appareil d'examen d'un milieu fluide
US20040204634A1 (en) * 2003-04-09 2004-10-14 Womble M. Edward Raman spectroscopic monitoring of hemodialysis

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7474906B2 (en) 2001-05-22 2009-01-06 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Method for dye injection for the transcutaneous measurement of cardiac output
US8082016B2 (en) 2001-05-22 2011-12-20 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Measurement of cardiac output and blood volume by non-invasive detection of indicator dilution
US8337444B2 (en) 2001-05-22 2012-12-25 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Measurement of cardiac output and blood volume by non-invasive detection of indicator dilution for hemodialysis
US8449470B2 (en) 2002-05-21 2013-05-28 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California System for repetitive measurements of cardiac output in freely moving individuals
CN103165010A (zh) * 2013-02-27 2013-06-19 泰山医学院 体外模拟血压波动性增高的装置及其使用方法和应用
WO2021138601A1 (fr) * 2019-12-31 2021-07-08 Chf Solutions, Inc. Système de filtration du sang et surveillance de volume de plasma

Also Published As

Publication number Publication date
AT501013B1 (de) 2007-01-15
AT501013A1 (de) 2006-05-15

Similar Documents

Publication Publication Date Title
DE3616062C2 (fr)
DE69838400T2 (de) Vorrichtung zur berechnung der dialyseeffizienz
DE69926418T2 (de) Vorrichtung zur Bestimmung von Hämodialyseparametern
EP2783715B1 (fr) Procédé de détection d'une recirculation dans un shunt artérioveineux pendant une hémodialyse et système de dialyse
EP1660154B1 (fr) Dispositif de traitement sanguin
EP0131615B1 (fr) appareil pour la determination du volume-minute du coeur
DE69531137T2 (de) System zum optimieren der dialyseclearance
DE19882693B4 (de) On-line-Sensoranordnung zum Messen eines Bioanalyten wie etwa Lactat
DE4424267C2 (de) Vorrichtung zur kontinuierlichen Erfassung von Blutparametern
EP2714128B1 (fr) Dispositif et procédé pour la détection d'un état de fonctionnement d'un traitement de sang extracorporel
EP2533827B1 (fr) Dispositif et procédé pour surveiller un accès vasculaire pour un traitement sanguin extra-corporel
DE3627814C2 (fr)
EP2579910B1 (fr) Dispositif de traitement sanguin extracorporel doté d'un dispositif de mesure pour déterminer la luminescence du liquide de dialyse usagé
EP2209421B1 (fr) Dispositif de détermination d'au moins un indice relatif au métabolisme du glucose d'un patient
EP3431118B1 (fr) Dispositif pour la mise en oeuvre d'une dialyse isonatrique
EP1192962A1 (fr) Méthode et dispositif de contrôle de l'ultrafiltration dans les procédures de traitement du sang
EP1813188A1 (fr) Dispositif pour fournir un point de mesure de la dilution
DE10114283A1 (de) Verfahren zur Konzentrationsermittlung; Dialysegerät
WO2003003911A2 (fr) Procede pour mesurer la concentration de substances dans des organismes vivants par microdialyse et dispositif pour mettre en oeuvre ce procede
EP2799097A2 (fr) Dispositif destiné au traitement extracorporel du sang
WO2006039731A1 (fr) Procede et dispositif pour mesurer la concentration d'indicateur et le degagement des appareils pour des procedes de traitement extracorporel du sang
DE102005044531A1 (de) Verfahren zur Bestimmung einer Perfusionsverteilung
EP1576341B1 (fr) Dispositif de determination du flux sanguin dans un vaisseau sanguin d'un patient
EP0794729A2 (fr) Procede et dispositif de determination du debit sanguin cerebral et du volume sanguin intracerebral
DE4130931C2 (de) Verfahren und Vorrichtung zum Ermitteln des zirkulierenden Blutvolumens

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BW BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EC EE EG ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KM KP KR KZ LC LK LR LS LT LU LV LY MA MD MG MK MN MW MX MZ NA NG NI NO NZ OM PG PH PL PT RO RU SC SD SE SG SK SL SM SY TJ TM TN TR TT TZ UA UG US UZ VC VN YU ZA ZM ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GM KE LS MW MZ NA SD SL SZ TZ UG ZM ZW AM AZ BY KG KZ MD RU TJ TM AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IS IT LT LU LV MC NL PL PT RO SE SI SK TR BF BJ CF CG CI CM GA GN GQ GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 05789359

Country of ref document: EP

Kind code of ref document: A1