PubMed · 14381736
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H A FRANK, M H CARR. 1955. A simplified dye method for estimating plasma volume.. https://pubmed.ncbi.nlm.nih.gov/14381736/
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The indocyanine green (ICG) dilution technique (DT) is frequently used for plasma volume (PV) measurement. However, because of inadequate knowledge about the properties of this dye, lack of accuracy has been attributed to the method. The aim of this report is to provide physiological background information about the ICG-DT to avoid some profound misunderstandings. When performing tracer dilution, one has to consider the tracer's distribution space before interpreting the result. For ICG, the distribution space is the total PV, i.e., circulating + noncirculating PV, fixed within the endothelial glycocalyx. The distribution space of red blood cells and large molecules, in contrast, is only the circulating part of PV. Therefore, it is erroneous to compare directly PV derived from different tracer dilution methods. The transcapillary escape rate of ICG should not relevantly influence measured PV if the method is performed properly, i.e., if a short time window of measurement is subjected to monoexponential extrapolation. A major problem of PV measurement in general is that the target itself is very inconstant. Thus, checking for constancy of ICG-DT with two consecutive measurements is unreliable. Nevertheless, the ICG-DT is a useful tool for determining PV, provided it is well understood by the investigator to enable correct interpretation of the results.
The prediction of which patients respond to fluid infusion and which patients do not is an important issue in the intensive care setting. Assessment of this response by monitoring changes in some hemodynamic characteristics in relation to spontaneous breathing efforts would be very helpful for the management of the critically ill. This unfortunately remains a difficult clinical problem, as discussed in the previous issue of the journal. Technical factors and physiological factors limit the usefulness of current techniques.
Blood hemoglobin concentration and hematocrit are probably the most widely used parameters for outpatient and inpatient examination. In addition to their inherent significance for evaluation of blood viscosity and oxygen carrying capacity, these parameters are traditionally used as tracers of plasma dilution. Blood test derived results are conventionally recorded on multiple pages in patient's medical records making dynamical investigations tedious and time-consuming. In addition, research results describing plasma dilution by means of hemoglobin or hematocrit are presented in a clinically unpractical way. A new method, referred to as HBS Graphics (patent pending--USA serial # 60/712809) is introduced for the first time in this article. This method of evaluation of dynamical hemoglobin concentration, hematocrit and mean corpuscular hemoglobin concentration value deploys interfering parameter shifts for the evaluation of plasma dilution in relation to osmotic dynamics. The HBS Graphics complements two coordinate systems--hemoglobin concentration and hematocrit--with incorporated mean corpuscular hemoglobin concentration value specific trends referred to as radiating lines. Isosmotic plasma dilution and erythrocyte volume shifts follow radiating lines, while osmotic shifts induce intertrend shifts. This article also reviews other methods of tracing plasma dilution by means of blood hemoglobin concentration and hematocrit dynamics.