Die Überwachung der Leberfunktionen

摘要

The relevance of liverndysfunction in the managementnof critically ill patients is increas-ningly being recognized. It hasnbeen found to affect mortality ofpatients with septic organ failurenin several studies. The increasingnprevalence of chronic liver diseasnamong intensive care patientsnadds importance to the issue ofnmonitoring the various aspects ofnliver function. An array of livernfunction tests as part of bloodnbiochemistry testing has longnbeen established. In the contextnof critical care and chronic liverndisease, however, they must beninterpreted cautiously. In addi-ntion, several dynamic tests of liv-ner function have been developed.nRelatively best explored are testsnbased on the hepatic eliminationnof indocyanine-green (ICG).nCommercially available systemsnanalyzing the plasma disappear-nance rate of ICG (ICG-PDR) arenbeing marketed but these para-nmeters also are difficult to inter-npret in the intensive care settingnand especially in patients withnchronic liver disease. ICG-PDRncorrelates with mortality in pa-ntients with septic organ dysfunc-ntion but studies investigating thenoutcome-oriented results of theranpeutic interventions directed bynthese parameters have not beennpublished. The possible relevancento intensive care management ofnseveral other dynamic tests ofnliver function, as well as intervenntional and ultrasonografic meth-nods to address liver perfusion,nare discussed in the article. Asyet, there is no single method tonmonitor the various aspects ofnliver function and no methodnwhose clinical value has beennproved. Clinicians therefore havento mostly rely on clinical judge-nment aided by a reasonable selec-ntion among existing monitoringntools.