Assessment of Intravascular Volume Status

A Game-changer in Clinical Flow

Assessment of intravascular volume status has been a great challenge for many years. Volume status is critical information in the treatment of patients in intensive care as well as for the treatment of heart failure and kidney disease. Even if CO-rebreathing for assessing intravascular volume  (blood volume measurement) has been around for more than 100 years it has never been simplified to a level at which it can be applied in clinical flow. However, Detalo Clinical™ is on its way for medical purposes which will allow medical doctors to get a precise understanding of blood volume, plasma volume and red blood cell volume in critically ill patients.

We believe the Detalo Clinical™ will be a game changer for clinical use.

Detalo Performance™ has already automized the process and has already performed thousands of measurements for athletes and for scientific research.

Intravascular Volume Status in Heart Failure

2018 research from Dr. Strobeck et al. published in Journal of American College of Cardiology, indicates that blood volume guided treatment can reduce mortality and readmissions significantly.

According to the study, the problem is that decongestion strategies in patients hospitalized for heart failure are based on clinical assessment of volume and is does not integrate a quantitative intravascular volume metric. This can be addressed by measuring blood volume.

In the study, treatment adjustments were determined by the primary MD  based upon the blood volume measurement and results were significant:

0%
reduction in 30 days mortality rate
0%
reduction in 365-day mortality
0%
reduction in readmissions

“Heart Failure Outcomes With Volume-Guided Management” by John E. Strobeck et. al, 2018 (link)

Detalo Blood Volume Analyzers

Detalo automatically determines total blood volume, red blood cell volume and plasma volume in humans in a rapid, safe and precise manner.

The Detalo Performance is to be used for athletes and science and is available for purchase today. The Detalo Clinical is currently going through the medical certification procedures and should be available for clinical use in 2020.

From spaceflight to blood doping: Devices for assessing haemoglobin mass and intravascular volumes

Quantification of total hemoglobin mass (Hbmass), red blood cell volume (RBCV), plasma volume (PV) and blood volume (BV) are common in a clinical and scientific context. A decline in BV is often observed in artificial microgravity and during spaceflight, while a PV reduction is observed when sojourning to high altitude as Hbmass and RBCV are two major determinants of physical performance.

Several pathologies are also associated with changes in the composition and/or amount of intravascular volumes: hematological disorders of various origins—polycythaemia or anemia, cancer, heart failure, and kidney diseases. Moreover, it is clinically challenging to detect variations in intravascular volumes in patients with heart failure and patients with hemodialysis for instance. Currently, dialyzed patients do not typically undergo BV estimations with dilution techniques. These patients often show a low peripheral [Hb], but the total RBCV is generally not determined and the low [Hb] could simply be the result of a PV expansion

The CO-rebreathing method has recently been implemented in a clinical context in patients with coronary heart disease and in preoperational patients and was demonstrated to be safe in patients with heart failure

Blood volume measurements was performed using a Detalo device.

Research by: A. Breenfeldt Andersen, L. Oberholzer, T. Haider, A. ‐K. Meinild‐Lundby, N. Fagoni, 2018 (link)

CORP: The assessment of total hemoglobin mass by carbon monoxide rebreathing

With CO rebreathing, a small quantity of CO is diluted in O2 and rebreathed for a specified time period, during which most of the CO is absorbed and bound to circulating hemoglobin. The dilution principle then allows calculation of the total number of circulating hemoglobin molecules based on the number of absorbed CO molecules and the resulting changes in the fraction of carboxyhemoglobin in blood. CO rebreathing has been used for >100 yr and has undergone steady improvement so that today excellent values in terms of accuracy and precision can be achieved if the methodological precautions are carefully followed.

Siebenmann, Keiser, Robach, Lundby, 2017 (link)

Effect of alterations in blood volume with bed rest on glucose tolerance

Bed rest leads to rapid impairments in glucose tolerance. Plasma volume and thus dilution space for glucose are also reduced with bed rest, but the potential influence on glucose tolerance has not been investigated. Accordingly, the aim was to investigate whether bed rest-induced impairments in glucose tolerance are related to a concomitant reduction in plasma volume. This hypothesis was tested mechanistically by restoring plasma volume with albumin infusion after bed rest and parallel determination of glucose tolerance.

During the study, blood volume, plasma volume and Haemoglobin mass (Hb mass) was determined using the Detalo Performance™.

Dandanell S, Oberholzer L, Keiser S, Andersen AB, Haider T, Hilty MP, Meinild-Lundby AK, Lundby C.(link)