Oxygen Delivery Index™

The Oxygen Delivery Index™ represents a function assessment of the microcirculatory system that can be used to diagnose circulatory failure on an individual patient basis.
 

Problem

Large patients groups are treated for circulatory failure by the health care system. Failure can be systemic, and affect all cells of the body. Examples are acute and chronic heart failure, bleeding shock, sepsis, too early born infants (prematurity), or diabetes. Circulatory failure can also be local, such as chronic wounds, critical limb ischemia or failure of a transplanted organ. 
 
A definition of circulatory failure may be described as the disability to deliver sufficient oxygen to meet the metabolic need in the cells of the body.  
 
Today diagnostic assessments of the respiratory and cardiovascular system are based on examination of the structure and function of the heart, arteries or veins (cardiac output and blood pressures), and on blood tests (blood gases, metabolic products and cell enzymes). None of these techniques assess the “end product” function of this system:  delivery of oxygen from the microcirculation to the cells.
 
It is a well-recognized dilemma in intensive care medicine that current state-of-the-art techniques can be within reference levels in cases of irreversible and fatal circulatory failure [1, 2]. In addition, present techniques are insensitive for early detection and early warning of circulatory failure. Lack of correlation between normalized monitoring parameters and patient outcome, and the insensitivity for early detection results in waste of resources from a society perspective, and unfavorable outcome for patients [3, 4]. 
 

Solution

The Oxygen Delivery Index™ represents the analysis of a series of microvascular parameters and is a method for assessing microcirculatory function: the capacity for delivery of oxygen from the circulatory system to the cells of the body. 
 
The Oxygen Deliver Index™ can be used to:
  1. Make a diagnosis of the function of the circulatory system, i.e. circulatory failure, on an individual patient basis.
  2. Provide a prognosis for the specific patient.
  3. Assess the efficacy of treatment in a specific patient by trend analyses of measurements before and after start of treatment
 
The Oxygen Delivery Index™, as presented here, describes for the first time a concept for bedside use which can quantify circulatory failure based on delivery of oxygen from the microcirculation to cells. 
 

How

Non-invasive data collection is performed bedside by trained health personnel (MD, nurse, technician), using the Microvascular Laboratory™ (mLab™) developed by ODI Medical.
The mLab™ contains optical data capture technology and may be applied on the skin, the eye, or the oral cavity. Measuring volumes are < 0.1 mm3 and collected data are transferred, using encrypted secure transfer, to the to ODI Medical Central Laboratory, cLab™, for advanced analysis of microvascular hemodynamics and oxygen delivery. 
 
From the captured data, a series of parameters are extracted in cLab™ and the total output represents an optical biomarker for oxygen delivery to cells in the measuring volume: the Oxygen Delivery Index™.  
 
All data analysis is reviewed and approved by trained clinical personnel.
 
The Oxygen Deliver Index™ is communicated to the responsible physician, and can be used for clinical decision-making and patient tailored treatment. 
 
References
  1. Arnaldo Dubin, Microcirculation in the intensive care unit, Rev Bras Ter Intensiva. 2011; 23(3):249-251.
  2. Wester T, Awan ZA, Kvernebo TS, Salerud G, Kvernebo K, Skin microvascular morphology and hemodynamics during treatment with veno- arterial extra-corporeal membrane oxygenation, Clin Hemorheol Microcirc, 2014; 56(2):119-31.
  3. Frazier SK, Skinner GJ, Pulmonary artery catheters: state of the controversy, J Cardiovasc Nurs (2008); 23: 113–121.
  4. J.M. Luce, G.D. Rubenfeld, Can Health Care Costs Be Reduced by Limiting Intensive Care at the End of Life?, Am J Respir Crit Care Med, 165 (2002), 750-754.