Continuous Cardiac Output & Filling Pressure Monitoring

连续心输出量

• 批准号: 7037157
• 负责人: RAMAKRISHNA MUKKAMALA
• 金额: $ 10.95万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7037157
• 关键词: automated medical record system; blood pressure; cardiac output; clinical research; computer data analysis; diagnosis design /evaluation; heart catheterization; heart disorder diagnosis; hemodynamics; human data; intensive care; mathematical model; patient /disease registry; patient monitoring device; pulmonary artery; statistics /biometry; technology /technique development; thermal blood flow measurement

DESCRIPTION (provided by applicant): The pulmonary artery catheter is routinely employed for hemodynamic monitoring of critically ill patients. This catheter permits the estimation of cardiac output (CO) via thermodilution and left heart filling pressure (i.e., left atrial pressure (LAP)) through pulmonary capillary wedge pressure (PCWP). However, these measurements are only obtained intermittently as an operator is required. On the other hand, pulmonary artery pressure (PAP) is measured continuously and automatically with the catheter. A few investigators have therefore proposed analysis techniques to continuously monitor CO from a PAP waveform. However, these techniques were not able to overcome the highly complex wave and inertial effects that corrupt PAP waveforms and were thus unsuccessful. Moreover, even though LAP is also a significant determinant of PAP, none of these techniques provided a means to monitor LAP. We have developed a one of a kind technique for continuously and automatically monitoring both CO and LAP by mathematical analysis of a PAP waveform. In contrast to all previous, related attempts, our technique analyzes the waveform over time scales greater than a cardiac cycle in which the complex wave and inertial effects cease to be a factor. We have conducted initial testing of the technique in nine intensive care unit (ICU) patients, and our results are in agreement with thermodilution and PCWP measurements. We propose further development and evaluation of the technique based on a growing database of ICU patients including hundreds of annotated pulmonary artery catheterization data sets. Specific Aim 1 is to optimize the mathematical analysis technique. We will refine the technique by optimally incorporating the long time scale PAP information in the analysis. Specific Aim 2 is to validate the technique with respect to the standard ICU measurements. We will statistically compare the CO and LAP estimated by the technique with thermodilution and PCWP over all, and under each, of the patient conditions (e.g., therapy, disease). Specific Aim 3 is to compare the performance of the technique to all other competing analysis techniques. We will implement all competing PAP waveform analysis techniques, optimize their performance, and likewise comprehensively evaluate and compare them. Successful achievement of these specific aims may ultimately lead to continuous and automatic monitoring of CO and LAP in ICUs and operating and recovery rooms and thereby benefit the clinical management of those patients with indications for pulmonary artery catheterization.

描述（由申请人提供）：肺动脉导管通常用于对重症患者的血液动力学监测。该导管允许通过热氧化和左心填充压力（即左心房压（LAP））通过肺毛细管楔压（PCWP）估算心脏输出（CO）。但是，这些测量仅在需要时间歇性地获得。另一方面，肺动脉压（PAP）与导管连续并自动测量。因此，一些研究者提出了分析技术，以从PAP波形连续监测CO。但是，这些技术无法克服高度复杂的波浪和惯性效应，从而破坏了Pap波形，因此未能成功。此外，即使膝盖也是PAP的重要决定因素，但这些技术都没有提供监测圈的手段。我们已经开发了一种通过对PAP波形的数学分析来连续和自动监测CO和LAP的一种类型技术。与以前的所有相关尝试相反，我们的技术分析了随时间尺度的波形大于心脏周期，即复杂波和惯性效应不再是一个因素。我们已经对九个重症监护病房（ICU）患者进行了该技术的初步测试，我们的结果与热稀释和PCWP测量一致。我们提出了基于不断增长的ICU患者数据库（包括数百个带注释的肺动脉导管数据集）的进一步开发和评估。具体目的1是优化数学分析技术。我们将通过将长时间规模的PAP信息最佳地结合到分析中来完善该技术。具体目标2是验证有关标准ICU测量的技术。我们将从统计学上比较该技术估计的CO和圈量，所有患者状况（例如，治疗，疾病）的所有和pCWP和PCWP。具体目标3是将技术的性能与所有其他竞争分析技术进行比较。我们将实施所有竞争性的PAP波形分析技术，优化其性能，并同样全面评估和比较它们。这些特定目标的成功实现最终可能导致对ICUS以及操作和恢复室的CO和LAP的持续和自动监测，从而使这些患者的临床管理有益于具有指示肺动脉导管插入术的患者。