Incorporating pulse wave velocity into model-based pulse contour analysis method for estimation of cardiac stroke volume (2019)
Background and Objectives: Stroke volume (SV) and cardiac output (CO) are important metrics for hemodynamic management of critically ill patients. Clinically available devices to continuously monitor these metrics are invasive, and less invasive methods perform poorly during hemodynamic instability. Pulse wave velocity (PWV) could potentially improve estimation of SV and CO by providing information on changing vascular tone. This study investigates whether using PWV for parameter identification of a model-based pulse contour analysis method improves SV estimation accuracy. Methods: Three implementations of a 3-element windkessel pulse contour analysis model are compared: constant-Z, water hammer, and BramwellHill methods. Each implementation identifies the characteristic impedance parameter (Z) differently. The first method identifies Z statically and does not use PWV, and the latter two methods use PWV to dynamically update Z. Accuracy of SV estimation is tested in an animal trial, where interventions induce severe hemodynamic changes in 5 pigs. Model-predicted SV is compared to SV measured using an aortic flow probe. Results: SV percentage error had median bias and [(IQR); (2.5th, 97.5th percentiles)] of -0.5% [(-6.1%, 4.7%); (-50.3%, +24.1%)] for the constantZ method, 0.6% [(-4.9%, 6.2%); (-43.4%, +29.3%)] for the water hammer method, and 0.8% [(-6.5, 8.6); (-37.1%, +47.6%)] for the Bramwell-Hill method. Conclusion: Incorporating PWV for dynamic Z parameter identification through either the Bramwell-Hill equation or the water hammer equation does not appreciably improve the 3-element windkessel pulse contour analysis model’s prediction of SV during hemodynamic changes compared to the constant-Z method.
CitationSmith R, Balmer J, Pretty C, Mehta-Wilson T, Desaive T, Shaw G, Chase G (2019). Incorporating pulse wave velocity into model-based pulse contour analysis method for estimation of cardiac stroke volume. Maastricht, Netherlands: Cardiac Physiome 2019. 04/12/2019-06/12/2019. Computer Methods and Programs in Biomedicine Volume 195, October 2020, 105553
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KeywordsPulse contour analysis; Pressure contour analysis; Pulse wave velocity; Windkessel model; Stroke volume; Cardiac output; Hemodynamic monitoring; Intensive care
ANZSRC Fields of Research40 - Engineering::4003 - Biomedical engineering::400305 - Biomedical instrumentation
32 - Biomedical and clinical sciences::3201 - Cardiovascular medicine and haematology::320101 - Cardiology (incl. cardiovascular diseases)
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
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Smith R; Balmer J; Shaw, Geoff; Chase, Geoff; Pretty, Christopher (Elsevier BV, 2020)Abstract: A system is needed for monitoring stroke volume (SV) and cardiac output (CO) in unstable patients which is non-additionally invasive, reproducible and reliable in a variety of physiological states. This study ...
Improved pressure contour analysis for estimating cardiac stroke volume using pulse wave velocity measurement Kamoi S; Pretty C; Balmer J; Davidson S; Pironet A; Desaive T; Shaw, Geoff; Chase, Geoff (2017)Background: Pressure contour analysis is commonly used to estimate cardiac performance for patients suffering from cardiovascular dysfunction in the intensive care unit. However, the existing techniques for continuous ...
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