Blood pressure waveform contour analysis for assessing peripheral resistance changes in sepsis

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Journal Article
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Date
2018
Authors
Davidson S
Pretty CG
balmer J
Desaive T
Chase, Geoff
Abstract

Background: This paper proposes a methodology for helping bridge the gap between the complex waveform information frequently available in an intensive care unit and the simple, lumped values favoured for rapid clinical diagnosis and management. This methodology employs a simple waveform contour analysis approach to compare aortic, femoral and central venous pressure waveforms on a beat-by-beat basis and extract lumped metrics pertaining to the pressure drop and pressure-pulse amplitude attenuation as blood passes through the various sections of systemic circulation. Results: Validation encompasses a comparison between novel metrics and wellknown, analogous clinical metrics such as mean arterial and venous pressures, across an animal model of induced sepsis. The novel metric Ofe → vc, the direct pressure offset between the femoral artery and vena cava, and the clinical metric, ΔMP, the difference between mean arterial and venous pressure, performed well. However, Ofe → vc reduced the optimal average time to sepsis detection after endotoxin infusion from 46.2 min for ΔMP to 11.6 min, for a slight increase in false positive rate from 1.8 to 6.2%. Thus, the novel Ofe → vc provided the best combination of specificity and sensitivity, assuming an equal weighting to both, of the metrics assessed. Conclusions: Overall, the potential of these novel metrics in the detection of diagnostic shifts in physiological behaviour, here driven by sepsis, is demonstrated

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Keywords
Septic shock, Cardiovascular monitoring, Arterial pressure waveform, Pressure catheter, Linear least-squares
Ngā upoko tukutuku/Māori subject headings
ANZSRC fields of research
Field of Research::09 - Engineering::0903 - Biomedical Engineering
Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
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© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.