Model-based prediction of the patient-specific response to adrenaline

Type of content
Journal Article
Thesis discipline
Degree name
Publisher
University of Canterbury. Electrical and Computer Engineering
University of Canterbury. Mechanical Engineering
Journal Title
Journal ISSN
Volume Title
Language
Date
2010
Authors
Chase, Geoff
Starfinger, C.
Hann, C.E.
Shaw, Geoff
Desaive, T.
Abstract

A model for the cardiovascular and circulatory systems has previously been validated in simulated cardiac and circulatory disease states. It has also been shown to accurately capture the main hemodynamic trends in porcine models of pulmonary embolism and PEEP (positive end-expiratory pressure) titrations at different volemic levels. In this research, the existing model and parameter identification process are used to study the effect of different adrenaline doses in healthy and critically ill patient populations, and to develop a means of predicting the hemodynamic response to adrenaline. The hemodynamic effects on arterial blood pressures and stroke volume (cardiac index) are simulated in the model and adrenaline-specific parameters are identified. The dose dependent changes in these parameters are then related to adrenaline dose using data from studies published in the literature. These relationships are then used to predict the future, patient-specific response to a change in dose or over time periods from 1-12 hours. The results are compared to data from 3 published adrenaline dosing studies comprising a total of 37 data sets. Absolute percentage errors for the identified model are within 10% when re-simulated and compared to clinical data for all cases. All identified parameter trends match clinically expected changes. Absolute percentage errors for the predicted hemodynamic responses (N=15) are also within 10% when re-simulated and compared to clinical data. Clinically accurate prediction of the effect of inotropic circulatory support drugs, such as adrenaline, offers significant potential for this type of model-based application. Overall, this work represents a further clinical, proof of concept, of the underlying fundamental mathematical model, methods and approach, as well as providing a template for using the model in clinical titration of adrenaline in a decision support role in critical care. They are thus a further justification in support of upcoming human clinical trials to validate this model.

Description
Citation
Chase, J.G., Starfinger, C., Hann, C.E., Shaw, G.M., Desaive, T. (2010) Model-based prediction of the patient-specific response to adrenaline. The Open Medical Informatics Journal, 4, pp. 149-163.
Keywords
cardiovascular system, cardiac model, parameter identification, integral method, adrenaline, epinephrine, mathematical model, simulation
Ngā upoko tukutuku/Māori subject headings
ANZSRC fields of research
Field of Research::11 - Medical and Health Sciences
Field of Research::11 - Medical and Health Sciences::1102 - Cardiovascular Medicine and Haematology
Field of Research::09 - Engineering::0903 - Biomedical Engineering
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