Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium.
Biomed Eng Online. 2018 Nov 20;17(1):171. doi: 10.1186/s12938-018-0603-4.
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.
Validation encompasses a comparison between novel metrics and well-known, analogous clinical metrics such as mean arterial and venous pressures, across an animal model of induced sepsis. The novel metric O, 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, O 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 O provided the best combination of specificity and sensitivity, assuming an equal weighting to both, of the metrics assessed.
Overall, the potential of these novel metrics in the detection of diagnostic shifts in physiological behaviour, here driven by sepsis, is demonstrated.
本文提出了一种方法学，旨在帮助弥合重症监护病房中常见的复杂波形信息与快速临床诊断和管理所需的简单、集中值之间的差距。该方法学采用简单的波形轮廓分析方法，在逐拍的基础上比较主动脉、股动脉和中心静脉压波形，并提取与血液流经全身循环各个部分时的压降和压力脉冲幅度衰减相关的集中度量。
验证包括在诱导性脓毒症的动物模型中，比较新指标与众所周知的类似临床指标，如平均动脉压和静脉压。新指标 O 是股动脉和腔静脉之间的直接压力偏移，临床指标ΔMP 是平均动脉压和静脉压之间的差异，表现良好。然而，O 将平均动脉压和静脉压之间的差异从 46.2 分钟减少到 11.6 分钟，检测内毒素输注后脓毒症的最佳平均时间，而假阳性率从 1.8%略微增加到 6.2%。因此，假设评估的指标具有同等权重，新的 O 提供了最佳的特异性和敏感性组合。
总体而言，这些新指标在检测生理行为的诊断变化方面具有潜力，本文中这些变化是由脓毒症驱动的。
