Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, 422 MAB, 1211 21st Ave South, Nashville, TN, 37212, USA.
Vanderbilt University Medical Center, S111 Medical Center North, 21st Ave South, Medical Art Building 422, Nashville, TN, 37212, USA.
BMC Nephrol. 2020 May 24;21(1):194. doi: 10.1186/s12882-020-01845-2.
Accurate assessment of volume status to direct dialysis remains a clinical challenge. Despite current attempts at volume-directed dialysis, inadequate dialysis and intradialytic hypotension (IDH) are common occurrences. Peripheral venous waveform analysis has recently been developed as a method to accurately determine intravascular volume status through algorithmic quantification of changes in the waveform that occur at different volume states. A noninvasive method to capture peripheral venous signals is described (Non-Invasive Venous waveform Analysis, NIVA). The objective of this proof-of-concept study was to characterize changes in NIVA signal with dialysis. We hypothesized that there would be a change in signal after dialysis and that the rate of intradialytic change in signal would be predictive of IDH.
Fifty subjects undergoing inpatient hemodialysis were enrolled. A 10-mm piezoelectric sensor was secured to the middle volar aspect of the wrist on the extremity opposite to the access site. Signals were obtained fifteen minutes before, throughout, and up to fifteen minutes after hemodialysis. Waveforms were analyzed after a fast Fourier transformation and identification of the frequencies corresponding to the cardiac rate, with a NIVA value generated based on the weighted powers of these frequencies.
Adequate quality (signal to noise ratio > 20) signals pre- and post- dialysis were obtained in 38 patients (76%). NIVA values were significantly lower at the end of dialysis compared to pre-dialysis levels (1.203 vs 0.868, p < 0.05, n = 38). Only 16 patients had adequate signals for analysis throughout dialysis, but in this small cohort the rate of change in NIVA value was predictive of IDH with a sensitivity of 80% and specificity of 100%.
This observational, proof-of-concept study using a NIVA prototype device suggests that NIVA represents a novel and non-invasive technique that with further development and improvements in signal quality may provide static and continuous measures of volume status to assist with volume directed dialysis and prevent intradialytic hypotension.
准确评估容量状态以指导透析仍然是一个临床挑战。尽管目前尝试了容量指导透析，但透析不充分和透析中低血压（IDH）仍然很常见。外周静脉波形分析最近已被开发为一种通过算法量化不同容量状态下波形变化来准确确定血管内容量状态的方法。描述了一种捕获外周静脉信号的非侵入性方法（非侵入性静脉波形分析，NIVA）。本概念验证研究的目的是描述 NIVA 信号随透析的变化。我们假设透析后信号会发生变化，并且信号在透析过程中的变化率将预测 IDH。
纳入 50 名接受住院血液透析的患者。在对侧通路部位的手腕中部掌侧用 10mm 压电器传感器固定传感器。在透析前 15 分钟、透析过程中和透析后 15 分钟内获取信号。在快速傅立叶变换后分析波形，并识别与心脏率对应的频率，基于这些频率的加权功率生成 NIVA 值。
38 名患者（76%）在透析前和透析后获得了足够质量（信噪比>20）的信号。与透析前相比，透析结束时的 NIVA 值明显降低（1.203 对 0.868，p<0.05，n=38）。仅有 16 名患者在整个透析过程中有足够的信号进行分析，但在这个小队列中，NIVA 值的变化率可预测 IDH，灵敏度为 80%，特异性为 100%。
这项使用 NIVA 原型设备的观察性概念验证研究表明，NIVA 代表了一种新颖的非侵入性技术，随着进一步的开发和提高信号质量，它可能提供静态和连续的容量状态测量，以协助容量指导透析并预防透析中低血压。
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