Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy.
Intensive Care Department, Hospital Universitario SAS de Jerez, Jerez de la Frontera, Spain.
Physiol Meas. 2024 Aug 22;45(8). doi: 10.1088/1361-6579/ad6acf.
Arterial pulse wave analysis (PWA) is now established as a powerful tool to investigate the cardiovascular system, and several clinical studies have shown how PWA can provide valuable prognostic information over and beyond traditional cardiovascular risk factors. Typically these techniques are applied to chronic conditions, such as hypertension or aging, to monitor the slow structural changes of the vascular system which lead to important alterations of the arterial PW. However, their application to acute critical illness is not currently widespread, probably because of the high hemodynamic instability and acute dynamic alterations affecting the cardiovascular system of these patients.In this work we propose a review of the physiological and methodological basis of PWA, describing how it can be used to provide insights into arterial structure and function, cardiovascular biomechanical properties, and to derive information on wave propagation and reflection.The applicability of these techniques to acute critical illness, especially septic shock, is extensively discussed, highlighting the feasibility of their use in acute critical patients and their role in optimizing therapy administration and hemodynamic monitoring.The potential for the clinical use of these techniques lies in the ease of computation and availability of arterial blood pressure signals, as invasive arterial lines are commonly used in these patients. We hope that the concepts illustrated in the present review will soon be translated into clinical practice.
动脉脉搏波分析（PWA）现已成为研究心血管系统的有力工具，多项临床研究表明，PWA 如何能够提供比传统心血管危险因素更有价值的预后信息。通常，这些技术应用于慢性疾病，如高血压或衰老，以监测导致动脉 PW 重要改变的血管系统的缓慢结构变化。然而，它们在急性危重病中的应用目前并不广泛，可能是因为这些患者的心血管系统受到高度血流动力学不稳定和急性动态变化的影响。在这项工作中，我们提出了对 PWA 的生理和方法学基础的回顾，描述了它如何用于提供对动脉结构和功能、心血管生物力学特性以及波传播和反射信息的深入了解。广泛讨论了这些技术在急性危重病中的适用性，特别是感染性休克，强调了它们在急性危重病患者中的使用可行性及其在优化治疗管理和血流动力学监测中的作用。这些技术的临床应用潜力在于计算和获取动脉血压信号的简便性，因为这些患者通常使用有创动脉线。我们希望本综述中阐述的概念能尽快转化为临床实践。
