Volatility: a new vital sign identified using a novel bedside monitoring strategy.

Volatility: a new vital sign identified using a novel bedside monitoring strategy.
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波动性:使用新颖的床边监测策略识别的新生命体征。

DOI:
10.1097/01.ta.0000151179.74839.98
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发表时间:
2005
期刊:
The Journal of trauma
影响因子:
--
通讯作者:
MorrisJr,JohnA
MorrisJr,JohnA
中科院分区:
--
文献类型:
--
作者:
Grogan,EricL;Norris,PatrickR;Speroff,Theodore;Ozdas,Asli;France,DanielJ;Harris,PaulA;Jenkins,JudithM;Stiles,Renee;Dittus,RobertS;MorrisJr,JohnA

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背景:SIMON (Signal Interpretation and Monitoring,信号解读与监测)监测并存档ICU的连续生理数据(HR、BP、CPP、ICP、CI、EDVI、sv2o、sp2o、SVRI、PAP和CVP)。我们假设:心率(HR)波动率比集中趋势(平均值和中位数)更好地预测结果。方法:对某一级创伤中心923例患者2年来的6亿多条生理数据点进行归档。每1 ~ 4秒收集一次数据,存储在MS-SQL 7.0关系数据库中,链接到TRACS,并去识别。使用logistic回归和泊松回归分析年龄、性别、种族、损伤严重程度评分(ISS)和HR统计结果(死亡和呼吸机天数)。结果:我们分析了8500万个人力资源数据点,这些数据点代表了超过71,000小时的连续数据捕获。平均HR因年龄、性别和ISS而异,但与死亡或呼吸机天数无关。挥发性指标(SD,% HR> 120)与死亡和延长通气时间相关。结论:1)波动性比集中趋势更能预测死亡。2)波动性是一个新的生命体征,我们将应用于其他生理参数,只有使用像SIMON这样的密集数据捕获技术才能充分探索。3)密集采样的聚合生理数据可以确定需要新治疗策略的患者亚群。
Background:SIMON (Signal Interpretation and Monitoring) monitors and archives continuous physiologic data in the ICU (HR, BP, CPP, ICP, CI, EDVI, S V O 2, S P O 2, SVRI, PAP, and CVP). We hypothesized: heart rate (HR) volatility predicts outcome better than measures of central tendency (mean and median).Methods:More than 600 million physiologic data points were archived from 923 patients over 2 years in a level one trauma center. Data were collected every 1 to 4 seconds, stored in a MS-SQL 7.0 relational database, linked to TRACS, and de-identified. Age, gender, race, Injury Severity Score (ISS), and HR statistics were analyzed with respect to outcome (death and ventilator days) using logistic and Poisson regression.Results:We analyzed 85 million HR data points, which represent more than 71,000 hours of continuous data capture. Mean HR varied by age, gender and ISS, but did not correlate with death or ventilator days. Measures of volatility (SD,% HR> 120) correlated with death and prolonged ventilation.Conclusions:1) Volatility predicts death better than measures of central tendency. 2) Volatility is a new vital sign that we will apply to other physiologic parameters, and that can only be fully explored using techniques of dense data capture like SIMON. 3) Densely sampled aggregated physiologic data may identify sub-groups of patients requiring new treatment strategies.
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