A novel method of trans-esophageal Doppler cardiac output monitoring utilizing peripheral arterial pulse contour with/without machine learning approach
A novel method of trans-esophageal Doppler cardiac output monitoring utilizing peripheral arterial pulse contour with/without machine learning approach
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DOI：
10.1007/s10877-021-00671-7
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发表时间：
2021-02
影响因子：
2.2
通讯作者：
K. Uemura;Takuya Nishikawa;T. Kawada;C. Zheng;Meihua Li;K. Saku;M. Sugimachi
中科院分区：
文献类型：
--
作者：
K. Uemura;Takuya Nishikawa;T. Kawada;C. Zheng;Meihua Li;K. Saku;M. Sugimachi
胸降主动脉（DA）中的经食管多普勒（TED）速度用于跟踪心输出量（CO）的变化。然而，通过这种方法进行的CO跟踪受到主动脉横截面积（CSA）或流向上半身和下半身的血流之间的比例的实质性变化的阻碍。为了克服这一点，我们开发了一种新的TED CO监测方法。在该方法中，TED信号主要从主动脉弓（AA）获得。使用AA速度信号，通过用外周动脉脉搏轮廓补偿主动脉CSA的变化来估计CO（COAA-CSA）。当AA无法正确显示或AA速度信号的质量不可接受时，我们的方法首先通过补偿主动脉CSA的变化，并通过对CSA调整的CO和参考CO（COref）之间的关系进行机器学习来补偿血流比例的变化，从而从DA速度信号中估计CO（CODA-ML）。在12只麻醉犬中，我们比较了COAA-CSA和CODA-ML与升主动脉血流探针在不同血流动力学条件下测量的COref（COref从723到7316 ml·min-1）。COAA-CSA和COref之间，四象限图分析的一致率为96%，而极坐标图分析的角度一致率为91%。CODA-M与COref的一致率为93%，角度一致率为94%。COAA-CSA和CODA-ML均表现出COref的“良好至边缘”跟踪能力。总之，我们的方法可以在围手术期血流动力学管理期间对CO进行稳健可靠的跟踪。
Transesophageal Doppler (TED) velocity in the descending thoracic aorta (DA) is used to track changes in cardiac output (CO). However, CO tracking by this method is hampered by substantial change in aortic cross-sectional area (CSA) or proportionality between blood flow to the upper and lower body. To overcome this, we have developed a new method of TED CO monitoring. In this method, TED signal is obtained primarily from the aortic arch (AA). Using AA velocity signal, CO (COAA-CSA) is estimated by compensating changes in the aortic CSA with peripheral arterial pulse contour. When AA cannot be displayed properly or when the quality of AA velocity signal is unacceptable, our method estimates CO (CODA-ML) from DA velocity signal first by compensating changes in the aortic CSA, and by compensating changes in the blood flow proportionality through a machine learning of the relation between the CSA-adjusted CO and a reference CO (COref). In 12 anesthetized dogs, we compared COAA-CSAand CODA-MLwith COrefmeasured by an ascending aortic flow probe under diverse hemodynamic conditions (COrefchanged from 723 to 7316 ml·min−1). Between COAA-CSAand COref, concordance rate in the four-quadrant plot analysis was 96%, while angular concordance rate in the polar plot analysis was 91%. Between CODA-MLand COref, concordance rate was 93% and angular concordance rate was 94%. Both COAA-CSAand CODA-MLdemonstrated “good to marginal” tracking ability of COref. In conclusion, our method may allow a robust and reliable tracking of CO during perioperative hemodynamic management.