A Dynamic Model of Rescuer Parameters for Optimizing Blood Gas Delivery during Cardiopulmonary Resuscitation.
A Dynamic Model of Rescuer Parameters for Optimizing Blood Gas Delivery during Cardiopulmonary Resuscitation.
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用于优化心肺复苏期间血气输送的救援者参数动态模型。
DOI：
10.1155/2018/3569346
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发表时间：
2018
影响因子：
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通讯作者：
Nataraj,Chandrasekhar
中科院分区：
文献类型：
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作者：
Jalali,Ali;Simpao,AllanF;Gálvez,JorgeA;Berg,RobertA;Nadkarni,VinayM;Nataraj,Chandrasekhar
介绍。心肺复苏（CPR）的质量已被证明会影响患者的预后。然而，心肺复苏术后的发病率和死亡率仍然很高，心肺复苏术优化是一个活跃的研究领域。优化心肺复苏术的一种方法是建立可靠的心肺复苏术性能指标，然后修改心肺复苏术参数，如按压和呼吸机呼吸，以加强这些措施。我们的目的是定义一个可靠的心肺复苏绩效指标，并在此基础上优化心肺复苏绩效，设计一个动态优化方案，通过改变心肺复苏参数来优化心肺复苏绩效。材料与方法。我们选择总血气输送（全身氧输送和二氧化碳输送到肺部）作为最大化的目标函数。心肺复苏术参数分为施救者依赖、患者依赖和恒定参数三类。采用模拟退火方法，提出了全局优化方案和顺序优化方案。结果和讨论。分析心肺复苏术参数随心肺复苏术序列（周期）的变化。在所有患者组中，与全局优化方案相比，顺序优化方案显著提高了心肺复苏术的有效性。我们的研究说明了在心肺复苏术中考虑施救者相关参数的动态变化以提高表现的潜在益处。序贯优化技术的优势在于它具有动态适应的效果。我们的心肺复苏术优化结果表明，随着心肺复苏术的进行，压通比应该降低，顺序优化技术可能会提高心肺复苏术的性能。在实际实践中实施这些更改之前，需要进行体内验证。
Introduction. The quality of cardiopulmonary resuscitation (CPR) has been shown to impact patient outcomes. However, post‐CPR morbidity and mortality remain high, and CPR optimization is an area of active research. One approach to optimizing CPR involves establishing reliable CPR performance measures and then modifying CPR parameters, such as compressions and ventilator breaths, to enhance these measures. We aimed to define a reliable CPR performance measure, optimize the CPR performance based on the defined measure and design a dynamically optimized scheme that varies CPR parameters to optimize CPR performance.Materials and Methods. We selected total blood gas delivery (systemic oxygen delivery and carbon dioxide delivery to the lungs) as an objective function for maximization. CPR parameters were divided into three categories: rescuer dependent, patient dependent, and constant parameters. Two optimization schemes were developed using simulated annealing method: a global optimization scheme and a sequential optimization scheme.Results and Discussion. Variations of CPR parameters over CPR sequences (cycles) were analyzed. Across all patient groups, the sequential optimization scheme resulted in significant enhancement in the effectiveness of the CPR procedure when compared to the global optimization scheme.Conclusions. Our study illustrates the potential benefit of considering dynamic changes in rescuer‐dependent parameters during CPR in order to improve performance. The advantage of the sequential optimization technique stemmed from its dynamically adapting effect. Our CPR optimization findings suggest that as CPR progresses, the compression to ventilation ratio should decrease, and the sequential optimization technique can potentially improve CPR performance. Validationin vivois needed before implementing these changes in actual practice.