Pulsus Paradoxus Monitor

奇脉监测仪

• 批准号: 6788511
• 负责人: GREGORY D. JAY
• 金额: $ 14.91万
• 依托单位: PLETHLOGIC
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-17 至 2006-09-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6788511
• 关键词: adolescence (12-20); adult human (21+); age difference; asthma; biomedical equipment development; blood pressure; child (0-11); clinical research; computer program /software; computer system design /evaluation; emergency care; human subject; patient care management; patient monitoring device; portable biomedical equipment

DESCRIPTION (provided by applicant): Pulsus paradoxus (PP) is a valuable pathological vital sign in the management of asthma and in the rapid evaluation of patients with dyspnea in general. Early asthma management guidelines published by NHLBI in 1991 included a recommendation for physicians to measure PP in acutely asthmatic patients. Recent evidence continues to show that PP can play a role as a metric indicative of respiratory effort during dysfunction. Unlike peak flow rate and spirometry, PP measurement is non-effort dependent and would theoretically result in better assessment of asthma severity. Pulsus paradoxus is present in asthma, croup, and pericardial tamponade and tension pneumothorax. It appears prior to hypoxia in all of these conditions. For this reason, PP monitoring would prove useful not only to physicians but also to physician extenders who may be unfamiliar with the physiological dyscrasias of these conditions and would be assisted by an expert monitoring system. We propose 3 interconnecting specific aims: 1) Improve the automated PP detection algorithm resulting in at least a 95% agreement between automated PP and true PP measurement from a continuous non-invasive blood pressure monitor (NIBP). 2) Is the PP threshold of 12 mmHg for hospital admission in the 1991 NHLBI ED Asthma Management Guidelines valid as measured with an automated non-invasive PP monitor among acutely asthmatic children? 3) Is the PP threshold of 12 mmHg for hospital admission in the 1991 NHLBI ED Asthma management guidelines valid as measured with an automated non-invasive PP monitor among acutely asthmatic adults? In aim 1 we will improve upon our existing PP detection algorithm as it analyzes data in real time from a NIBP monitor. Aims 2 & 3 will test whether the original NHLBI emergency department asthma management guidelines, which included an actual PP threshold, are valid. Data from aims 2 & 3 will provide real world blood pressure data from acutely asthmatic patients for the iterative refinement efforts in aim 1. This Phase 1 effort will result in a refined PP monitor, for which we have a strong intellectual property position, and clinically relevant (validated) PP thresholds, which future asthma management guidelines will reference. Future Phase 2 activities could include prospective PP threshold testing in the emergency department and home monitoring of selected asthmatic patients, both of which would impact efficient clinical resource utilization.

描述（由申请人提供）： 奇脉 (PP) 是哮喘治疗和呼吸困难患者快速评估中有价值的病理生命体征。 NHLBI 于 1991 年发布的早期哮喘管理指南包括建议医生测量急性哮喘患者的 PP。最近的证据继续表明，PP 可以作为功能障碍期间呼吸努力的指示指标。与峰值流速和肺活量测定不同，PP 测量不依赖于努力程度，理论上可以更好地评估哮喘严重程度。奇脉见于哮喘、哮吼、心包填塞和张力性气胸。在所有这些情况下，它都出现在缺氧之前。 因此，PP 监测不仅对医生有用，而且对可能不熟悉这些病症的生理恶液质并会得到专家监测系统协助的医生延伸者有用。我们提出了 3 个相互关联的具体目标：1) 改进自动 PP 检测算法，使自动 PP 与连续无创血压监测仪 (NIBP) 的真实 PP 测量值之间至少有 95% 的一致性。 2) 1991 年 NHLBI ED 哮喘管理指南中规定的入院 PP 阈值 12 mmHg 在急性哮喘儿童中使用自动无创 PP 监测仪测量是否有效？ 3) 1991 年 NHLBI ED 哮喘管理指南中入院的 PP 阈值 12 mmHg 在急性哮喘成人中使用自动无创 PP 监测仪测量是否有效？在目标 1 中，我们将改进现有的 PP 检测算法，因为它实时分析来自 NIBP 监测仪的数据。目标 2 和 3 将测试原来的 NHLBI 急诊科哮喘管理指南（其中包括实际 PP 阈值）是否有效。目标 2 和 3 的数据将为目标 1 中的迭代细化工作提供急性哮喘患者的真实血压数据。这一阶段 1 的工作将产生完善的 PP 监测器（我们对此拥有强大的知识产权地位）和临床相关（经过验证的） PP 阈值（未来的哮喘管理指南将参考这些阈值）。未来的第二阶段活动可能包括在急诊科进行前瞻性 PP 阈值测试和对选定的哮喘患者进行家庭监测，这两者都将影响临床资源的有效利用。