Cardiovascular Variability and Control in Early Sepsis

描述(由申请人提供)：败血症是一种常见的、复杂的、危及生命的综合征，由严重感染引起。早期、量身定制的治疗对脓毒症的结局至关重要，但可靠的治疗终点已被证明难以实现。缺乏对人体心血管控制系统变异性的可靠统计和信号处理分析，可能有助于确定脓毒症早期治疗的有效终点，以及识别脓毒症预后不良的高危患者。这项建议利用InterMountain Healthcare非常详细的电子病历，旨在研究大量严重败血症和感染性休克患者的心率和动脉血压变异性的模式。这项研究假设，心血管变异性的光谱和非线性测量，如频谱功率、样本熵和分形指数，将在败血症患者出现24小时后预测心血管内稳态的恢复。这项研究进一步假设，早期治疗后心血管变异性的变化将提高我们预测心血管内稳态恢复的能力。最后，这项研究假设变异性的模式将预测给予血管加压剂药物或静脉输液的即时反应。这项研究旨在为改善脓毒症患者的床边护理以及更好地了解脓毒症患者体内平衡的破坏和恢复机制奠定基础。 公共卫生相关性：这项研究试图确定危及生命的感染患者的心率和血压的隐藏模式，这种情况被称为败血症。这些模式应该有助于我们识别有严重并发症风险的患者，并帮助指导这些危重患者的复苏。这项研究还应显著加强对脓毒症的病因、遗传基础和可能的新治疗方法的进一步研究。

DESCRIPTION (provided by applicant): Sepsis is a common, complex, life-threatening syndrome arising from serious infection. Early, tailored therapy is crucial to the outcome of sepsis, but reliable endpoints for therapy have proved elusive. This lack of reliable Statistical and signal-processing analyses of variability in the body's cardiovascular control system may prove useful in defining valid endpoints for early therapy of sepsis, as well as identifying patients at high risk for poor outcome from sepsis. Employing the highly detailed electronic medical record at Intermountain Healthcare, this proposal aims to study patterns in the variability of heart rate and arterial blood pressure in a large cohort of patients with severe sepsis and septic shock. This research hypothesizes that spectral and non-linear measures of cardiovascular variability like spectral power, sample entropy, and fractal exponents will predict recovery of cardiovascular homeostasis by 24 hours after presentation in septic patients. This research further hypothesizes that changes in cardiovascular variability in response to early therapies will improve our ability to predict recovery of cardiovascular homeostasis. Finally, this research hypothesizes that patterns in variability will predict immediate response to administration of vasopressor drugs or intravenous fluids. This research intends to lay the groundwork for improved bedside care of patients with sepsis as well as better understanding of mechanisms of disruption and restoration of homeostasis in patients with sepsis. PUBLIC HEALTH RELEVANCE: This research seeks to identify hidden patterns in heart rate and blood pressure in patients with life-threatening infection, a condition called sepsis. These patterns should help us identify patients at risk for serious complications and help guide resuscitation of these critically ill individuals. This research should also significantly strengthen further research into the causes of sepsis, its genetic basis, and possible new treatments.