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预后至关重要，但可靠的治疗终点已被证明是难以捉摸的。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，可能有助于确定败血症早期治疗的有效终点，以及识别败血症预后不良的高风险患者。利用Intermountain Healthcare非常详细的电子医疗记录，本提案旨在研究大量严重脓毒症和感染性休克患者心率和动脉血压变异性的模式。本研究假设，谱和非线性测量心血管变异性，如谱功率、样本熵和分形指数，可以预测脓毒症患者出现后24小时内心血管稳态的恢复。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稳态恢复的能力。最后，本研究假设变异性的模式将预测对血管加压药物或静脉输液的立即反应。本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。

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.