Continuous Cardiac Output & Filling Pressure Monitoring

描述（申请人提供）：肺动脉导管常规用于危重患者的血流动力学监测。该导管可以通过热稀释和左心充盈压力（即左房压（LAP））通过肺毛细血管楔压（PCWP）来估计心输出量（CO）。然而，这些测量只能在需要操作员时间歇性地获得。另一方面，使用导管连续自动测量肺动脉压（PAP）。因此，一些研究人员提出了从PAP波形中连续监测CO的分析技术。然而，这些技术无法克服破坏PAP波形的高度复杂的波和惯性效应，因此不成功。此外，尽管LAP也是PAP的重要决定因素，但这些技术都没有提供监测LAP的手段。通过对PAP波形的数学分析，我们开发了一种独一无二的连续自动监测CO和LAP的技术。与之前所有相关的尝试相比，我们的技术分析了超过心脏周期的时间尺度的波形，其中复杂的波和惯性效应不再是一个因素。我们对9名重症监护病房（ICU）患者进行了该技术的初步测试，我们的结果与热稀释和PCWP测量结果一致。我们建议基于不断增长的ICU患者数据库，包括数百个带注释的肺动脉导管数据集，进一步开发和评估该技术。具体目标1是优化数学分析技术。我们将通过在分析中最佳地结合长时间尺度PAP信息来改进技术。具体目标2是通过标准ICU测量来验证该技术。我们将统计比较该技术与热稀释和PCWP估计的CO和LAP在所有情况下以及在每种患者情况下（例如，治疗，疾病）。具体目标3是将该技术的性能与所有其他竞争分析技术进行比较。我们将实现所有竞争的PAP波形分析技术，优化其性能，同样全面评估和比较它们。这些具体目标的成功实现，最终可能导致icu和手术恢复室CO和LAP的持续和自动监测，从而有利于那些有肺动脉导管指征的患者的临床管理。

DESCRIPTION (provided by applicant): The pulmonary artery catheter is routinely employed for hemodynamic monitoring of critically ill patients. This catheter permits the estimation of cardiac output (CO) via thermodilution and left heart filling pressure (i.e., left atrial pressure (LAP)) through pulmonary capillary wedge pressure (PCWP). However, these measurements are only obtained intermittently as an operator is required. On the other hand, pulmonary artery pressure (PAP) is measured continuously and automatically with the catheter. A few investigators have therefore proposed analysis techniques to continuously monitor CO from a PAP waveform. However, these techniques were not able to overcome the highly complex wave and inertial effects that corrupt PAP waveforms and were thus unsuccessful. Moreover, even though LAP is also a significant determinant of PAP, none of these techniques provided a means to monitor LAP. We have developed a one of a kind technique for continuously and automatically monitoring both CO and LAP by mathematical analysis of a PAP waveform. In contrast to all previous, related attempts, our technique analyzes the waveform over time scales greater than a cardiac cycle in which the complex wave and inertial effects cease to be a factor. We have conducted initial testing of the technique in nine intensive care unit (ICU) patients, and our results are in agreement with thermodilution and PCWP measurements. We propose further development and evaluation of the technique based on a growing database of ICU patients including hundreds of annotated pulmonary artery catheterization data sets. Specific Aim 1 is to optimize the mathematical analysis technique. We will refine the technique by optimally incorporating the long time scale PAP information in the analysis. Specific Aim 2 is to validate the technique with respect to the standard ICU measurements. We will statistically compare the CO and LAP estimated by the technique with thermodilution and PCWP over all, and under each, of the patient conditions (e.g., therapy, disease). Specific Aim 3 is to compare the performance of the technique to all other competing analysis techniques. We will implement all competing PAP waveform analysis techniques, optimize their performance, and likewise comprehensively evaluate and compare them. Successful achievement of these specific aims may ultimately lead to continuous and automatic monitoring of CO and LAP in ICUs and operating and recovery rooms and thereby benefit the clinical management of those patients with indications for pulmonary artery catheterization.