Continuous Cardiac Output & Filling Pressure Monitoring

描述(申请人提供)：肺动脉导管常规用于危重病人的血流动力学监测。该导管可以通过热稀释和通过肺毛细血管楔压(PCWP)估计心输出量(CO)和左心充盈压(即左房压(LAP))。然而，这些测量值仅在需要操作员时才间歇性地获得。另一方面，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波形连续监测CO的分析技术。然而，这些技术不能克服高度复杂的波和惯性效应，这些效应破坏了PAP波形，因此没有成功。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一种监测LAP的方法。我们开发了一种通过对PAP波形的数学分析来连续自动监测CO和LAP的技术之一。与所有以前的相关尝试不同，我们的技术分析的波形在时间尺度上大于心脏周期，在该周期中，复杂的波形和惯性效应不再是一个因素。我们已经在9名重症监护病房(ICU)患者中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，包括数百个注释的肺动脉插管数据集，对该技术进行进一步的开发和评估。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的PAP信息来改进技术。具体目标2是根据标准的ICU测量来验证该技术。我们将在所有患者条件下(例如，治疗、疾病)，将该技术估算的CO和LAP与热稀释和PCWP进行统计比较。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。我们将实施所有竞争的PAP波形分析技术，优化它们的性能，并同样全面地评估和比较它们。这些特定目标的成功实现可能最终导致在ICU和手术恢复室连续自动监测CO和LAP，从而有利于那些有肺动脉插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.