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Continuous Cardiac Output & Filling Pressure Monitoring

连续心输出量

基本信息

批准号：
7229994
负责人：
RAMAKRISHNA MUKKAMALA
金额：
$ 10.61万
依托单位：
MICHIGAN STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-06-01 至 2009-05-31
项目状态：
已结题

项目摘要

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.

描述（由申请人提供）：肺动脉导管常规用于危重患者的血流动力学监测。该导管允许通过热稀释和左心充盈压（即，左心房压力（ECG）通过肺毛细血管楔压（PCWP）。然而，这些测量仅在需要操作者时间歇地获得。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分析技术，以连续监测来自PAP波形的CO。然而，这些技术不能克服破坏PAP波形的高度复杂的波和惯性效应，因此是不成功的。此外，尽管肺动脉压也是PAP的重要决定因素，但这些技术都没有提供监测肺动脉压的方法。我们已经开发了一种技术，通过对PAP波形的数学分析，连续自动监测CO和CO2。与所有以前的相关尝试相比，我们的技术分析了大于心动周期的时间尺度上的波形，其中复杂的波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法和PCWP测量结果一致。我们建议进一步开发和评估的基础上不断增长的ICU患者的数据库，包括数百个注释的肺动脉导管插入术数据集的技术。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信息来改进该技术。具体目标2是针对标准ICU测量验证该技术。我们将在所有患者条件下（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。我们将实施所有竞争的PAP波形分析技术，优化其性能，并对它们进行全面评估和比较。这些特定目标的成功实现可能最终导致ICU、手术室和恢复室中CO和CO2的连续和自动监测，从而有益于具有肺动脉导管插入术指征的患者的临床管理。