Non-Invasive Venous waveform Analysis (NIVA) for monitoring blood loss in human blood donors and validation in a porcine hemorrhage model.
Non-Invasive Venous waveform Analysis (NIVA) for monitoring blood loss in human blood donors and validation in a porcine hemorrhage model.
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DOI：
10.1016/j.jclinane.2019.109664
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发表时间：
2020-05
影响因子：
6.7
通讯作者：
Hocking K
中科院分区：
文献类型：
--
作者：
Alvis BD;McCallister R;Polcz M;Lima JLO;Sobey JH;Brophy DR;Miles M;Brophy C;Hocking K
对于在生命体征发生变化之前早期诊断出血的非侵入性方法存在未满足的需求。无创静脉波形分析（尼瓦）使用独特的生理信号（外周静脉波形）评估血管内容量。我们假设在健康成人献血者中观察到静脉波形的变化，并在猪模型中使用侵入性监测表征出血。前瞻性观察研究美国红十字会献血中心50名献血者和12名非献血对照; 7只约克郡猪将静脉波形捕获原型（尼瓦装置）固定到人类受试者的腕部的掌侧。使用中心静脉导管获得血液动力学指标，并在猪模型中400 mL分级出血期间使用原型尼瓦器械在隐静脉上获得静脉波形。将静脉波形从时域转换到频域。心脏频率的比率功率贡献用于计算代表容量状态的尼瓦值。献血500 mL后，观察到尼瓦值显著降低（p < 0.05）。尼瓦检测500 mL失血量能力的ROC曲线显示曲线下面积（AUC）为0.94。在猪模型中，尼瓦值的变化与失血量和血流动力学指标的变化呈线性相关。本研究为尼瓦在失血检测中的潜在应用提供了概念验证。尼瓦代表了一种新的生理信号，用于检测早期失血，可用于早期分诊和围手术期管理。
There is an unmet need for a non-invasive approach to diagnose hemorrhage early, before changes in vital signs occur. Non-Invasive Venous waveform Analysis (NIVA) uses a unique physiological signal (the peripheral venous waveform) to assess intravascular volume. We hypothesized changes in the venous waveform would be observed with blood loss in healthy adult blood donors and characterized hemorrhage using invasive monitoring in a porcine model. Prospective observational study American Red Cross donation center 50 human blood donors and 12 non-donating controls; 7 Yorkshire pigs A venous waveform capturing prototype (NIVA device) was secured to the volar aspect of the wrist in human subjects. A central venous catheter was used to obtain hemodynamic indices and venous waveforms were obtained using the prototype NIVA device over the saphenous vein during 400 mL of graded hemorrhage in a porcine model. Venous waveforms were transformed from the time to the frequency domain. The ratiometric power contributions of the cardiac frequencies was used to calculate a NIVA value representative of volume status. A significant decrease in NIVA value was observed after 500mL of whole blood donation (p < 0.05). A ROC curve for the ability of the NIVA to detect 500 mL of blood loss demonstrated an area under the curve (AUC) of 0.94. In the porcine model, change in NIVA value correlated linearly with blood loss and with changes in hemodynamic indices. This study provides proof-of-concept for a potential application of NIVA in detection of blood loss. NIVA represents a novel physiologic signal for detection of early blood loss that may be useful in early triage and perioperative management.
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作者：
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DOI：
10.1097/ta.0b013e31812e51e5
发表时间：
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影响因子：
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作者：
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通讯作者：
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