Venous Waveform analysis to predict volume changes in pediatric patients during anesthesia

项目总结 在围手术期环境中，准确了解和监测血管内容量 地位很重要。儿科患者生命体征(血压和心率)的变化 通常在大量失血和终末器官损害发生后才会发生。出血 手术期间是儿科围手术期并发症的主要原因，早期和 充分的复苏可以提高存活率。不幸的是，临床体征和目前的监测 在提供准确、实时的数量状态评估方面，策略不一致 儿科病人。这项提议将发展一种独特的生理信号的使用，非 有创静脉波形分析(NIVA)，用于监测两者的血管内容量状态 出血和容量超载。人类和实验动物的概念验证数据 模型表明，NIVA提供了血管内容量状态的可靠指示， 支持这项提议的前提。该提案将使用一种实验性的仔猪模型 控制出血、复苏和容量过载，以验证和改进算法 用于波形分析。此外，该提案还将评估国家环境基金的应用情况。 小儿复杂颅顶重建术的算法评估 能够检测围手术期环境中的容量变化这些研究将被用于 降低与使用Niva相关的风险，并将导致更好地了解静脉 波形分析(用于精确管理血管内容量)和静脉 儿童的血流动力学(心血管系统的一个主要未被研究的部分) 人口。

PROJECT SUMMARY In the perioperative environment, precise understanding and monitoring of intravascular volume status is important. In pediatric patients, changes in vital signs (blood pressure and heart rate) often do not occur until significant blood loss and end-organ damage have ensued. Hemorrhage during surgery represents a major cause of pediatric perioperative morbidity, and early and adequate resuscitation improves survival. Unfortunately, clinical signs and current monitoring strategies are inconsistent in providing accurate, real-time assessment of volume status in pediatric patients. This proposal will develop the use of a unique physiologic signal, Non- Invasive Venous waveform Analysis (NIVA), for monitoring intravascular volume status for both hemorrhage and volume overload. Proof of concept data in humans and experimental animal models demonstrate that NIVA provides a reliable indication of intravascular volume status, supporting the premise of this proposal. This proposal will use an experimental piglet model of controlled hemorrhage, resuscitation, and volume overload to validate and refine the algorithm for waveform analysis. Additionally, the proposal will evaluate the application of the NIVA algorithm for pediatric patients undergoing complex cranial vault reconstruction to assess its ability to detect volume changes in the perioperative setting These studies will be used to mitigate risks associated with the use of NIVA and will lead to a better understanding of venous waveform analysis (for precise management of intravascular volume) and of venous hemodynamics (a largely under-studied part of the cardiovascular system) in the pediatric population.