Venous Waveform Analysis to Predict Volume Overload

项目摘要 在围手术期环境中，精确控制血管内容量状态非常重要。它 已经证明，在围手术期容量超负荷和复苏下， 围手术期可增加发病率、死亡率、住院时间和围手术期护理费用。 不幸的是，临床体征和当前的监测策略在提供 准确、真实的时间容量状态评估。这项建议将发展使用一个 独特的生理信号，无创静脉波形分析（尼瓦），用于监测 出血和容量超负荷的血管内容量状态。中的概念验证数据 人类和实验动物模型，证明尼瓦提供了可靠的指示 血管内容量状态，支持本提案的前提。该提案将使用一个 控制出血、复苏和容量超负荷的实验猪模型 复苏以验证和改进波形分析算法。尼瓦将在 进一步的猪研究和台架上的人隐静脉在离体流动回路中， 作为受控模型系统的模拟细胞外基质，以确定局限性， 尼瓦的作用机制。这些研究将用于缓解与使用 尼瓦，并将导致更好地理解静脉波形分析（精确 血管内容量的管理）和静脉血流动力学（一个大部分正在研究 心血管系统的一部分）。

PROJECT SUMMARY In the perioperative environment, precise control of intravascular volume status is important. It has been demonstrated that both volume overload and under resuscitation in the perioperative period can increase morbidity, mortality, length of stay, and cost of perioperative care. Unfortunately, clinical signs and current monitoring strategies are unreliable in providing accurate, real time assessments of volume status. This proposal will develop the use of a unique physiologic signal, Non-Invasive Venous waveform Analysis (NIVA), for monitoring intravascular volume status of 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 porcine model of controlled hemorrhage, resuscitation, and volume overload resuscitation to validate and refine an algorithm for waveform analysis. NIVA will be tested in further porcine studies and bench-top human saphenous veins in an ex vivo flow loop with a simulated extracellular matrix as a controlled model system to determine limitations and mechanisms of NIVA. 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).