Pulsus Paradoxus Monitor

描述(由申请人提供)： 脉搏异常(PP)对于哮喘的治疗和对呼吸困难患者的快速评估是一个有价值的病理生命体征。NHLBI在1991年发布的早期哮喘管理指南包括建议医生测量急性哮喘患者的脉压。最近的证据继续表明，PP可以作为功能障碍期间呼吸努力的一种指标。与峰值流率和肺活量测定不同，PP测量不依赖于努力，理论上可以更好地评估哮喘的严重程度。脉搏反常见于哮喘、哮喘、心包填塞和张力性气胸。在所有这些情况下，它都出现在缺氧之前。因此，PP监测不仅对内科医生有用，而且对那些可能不熟悉这些疾病的生理障碍并将得到专家监测系统帮助的内科医生也是有用的。我们提出了三个相互关联的具体目标：1)改进自动PP检测算法，使自动PP测量结果与连续无创血压监测仪(NIBP)的真实PP测量结果至少有95%的符合率。2)1991年NHLBI ED哮喘管理指南中12 mm Hg的入院PP阈值在急性哮喘儿童中用自动非侵入性PP监测仪测量是否有效？3)1991年NHLBI ED哮喘管理指南中12 mm Hg的入院PP阈值在急性哮喘成人中用自动无创PP监测仪测量是否有效？在目标1中，我们将改进现有的PP检测算法，因为它实时分析来自NIBP监视器的数据。AIMS 2和3将测试最初的NHLBI急诊科哮喘管理指南是否有效，其中包括实际的PP阈值。AIMS 2和AIMS 3的数据将提供急性哮喘患者的真实血压数据，用于AIM 1的迭代改进工作。这一阶段的工作将产生一个精细化的PP监测仪，我们在这方面拥有强大的知识产权地位，以及临床上相关的(已验证的)PP阈值，未来的哮喘管理指南将参考这些数据。未来的第二阶段活动可能包括在急诊科进行预期的PP阈值测试，以及对选定的哮喘患者进行家庭监测，这两者都将影响有效的临床资源利用。

DESCRIPTION (provided by applicant): Pulsus paradoxus (PP) is a valuable pathological vital sign in the management of asthma and in the rapid evaluation of patients with dyspnea in general. Early asthma management guidelines published by NHLBI in 1991 included a recommendation for physicians to measure PP in acutely asthmatic patients. Recent evidence continues to show that PP can play a role as a metric indicative of respiratory effort during dysfunction. Unlike peak flow rate and spirometry, PP measurement is non-effort dependent and would theoretically result in better assessment of asthma severity. Pulsus paradoxus is present in asthma, croup, and pericardial tamponade and tension pneumothorax. It appears prior to hypoxia in all of these conditions. For this reason, PP monitoring would prove useful not only to physicians but also to physician extenders who may be unfamiliar with the physiological dyscrasias of these conditions and would be assisted by an expert monitoring system. We propose 3 interconnecting specific aims: 1) Improve the automated PP detection algorithm resulting in at least a 95% agreement between automated PP and true PP measurement from a continuous non-invasive blood pressure monitor (NIBP). 2) Is the PP threshold of 12 mmHg for hospital admission in the 1991 NHLBI ED Asthma Management Guidelines valid as measured with an automated non-invasive PP monitor among acutely asthmatic children? 3) Is the PP threshold of 12 mmHg for hospital admission in the 1991 NHLBI ED Asthma management guidelines valid as measured with an automated non-invasive PP monitor among acutely asthmatic adults? In aim 1 we will improve upon our existing PP detection algorithm as it analyzes data in real time from a NIBP monitor. Aims 2 & 3 will test whether the original NHLBI emergency department asthma management guidelines, which included an actual PP threshold, are valid. Data from aims 2 & 3 will provide real world blood pressure data from acutely asthmatic patients for the iterative refinement efforts in aim 1. This Phase 1 effort will result in a refined PP monitor, for which we have a strong intellectual property position, and clinically relevant (validated) PP thresholds, which future asthma management guidelines will reference. Future Phase 2 activities could include prospective PP threshold testing in the emergency department and home monitoring of selected asthmatic patients, both of which would impact efficient clinical resource utilization.