Pulsus Paradoxus Monitor

描述（由申请人提供）： 奇脉（PP）是一个有价值的病理生命体征在管理哮喘和快速评估患者的呼吸困难一般。NHLBI在1991年出版的早期哮喘管理指南中建议医生测量急性哮喘患者的PP。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指标发挥作用。与峰值流速和肺量测定法不同，PP测量不依赖于努力，理论上可以更好地评估哮喘严重程度。奇脉常见于哮喘、哮吼、心包填塞和张力性气胸。在所有这些条件下，它都出现在缺氧之前。 出于这个原因，PP监测将证明不仅对医生有用，而且对可能不熟悉这些条件的生理性恶液质的医生扩展者也有用，并且将由专家监测系统辅助。我们提出了3个相互关联的具体目标：1）改进自动PP检测算法，使自动PP和连续无创血压监测仪（NIBP）的真实PP测量结果之间至少有95%的一致性。2)1991年NHLBI艾德哮喘管理指南中入院时PP阈值12 mmHg在急性哮喘儿童中使用自动无创PP监测仪测量是否有效？3)1991年NHLBI艾德哮喘管理指南中入院的PP阈值12 mmHg在急性哮喘成人中使用自动无创PP监测仪测量是否有效？在目标1中，我们将改进我们现有的PP检测算法，因为它分析来自NIBP监测器的真实的数据。目标2和3将测试包括实际PP阈值的原始NHLBI急诊科哮喘管理指南是否有效。aim2和aim3的数据将为aim1的迭代改进工作提供急性哮喘患者的真实的世界血压数据。这一第一阶段的努力将导致一个完善的PP监测，我们有一个强大的知识产权地位，和临床相关的（验证）PP阈值，未来的哮喘管理指南将参考。未来的第二阶段活动可能包括在急诊室进行前瞻性PP阈值测试和对选定的哮喘患者进行家庭监测，这两者都将影响临床资源的有效利用。

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.