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

项目摘要 在围手术期环境中，精确了解和监测血管内容量 地位很重要。在儿科患者中，生命体征（血压和心率）的变化 通常直到严重失血和终末器官损伤后才发生。出血 手术期间是儿科围手术期发病率的主要原因， 适当的复苏可提高存活率。不幸的是，临床症状和目前的监测 策略在提供准确、实时的容量状态评估方面不一致， 儿科患者。该提案将开发一种独特的生理信号的使用， 有创静脉波形分析（尼瓦），用于监测血管内容量状态， 出血和容量超负荷。人类和实验动物的概念验证数据 模型证明尼瓦提供了血管内容量状态的可靠指示， 支持这一提议的前提。这项建议将使用一个实验性的仔猪模型， 控制出血、复苏和容量超负荷，以验证和完善算法 用于波形分析。此外，该提案将评估尼瓦的应用 接受复杂颅穹窿重建的儿科患者的算法，以评估其 在围手术期环境中检测体积变化的能力这些研究将用于 降低与使用尼瓦相关的风险，并将有助于更好地了解静脉 波形分析（用于精确管理血管内容量）和静脉 血液动力学（心血管系统的一个主要研究不足的部分）在儿科 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.