Clinically applicable model-based method, for physiologically accurate flow waveform and stroke volume estimation

doi:10.1016/j.cmpb.2019.105125

2020-03-01

PRE

Joel Balmer *

Christopher G. Pretty

DOI：10.1016/j.cmpb.2019.105125

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摘要

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Background and Objectives: Cardiovascular dysfunction can be more effectively monitored and treated, with accurate, continuous, stroke volume (SV) and/or cardiac output (CO) measurements. Since direct measurements of SV/CO are highly invasive, clinical measures are often discrete, or if continuous, can require recalibration with a discrete SV measurement after hemodynamic instability. This study presents a clinically applicable, non-additionally invasive, physiological model-based, SV and CO measurement method, which does not require recalibration during or after hemodynamic instability. Methods and Results: The model's ability to predict flow profiles and SV is assessed in an animal trial, using endotoxin to induce sepsis in 5 pigs. Mean percentage error between beat-to-beat SV measured from an aortic flow probe and estimated by the model was -2%, while 90% of estimations fell within -24.2% and +27.9% error. Error between estimated and measured changes in mean SV following interventions was less than 30% for 4 out of the 5 pigs. Correlations between model estimated and probe measured flow, for each pig and hemodynamic interventions, was r(2) = 0.58 - 0.96, with 21 of the 25 pig intervention stages having r(2) > 0.80. Conclusion: The results demonstrate the model accurately estimates and tracks changes in flow profiles and resulting SV, without requiring model recalibration. (C) 2019 Elsevier B.V. All rights reserved.

Keyword:

Pulse contour analysis

Pressure contour analysis

Windkessel model

Stroke volume

Cardiac output

End systole detection

Hemodynamic monitoring

Intensive care