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Acosta S, Ahmed M, Yin SM, Brady KM, Penny DJ, Rusin CG. A robust Fourier-based method to measure pulse pressure variability. Biomed Signal Process Control 2020; 60. [PMID: 32719724 DOI: 10.1016/j.bspc.2020.101947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To propose a new method to estimate pulse pressure variability (PPV) in the arterial blood pressure waveform. Methods Traditional techniques of calculating PPV using peak finding have a fundamental flaw that prevents them from accurately resolving PPV for small tidal volumes, limiting the use of PPV to only mechanical ventilated patients. The improved method described here addresses this limitation using Fourier analysis of an oscillatory signal that exhibits a time-varying modulation of its amplitude. The analysis reveals a constraint on the spectral representation that must be satisfied for any oscillatory signal that exhibits a time-varying modulation of its amplitude. This intrinsic mathematical structure is taken advantage of in order to improve the robustness of the algorithm. Results The applicability of the method is tested using synthetic data and 100 h of physiologic data collected from patients admitted to Texas Children's Hospital. Significance and conclusion The proposed method accurately recovers values of PPV at signal-to-noise ratios six times smaller than the traditional method. This is a significant advance for the potential use of PPV to recognize fluid responsiveness during low tidal volume ventilation or spontaneous breathing for which the signal-to-noise ratio is expected to be small.
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Affiliation(s)
- Sebastian Acosta
- Department of Pediatrics-Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Mubbasheer Ahmed
- Department of Pediatrics-Critical Care, Baylor College of Medicine, Houston, TX, USA
| | - Suellen M Yin
- Division of Cardiology at Children's Hospital of Philadelphia, PA, USA
| | - Ken M Brady
- Division of Cardiac Anesthesia at Lurie Children's Hospital of Chicago, IL, USA
| | - Daniel J Penny
- Department of Pediatrics-Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Craig G Rusin
- Department of Pediatrics-Cardiology, Baylor College of Medicine, Houston, TX, USA
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Roach JK, Thiele RH. Perioperative blood pressure monitoring. Best Pract Res Clin Anaesthesiol 2019; 33:127-138. [DOI: 10.1016/j.bpa.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Pybus DA. Real-time, spectral analysis of the arterial pressure waveform using a wirelessly-connected, tablet computer: a pilot study. J Clin Monit Comput 2018; 33:53-63. [PMID: 29705865 PMCID: PMC6314984 DOI: 10.1007/s10877-018-0145-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
Abstract
Spectral analysis of the arterial pressure waveform, using specialized hardware, has been used for the retrospective calculation of the 'Spectral Peak Ratio' (SPeR) of the respiratory and cardiac arterial spectral peaks. The metric can quantify the cardiovascular response to volume loading by analysing the effect of changing tidal volume (indexed to body weight) (VTI) on pulse pressure variability. In this pilot study, the feasibility of real-time SPeR calculation, using a mobile computer which was wirelessly connected to the patient monitor, was evaluated by examining the determinants of SPeR in 60 cardiac-surgical patients. In 30 patients undergoing aortic valve replacement (AVR), graded cyclical changes in ventricular loading were induced by increasing VTI over 2 min, while performing spectral analysis at 1 Hz, before and after AVR. A strong, linear correlation between SPeR and VTI was found and the slope of the regression line (β) changed significantly after AVR. The change in β correlated with the width of the preoperative vena contracta. In another 30 patients, SPeR at constant VTI was calculated at 1 Hz during passive leg raising. β fell significantly on leg raising. The mean arterial pressure change during the manoeuvre was linearly related to the change in β. Real-time spectral analysis of the arterial waveform was easily accomplished. The regression of SPeR on VTI was linear. β appeared to represent the slope of the cardiac response curve at the venous return curve equilibrium point. Measurements were possible at a significantly lower VTI than the equivalent time domain metrics.
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Affiliation(s)
- David Andrew Pybus
- St. George Private Hospital, 1 South St., Kogarah, NSW, 2217, Australia.
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Giraud R, Abraham PS, Brindel P, Siegenthaler N, Bendjelid K. Respiratory changes in subclavian vein diameters predicts fluid responsiveness in intensive care patients: a pilot study. J Clin Monit Comput 2018; 32:1049-1055. [PMID: 29380189 DOI: 10.1007/s10877-018-0103-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022]
Abstract
The present pilot study investigated whether respiratory variation in subclavian vein (SCV) diameters correlates with fluid responsiveness in mechanically ventilated patients. Monocentric, prospective clinical study on fluid responsiveness in adult sedated, mechanically ventilated ICU patient, monitored with the PiCCO™ system (Pulsion Medical System, Germany), and requiring a fluid challenge (FC). A 10-min fluid bolus of 500 mL of 0.9% saline was administered. Cardiac output (CO) and dynamic parameters [stroke volume variation (SVV) and pulse pressure variation (PPV)] measured by transpulmonary thermodilution and pulse contour analysis (PiCCO™) as well as classical hemodynamic parameters were recorded at baseline and after FC. Fluid responsiveness was described as an increase in CO of ≥ 15%. Ultrasound measurements obtained in the subclavian long-axis view were used to calculate the SCVvariability index. A cut-off value for SCV variation for the prediction of fluid responsiveness was determined using receiver operating curve (ROC) analysis. Nine of 20 FCs (45%) induced an increase in CO of ≥ 15%. At baseline, the SCVvariability index was greater in responders than in non-responders (34.0 ± 21.4 vs. 9.0 ± 5.5; p = 0.0005). Diagnostic performance for the SCVvariability index revealed a cut-off value of 14 with a sensitivity of 100% [Confidence interval (CI) 95% (90; 100)] and a specificity of 82% [CI 95% (48; 98)] for the prediction of fluid responsiveness. Other parameters, such as SVV and PPV, could not predict fluid responsiveness. The correlation coefficient between CO variation and the SCVvariability index was 0.73 (p < 0.001). The SCVvariability index was a reliable, non-invasive parameter for the prediction of fluid responsiveness at the bedside of mechanically ventilated, critically ill patients in this pilot study.
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Affiliation(s)
- Raphaël Giraud
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, University of Geneva, Geneva, Switzerland
| | - Paul S Abraham
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland. .,Geneva Hemodynamic Research Group, University of Geneva, Geneva, Switzerland.
| | - Pauline Brindel
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Siegenthaler
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, University of Geneva, Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Service, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, University of Geneva, Geneva, Switzerland
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Bartels K, Esper SA, Thiele RH. Blood Pressure Monitoring for the Anesthesiologist. Anesth Analg 2016; 122:1866-79. [DOI: 10.1213/ane.0000000000001340] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Agreement in hemodynamic monitoring during orthotopic liver transplantation: a comparison of FloTrac/Vigileo at two monitoring sites with pulmonary artery catheter thermodilution. J Clin Monit Comput 2016. [PMID: 26884378 DOI: 10.1007/s10877-016-9840-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To study agreement in cardiac index (CI), systemic vascular resistance index (Systemic VRI) and stroke volume variation (SV variation) between the FloTrac/Vigileo at radial and femoral arterial cannulation sites, and pulmonary artery catheter (PAC) thermodilution, in patients undergoing orthotopic liver transplantation. A prospective observational study of 25 adult patients with liver failure. Radial and femoral arteries were cannulated with standardised FloTrac/Vigileo arterial transducer kits and a PAC was inserted. CI, SV variation and Systemic VRI were measured four times (30 min after induction of anesthesia, 30 min after portal vein clamping, 30 min after graft reperfusion, 30 min after commencement of bile duct anastomosis). The bias, precision, limits of agreement (LOA) and percentage errors were calculated using Bland-Altman statistics to compare measurements from radial and femoral arterial cannulation sites and PAC thermodilution. Neither radial nor femoral CI achieved acceptable agreement with PAC CI [radial to PAC bias (SD) 1.17 (1.49) L/min/m2, percentage error 64.40 %], [femoral to PAC bias (SD) -0.71 (1.81) L/min/m2, percentage error 74.20 %]. Agreement between radial and femoral sites for CI [mean difference (SD) -0.43 (1.51) L/min/m2, percentage error 70.40 %] and Systemic VRI [mean difference (SD) 0.03 (4.17) LOA ±8.17 mmHg min m2/L] were also unacceptable. Agreement in SV variation between radial and femoral measurement sites approached a clinically acceptable threshold [mean difference (SD) 0.68 (2.44) %), LOA ±4.78 %]. FloTrac/Vigileo CI cannot substitute for PAC thermodilution CI, regardless of measurement site. SV variation measurements may be interchangeable between radial and femoral sites for determining fluid responsiveness.
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Lee M, Weinberg L, Pearce B, Scurrah N, Story DA, Pillai P, McCall PR, P McNicol L, Peyton PJ. Agreement in hemodynamic monitoring during orthotopic liver transplantation: a comparison of FloTrac/Vigileo at two monitoring sites with pulmonary artery catheter thermodilution. J Clin Monit Comput 2016; 31:343-351. [PMID: 26884378 DOI: 10.1007/s10877-016-9840-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
To study agreement in cardiac index (CI), systemic vascular resistance index (Systemic VRI) and stroke volume variation (SV variation) between the FloTrac/Vigileo at radial and femoral arterial cannulation sites, and pulmonary artery catheter (PAC) thermodilution, in patients undergoing orthotopic liver transplantation. A prospective observational study of 25 adult patients with liver failure. Radial and femoral arteries were cannulated with standardised FloTrac/Vigileo arterial transducer kits and a PAC was inserted. CI, SV variation and Systemic VRI were measured four times (30 min after induction of anesthesia, 30 min after portal vein clamping, 30 min after graft reperfusion, 30 min after commencement of bile duct anastomosis). The bias, precision, limits of agreement (LOA) and percentage errors were calculated using Bland-Altman statistics to compare measurements from radial and femoral arterial cannulation sites and PAC thermodilution. Neither radial nor femoral CI achieved acceptable agreement with PAC CI [radial to PAC bias (SD) 1.17 (1.49) L/min/m2, percentage error 64.40 %], [femoral to PAC bias (SD) -0.71 (1.81) L/min/m2, percentage error 74.20 %]. Agreement between radial and femoral sites for CI [mean difference (SD) -0.43 (1.51) L/min/m2, percentage error 70.40 %] and Systemic VRI [mean difference (SD) 0.03 (4.17) LOA ±8.17 mmHg min m2/L] were also unacceptable. Agreement in SV variation between radial and femoral measurement sites approached a clinically acceptable threshold [mean difference (SD) 0.68 (2.44) %), LOA ±4.78 %]. FloTrac/Vigileo CI cannot substitute for PAC thermodilution CI, regardless of measurement site. SV variation measurements may be interchangeable between radial and femoral sites for determining fluid responsiveness.
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Affiliation(s)
- Matthew Lee
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Brett Pearce
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Nicholas Scurrah
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - David A Story
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Param Pillai
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Peter R McCall
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Larry P McNicol
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Philip J Peyton
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
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Frequency domain analysis of cerebral near infrared spectroscopy signals during application of an impedance threshold device in spontaneously ventilating volunteers. J Clin Monit Comput 2015; 30:389-98. [PMID: 26115773 DOI: 10.1007/s10877-015-9729-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 06/18/2015] [Indexed: 01/20/2023]
Abstract
Currently available near infrared spectroscopy (NIRS) devices are unable to discriminate between arterial and venous blood, a potential source of artifact. The purpose of this study was to test the hypothesis that oscillations in NIR signals at the respiratory and cardiac frequency could be attributed to venous and arterial blood, respectively, and thereby isolated. After written informed consent was obtained, a two-wavelength NIRS device was placed over the left frontal cortex in 20 volunteers. After 5 min of unimpeded spontaneous ventilation, an impedance threshold device (ITD, average resistance-7 cm H2O) was applied and an additional two minutes of data recorded. Tissue saturation (StO2) calculated at the ventilatory and cardiac frequencies was compared to non-pulsatile StO2, before and after application of the ITD using spectral peak and power algorithms. The ITD increased non-pulsatile cerebral saturation by 3.6 %. The ITD had no discernable effect on pulsatile estimates of StO2 at either the ventilatory or cardiac frequencies. StO2 estimated at the NIRS spectral peak from 0.75 to 1.75 Hz was 24 % higher than non-pulsatile StO2 (p = 0.0013). There were no other significant differences between pulsatile and non-pulsatile algorithms in the estimation of StO2. In 64 % of cases, both the low (ventilator) and high (cardiac) frequency estimates of StO2 were either both larger or both smaller than non-pulsatile StO2, suggesting that they were interrogating the same vascular bed. Frequency domain analysis cannot reliably separate NIRS waveforms into arterial and venous components.
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