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Chiu NT, Chuang B, Anakmeteeprugsa S, Shelley KH, Alian AA, Wu HT. Signal quality assessment of peripheral venous pressure. J Clin Monit Comput 2024; 38:101-112. [PMID: 37917210 DOI: 10.1007/s10877-023-01071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 11/04/2023]
Abstract
Develop a signal quality index (SQI) for the widely available peripheral venous pressure waveform (PVP). We focus on the quality of the cardiac component in PVP. We model PVP by the adaptive non-harmonic model. When the cardiac component in PVP is stronger, the PVP is defined to have a higher quality. This signal quality is quantified by applying the synchrosqueezing transform to decompose the cardiac component out of PVP, and the SQI is defined as a value between 0 and 1. A database collected during the lower body negative pressure experiment is utilized to validate the developed SQI. All signals are labeled into categories of low and high qualities by experts. A support vector machine (SVM) learning model is trained for practical purpose. The developed signal quality index coincide with human experts' labels with the area under the curve 0.95. In a leave-one-subject-out cross validation (LOSOCV), the SQI achieves accuracy 0.89 and F1 0.88, which is consistently higher than other commonly used signal qualities, including entropy, power and mean venous pressure. The trained SVM model trained with SQI, entropy, power and mean venous pressure could achieve an accuracy 0.92 and F1 0.91 under LOSOCV. An exterior validation of SQI achieves accuracy 0.87 and F1 0.92; an exterior validation of the SVM model achieves accuracy 0.95 and F1 0.96. The developed SQI has a convincing potential to help identify high quality PVP segments for further hemodynamic study. This is the first work aiming to quantify the signal quality of the widely applied PVP waveform.
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Affiliation(s)
- Neng-Tai Chiu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Beau Chuang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Suthawan Anakmeteeprugsa
- Department of Anesthesiology, Yale School of Medicine, Yale University, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA
| | - Kirk H Shelley
- Department of Anesthesiology, Yale School of Medicine, Yale University, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA
| | - Aymen Awad Alian
- Department of Anesthesiology, Yale School of Medicine, Yale University, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA.
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, 140 Science Drive, Durham, NC, 27705, USA.
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Barajas MB, Riess ML, Hampton MJW, Li Z, Shi Y, Shotwell MS, Staudt G, Baudenbacher FJ, Lefevre RJ, Eagle SS. Peripheral Intravenous Waveform Analysis Responsiveness to Subclinical Hemorrhage in a Rat Model. Anesth Analg 2023; 136:941-948. [PMID: 37058731 DOI: 10.1213/ane.0000000000006349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Early detection and quantification of perioperative hemorrhage remains challenging. Peripheral intravenous waveform analysis (PIVA) is a novel method that uses a standard intravenous catheter to detect interval hemorrhage. We hypothesize that subclinical blood loss of 2% of the estimated blood volume (EBV) in a rat model of hemorrhage is associated with significant changes in PIVA. Secondarily, we will compare PIVA association with volume loss to other static, invasive, and dynamic markers. METHODS Eleven male Sprague Dawley rats were anesthetized and mechanically ventilated. A total of 20% of the EBV was removed over ten 5 minute-intervals. The peripheral intravenous pressure waveform was continuously transduced via a 22-G angiocatheter in the saphenous vein and analyzed using MATLAB. Mean arterial pressure (MAP) and central venous pressure (CVP) were continuously monitored. Cardiac output (CO), right ventricular diameter (RVd), and left ventricular end-diastolic area (LVEDA) were evaluated via transthoracic echocardiogram using the short axis left ventricular view. Dynamic markers such as pulse pressure variation (PPV) were calculated from the arterial waveform. The primary outcome was change in the first fundamental frequency (F1) of the venous waveform, which was assessed using analysis of variance (ANOVA). Mean F1 at each blood loss interval was compared to the mean at the subsequent interval. Additionally, the strength of the association between blood loss and F1 and each other marker was quantified using the marginal R2 in a linear mixed-effects model. RESULTS PIVA derived mean F1 decreased significantly after hemorrhage of only 2% of the EBV, from 0.17 to 0.11 mm Hg, P = .001, 95% confidence interval (CI) of difference in means 0.02 to 0.10, and decreased significantly from the prior hemorrhage interval at 4%, 6%, 8%, 10%, and 12%. Log F1 demonstrated a marginal R2 value of 0.57 (95% CI 0.40-0.73), followed by PPV 0.41 (0.28-0.56) and CO 0.39 (0.26-0.58). MAP, LVEDA, and systolic pressure variation displayed R2 values of 0.31, and the remaining predictors had R2 values ≤0.2. The difference in log F1 R2 was not significant when compared to PPV 0.16 (95% CI -0.07 to 0.38), CO 0.18 (-0.06 to 0.04), or MAP 0.25 (-0.01 to 0.49) but was significant for the remaining markers. CONCLUSIONS The mean F1 amplitude of PIVA was significantly associated with subclinical blood loss and most strongly associated with blood volume among the markers considered. This study demonstrates feasibility of a minimally invasive, low-cost method for monitoring perioperative blood loss.
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Affiliation(s)
- Matthew B Barajas
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Anesthesiology, Tennessee Valley Healthcare System Veterans Affairs Medical Center, Nashville, Tennessee
| | - Matthias L Riess
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Anesthesiology, Tennessee Valley Healthcare System Veterans Affairs Medical Center, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - Matthew J W Hampton
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhu Li
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew S Shotwell
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Genevieve Staudt
- Department of Anesthesiology, Monroe Carroll Jr Vanderbilt Children's Hospital, Nashville, Tennessee
| | - Franz J Baudenbacher
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Ryan J Lefevre
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan S Eagle
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation. J Am Coll Surg 2023; 236:294-304. [PMID: 36648257 DOI: 10.1097/xcs.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiac output (CO) is a valuable proxy for perfusion, and governs volume responsiveness during resuscitation from distributive shock. The underappreciated venous system has nuanced physiology that confers valuable hemodynamic information. In this investigation, deconvolution of the central venous waveform by the fast Fourier transformation (FFT) algorithm is performed to assess its ability to constitute a CO surrogate in a porcine model of endotoxemia-induced distributive hypotension and resuscitation. STUDY DESIGN Ten pigs were anesthetized, catheterized, and intubated. A lipopolysaccharides infusion protocol was used to precipitate low systemic vascular resistance hypotension. Four crystalloid boluses (10 cc/kg) were then given in succession, after which heart rate, mean arterial pressure, thermodilution-derived CO, central venous pressure (CVP), and the central venous waveform were collected, the last undergoing fast Fourier transformation analysis. The amplitude of the fundamental frequency of the central venous waveform's cardiac wave (f0-CVP) was obtained. Heart rate, mean arterial pressure, CVP, f0-CVP, and CO were plotted over the course of the boluses to determine whether f0-CVP tracked with CO better than the vital signs, or than CVP itself. RESULTS Distributive hypotension to a 25% mean arterial pressure decrement was achieved, with decreased systemic vascular resistance (mean 918 ± 227 [SD] dyne/s/cm-5 vs 685 ± 180 dyne/s/cm-5; p = 0.038). Full hemodynamic parameters characterizing this model were reported. Slopes of linear regression lines of heart rate, mean arterial pressure, CVP, f0-CVP, and CO were -2.8, 1.7, 1.8, 0.40, and 0.35, respectively, demonstrating that f0-CVP values closely track with CO over the 4-bolus range. CONCLUSIONS Fast Fourier transformation analysis of the central venous waveform may allow real-time assessment of CO during resuscitation from distributive hypotension, possibly offering a venous-based approach to clinical estimation of volume responsiveness.
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Alvis B, Huston J, Schmeckpeper J, Polcz M, Case M, Harder R, Whitfield JS, Spears KG, Breed M, Vaughn L, Brophy C, Hocking KM, Lindenfeld J. Noninvasive Venous Waveform Analysis Correlates With Pulmonary Capillary Wedge Pressure and Predicts 30-Day Admission in Patients With Heart Failure Undergoing Right Heart Catheterization. J Card Fail 2022; 28:1692-1702. [PMID: 34555524 PMCID: PMC8934313 DOI: 10.1016/j.cardfail.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heart failure is the leading cause of hospitalization in the elderly and readmission is common. Clinical indicators of congestion may not precede acute congestion with enough time to prevent hospital admission for heart failure. Thus, there is a large and unmet need for accurate, noninvasive assessment of congestion. Noninvasive venous waveform analysis in heart failure (NIVAHF) is a novel, noninvasive technology that monitors intravascular volume status and hemodynamic congestion. The objective of this study was to determine the correlation of NIVAHF with pulmonary capillary wedge pressure (PCWP) and the ability of NIVAHF to predict 30-day admission after right heart catheterization. METHODS AND RESULTS The prototype NIVAHF device was compared with the PCWP in 106 patients undergoing right heart catheterization. The NIVAHF algorithm was developed and trained to estimate the PCWP. NIVA scores and central hemodynamic parameters (PCWP, pulmonary artery diastolic pressure, and cardiac output) were evaluated in 84 patients undergoing outpatient right heart catheterization. Receiver operating characteristic curves were used to determine whether a NIVA score predicted 30-day hospital admission. The NIVA score demonstrated a positive correlation with PCWP (r = 0.92, n = 106, P < .0001). The NIVA score at the time of hospital discharge predicted 30-day admission with an AUC of 0.84, a NIVA score of more than 18 predicted admission with a sensitivity of 91% and specificity of 56%. Residual analysis suggested that no single patient demographic confounded the predictive accuracy of the NIVA score. CONCLUSIONS The NIVAHF score is a noninvasive monitoring technology that is designed to provide an estimate of PCWP. A NIVA score of more than 18 indicated an increased risk for 30-day hospital admission. This noninvasive measurement has the potential for guiding decongestive therapy and the prevention of hospital admission in patients with heart failure.
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Affiliation(s)
- Bret Alvis
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee; VoluMetrix, LLC, Nashville, Tennessee.
| | - Jessica Huston
- Department of Medicine, Division of Cardiovascular Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffery Schmeckpeper
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marisa Case
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Meghan Breed
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lexie Vaughn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Colleen Brophy
- VoluMetrix, LLC, Nashville, Tennessee; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle M Hocking
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee; VoluMetrix, LLC, Nashville, Tennessee; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joann Lindenfeld
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Crimmins-Pierce LD, Bonvillain GP, Henry KR, Hayat MA, Villafranca AA, Stephens SE, Jensen HK, Sanford JA, Wu J, Sexton KW, Jensen MO. Critical Information from High Fidelity Arterial and Venous Pressure Waveforms During Anesthesia and Hemorrhage. Cardiovasc Eng Technol 2022; 13:886-898. [PMID: 35545752 DOI: 10.1007/s13239-022-00624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/08/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Peripheral venous pressure (PVP) waveform analysis is a novel, minimally invasive, and inexpensive method of measuring intravascular volume changes. A porcine cohort was studied to determine how venous and arterial pressure waveforms change due to inhaled and infused anesthetics and acute hemorrhage. METHODS Venous and arterial pressure waveforms were continuously collected, while each pig was under general anesthesia, by inserting Millar catheters into a neighboring peripheral artery and vein. The anesthetic was varied from inhaled to infused, then the pig underwent a controlled hemorrhage. Pearson correlation coefficients between the power of the venous and arterial pressure waveforms at each pig's heart rate frequency were calculated for each variation in the anesthetic, as well as before and after hemorrhage. An analysis of variance (ANOVA) test was computed to determine the significance in changes of the venous pressure waveform means caused by each variation. RESULTS The Pearson correlation coefficients between venous and arterial waveforms decreased as anesthetic dosage increased. In an opposing fashion, the correlation coefficients increased as hemorrhage occurred. CONCLUSION Anesthetics and hemorrhage alter venous pressure waveforms in distinctly different ways, making it critical for researchers and clinicians to consider these confounding variables when utilizing pressure waveforms. Further work needs to be done to determine how best to integrate PVP waveforms into clinical decision-making.
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Affiliation(s)
| | - Gabriel P Bonvillain
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kaylee R Henry
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Md Abul Hayat
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Adria Abella Villafranca
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sam E Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hanna K Jensen
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joseph A Sanford
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingxian Wu
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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Venous waveform analysis detects acute right ventricular failure in a rat respiratory arrest model. Pediatr Res 2022; 93:1539-1545. [PMID: 36042330 PMCID: PMC9971354 DOI: 10.1038/s41390-022-02278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Peripheral intravenous analysis (PIVA) has been shown to be more sensitive than central venous pressure (CVP) for detecting hemorrhage and volume overload. We hypothesized that PIVA is superior to CVP for detecting right ventricular (RV) failure in a rat model of respiratory arrest. METHODS Eight Wistar rats were studied in accordance with the ARRIVE guidelines. CVP, mean arterial pressure (MAP), and PIVA were recorded. Respiratory arrest was achieved with IV Rocuronium. PIVA utilizes Fourier transform to quantify the amplitude of the peripheral venous waveform, expressed as the "f1 amplitude". RV diameter was measured with transthoracic echocardiography. RESULTS RV diameter increased from 0.34 to 0.54 cm during arrest, p = 0.001, and returned to 0.33 cm post arrest, p = 0.97. There was an increase in f1 amplitude from 0.07 to 0.38 mmHg, p = 0.01 and returned to 0.08 mmHg, p = 1.0. MAP decreased from 119 to 67 mmHg, p = 0.004 and returned to 136 mmHg, p = 0.50. There was no significant increase in CVP from 9.3 mmHg at baseline to 10.5 mmHg during respiratory arrest, p = 0.91, and recovery to 8.6 mmHg, p = 0.81. CONCLUSIONS This study highlights the utility of PIVA to detect RV failure in small-caliber vessels, comparable to peripheral veins in the human pediatric population. IMPACT Right ventricular failure remains a diagnostic challenge, particularly in pediatric patients with small vessel sizes limiting invasive intravascular monitor use. Intravenous analysis has shown promise in detecting hypovolemia and volume overload. Intravenous analysis successfully detects right ventricular failure in a rat respiratory arrest model. Intravenous analysis showed utility despite utilizing small peripheral venous access and therefore may be applicable to a pediatric population. Intravenous analysis may be helpful in differentiating various types of shock.
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Wise ES, Hocking KM, Polcz ME, Beilman GJ, Brophy CM, Sobey JH, Leisy PJ, Kiberenge RK, Alvis BD. Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model. Anesthesiology 2021; 134:607-616. [PMID: 33635950 PMCID: PMC7946734 DOI: 10.1097/aln.0000000000003724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more difficult. Using a porcine model of hemorrhage and over-resuscitation, it is hypothesized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs. METHODS Eight anesthetized female pigs were hemorrhaged at 30 ml/min to a blood loss of 400 ml. After each 100 ml of hemorrhage, vital signs (heart rate, systolic blood pressure, mean arterial pressure, diastolic blood pressure, pulse pressure, pulse pressure variation) and centrally obtained hemodynamic parameters (mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output) were obtained. Blood volume was restored, and the pigs were over-resuscitated with 2,500 ml of crystalloid, collecting parameters after each 500-ml bolus. Hemorrhage and resuscitation phases were analyzed separately to determine differences among parameters over the range of volume. Conformity of parameters during hemorrhage or over-resuscitation was assessed. RESULTS During the course of hemorrhage, changes from baseline euvolemia were observed in vital signs (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) after 100 ml of blood loss. Central hemodynamic parameters (mean pulmonary artery pressure and pulmonary capillary wedge pressure) were changed after 200 ml of blood loss, and central venous pressure after 300 ml of blood loss. During the course of resuscitative volume overload, changes were observed from baseline euvolemia in mean pulmonary artery pressure and central venous pressure after 500-ml resuscitation, in pulmonary capillary wedge pressure after 1,000-ml resuscitation, and cardiac output after 2,500-ml resuscitation. In contrast to hemorrhage, vital sign parameters did not change during over-resuscitation. The strongest linear correlation was observed with pulmonary capillary wedge pressure in both hemorrhage (r2 = 0.99) and volume overload (r2 = 0.98). CONCLUSIONS Pulmonary capillary wedge pressure is the most accurate parameter to track both hemorrhage and over-resuscitation, demonstrating the unmet clinical need for a less invasive pulmonary capillary wedge pressure equivalent. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Eric S Wise
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica E Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory J Beilman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Colleen M Brophy
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Philip J Leisy
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy K Kiberenge
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Bret D Alvis
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Murugan R, Bellomo R, Palevsky PM, Kellum JA. Ultrafiltration in critically ill patients treated with kidney replacement therapy. Nat Rev Nephrol 2021; 17:262-276. [PMID: 33177700 PMCID: PMC9826716 DOI: 10.1038/s41581-020-00358-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 01/30/2023]
Abstract
Management of fluid overload is one of the most challenging problems in the care of critically ill patients with oliguric acute kidney injury. Various clinical practice guidelines support fluid removal using ultrafiltration during kidney replacement therapy. However, ultrafiltration is associated with considerable risks. Emerging evidence from observational studies suggests that both slow and fast rates of net fluid removal (that is, net ultrafiltration (UFNET)) during continuous kidney replacement therapy are associated with increased mortality compared with moderate UFNET rates. In addition, fast UFNET rates are associated with an increased risk of cardiac arrhythmias. Experimental studies in patients with kidney failure who were treated with intermittent haemodialysis suggest that fast UFNET rates are also associated with ischaemic injury to the heart, brain, kidney and gut. The UFNET rate should be prescribed based on patient body weight in millilitres per kilogramme per hour with close monitoring of patient haemodynamics and fluid balance. Dialysate cooling and sodium modelling may prevent haemodynamic instability and facilitate large volumes of fluid removal in patients with kidney failure who are treated with intermittent haemodialysis, but the effects of this strategy on organ injury are less well studied in critically ill patients treated with continuous kidney replacement therapy. Randomized trials are required to examine whether moderate UFNET rates are associated with a reduced risk of haemodynamic instability, organ injury and improved outcomes in critically ill patients.
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Affiliation(s)
- Raghavan Murugan
- The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Rinaldo Bellomo
- Department of Intensive Care Medicine, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Paul M Palevsky
- The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John A Kellum
- The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
Emerging evidence from observational studies suggests that both slower and faster net ultrafiltration rates during kidney replacement therapy are associated with increased mortality in critically ill patients with acute kidney injury and fluid overload. Faster rates are associated with ischemic organ injury. The net ultrafiltration rate should be prescribed based on patient body weight in milliliters per kilogram per hour, with close monitoring of patient hemodynamics and fluid balance. Randomized trials are required to examine whether moderate net ultrafiltration rates compared with slower and faster rates are associated with reduced risk of hemodynamic instability, organ injury, and improved outcomes.
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Affiliation(s)
- Vikram Balakumar
- Department of Critical Care Medicine, Mercy Hospitals, Springfield, MO, USA; Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. https://twitter.com/vikrambalakumar
| | - Raghavan Murugan
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, University of Pittsburgh, 3347 Forbes Avenue, Suite 220, Room 206, Pittsburgh, PA 15261, USA.
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Al-Alawi AZ, Henry KR, Crimmins LD, Bonasso PC, Hayat MA, Dassinger MS, Burford JM, Jensen HK, Sanford J, Wu J, Sexton KW, Jensen MO. Anesthetics affect peripheral venous pressure waveforms and the cross-talk with arterial pressure. J Clin Monit Comput 2021; 36:147-159. [PMID: 33606187 PMCID: PMC8894218 DOI: 10.1007/s10877-020-00632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two pediatric cohorts were studied to test the effect of anesthetic agents on the PVP waveform and cross-talk between peripheral veins and arteries: (1) dehydration setting in a pyloromyotomy using the infused anesthetic propofol and (2) hemorrhage setting during elective surgery for craniosynostosis with the inhaled anesthetic isoflurane. PVP waveforms were collected from 39 patients that received propofol and 9 that received isoflurane. A multiple analysis of variance test determined if anesthetics influence the PVP waveform. A prediction system was built using k-nearest neighbor (k-NN) to distinguish between: (1) PVP waveforms with and without propofol and (2) different minimum alveolar concentration (MAC) groups of isoflurane. 52 porcine, 5 propofol, and 7 isoflurane subjects were used to determine the cross-talk between veins and arteries at the heart and respiratory rate frequency during: (a) during and after bleeding with constant anesthesia, (b) before and after propofol, and (c) at each MAC value. PVP waveforms are influenced by anesthetics, determined by MANOVA: p value < 0.01, η2 = 0.478 for hypovolemic, and η2 = 0.388 for euvolemic conditions. The k-NN prediction models had 82% and 77% accuracy for detecting propofol and MAC, respectively. The cross-talk relationship at each stage was: (a) ρ = 0.95, (b) ρ = 0.96, and (c) could not be evaluated using this cohort. Future research should consider anesthetic agents when analyzing PVP waveforms developing future clinical monitoring technology that uses PVP.
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Affiliation(s)
- Ali Z Al-Alawi
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kaylee R Henry
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Lauren D Crimmins
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Patrick C Bonasso
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Md Abul Hayat
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Melvin S Dassinger
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Burford
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joseph Sanford
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingxian Wu
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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Broyles MG, Subramanyam S, Barker AB, Tolwani AJ. Fluid Responsiveness in the Critically Ill Patient. Adv Chronic Kidney Dis 2021; 28:20-28. [PMID: 34389133 DOI: 10.1053/j.ackd.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 12/19/2022]
Abstract
Accurate assessment of intravascular volume status in critically ill patients remains a very challenging task. Recent data have shown adverse outcomes in critically ill patients with either inadequate or overaggressive fluid therapy. Understanding the tools and techniques available for accurate volume assessment is imperative. This article discusses the concept of fluid responsiveness and reviews methods for assessing fluid responsiveness in critically ill patients.
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12
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Chang D, Leisy PJ, Sobey JH, Reddy SK, Brophy C, Alvis BD, Hocking K, Polcz M. Physiology and clinical utility of the peripheral venous waveform. JRSM Cardiovasc Dis 2020; 9:2048004020970038. [PMID: 33194174 PMCID: PMC7605016 DOI: 10.1177/2048004020970038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 12/19/2022] Open
Abstract
The peripheral venous system serves as a volume reservoir due to its high compliance and can yield information on intravascular volume status. Peripheral venous waveforms can be captured by direct transduction through a peripheral catheter, non-invasive piezoelectric transduction, or gleaned from other waveforms such as the plethysmograph. Older analysis techniques relied upon pressure waveforms such as peripheral venous pressure and central venous pressure as a means of evaluating fluid responsiveness. Newer peripheral venous waveform analysis techniques exist in both the time and frequency domains, and have been applied to various clinical scenarios including hypovolemia (i.e. hemorrhage, dehydration) and volume overload.
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Affiliation(s)
- Devin Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Philip J Leisy
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville TN, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville TN, USA
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville TN, USA
| | - Colleen Brophy
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville TN, USA
| | - Bret D Alvis
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Lefevre RJ, Balzer C, Baudenbacher FJ, Riess ML, Hernandez A, Eagle SS. Venous Waveform Analysis Correlates With Echocardiography in Detecting Hypovolemia in a Rat Hemorrhage Model. Semin Cardiothorac Vasc Anesth 2020; 25:11-18. [PMID: 32957831 DOI: 10.1177/1089253220960894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Assessing intravascular hypovolemia due to hemorrhage remains a clinical challenge. Central venous pressure (CVP) remains a commonly used monitor in surgical and intensive care settings for evaluating blood loss, despite well-described pitfalls of static pressure measurements. The authors investigated an alternative to CVP, intravenous waveform analysis (IVA) as a method for detecting blood loss and examined its correlation with echocardiography. METHODS Seven anesthetized, spontaneously breathing male Sprague Dawley rats with right internal jugular central venous and femoral arterial catheters underwent hemorrhage. Mean arterial pressure (MAP), heart rate, CVP, and IVA were assessed and recorded. Hemorrhage was performed until each rat had 25% estimated blood volume removed. IVA was obtained using fast Fourier transform and the amplitude of the fundamental frequency (f1) was measured. Transthoracic echocardiography was performed utilizing a parasternal short axis image of the left ventricle during hemorrhage. MAP, CVP, and IVA were compared with blood removed and correlated with left ventricular end diastolic area (LVEDA). RESULTS All 7 rats underwent successful hemorrhage. MAP and f1 peak amplitude obtained by IVA showed significant changes with hemorrhage. MAP and f1 peak amplitude also significantly correlated with LVEDA during hemorrhage (R = 0.82 and 0.77, respectively). CVP did not significantly change with hemorrhage, and there was no significant correlation between CVP and LVEDA. CONCLUSIONS In this study, f1 peak amplitude obtained by IVA was superior to CVP for detecting acute, massive hemorrhage. In addition, f1 peak amplitude correlated well with LVEDA on echocardiography. Translated clinically, IVA might provide a viable alternative to CVP for detecting hemorrhage.
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Affiliation(s)
- Ryan J Lefevre
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Matthias L Riess
- Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University, Nashville, TN, USA.,TVHS VA Medical Center, Nashville, TN, USA
| | | | - Susan S Eagle
- Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Unsupervised anomaly detection in peripheral venous pressure signals with hidden Markov models. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Polcz M, Hocking KM, Chang D, Leisy P, Sobey JH, Huston J, Eagle S, Brophy C, Alvis BD. A brief report on the effects of vasoactive agents on peripheral venous waveforms in a porcine model. JRSM Cardiovasc Dis 2020; 9:2048004020940857. [PMID: 32864123 PMCID: PMC7430072 DOI: 10.1177/2048004020940857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives Non-invasive venous waveform analysis (NIVA) is a recently described, novel technique to assess intravascular volume status. Waveforms are captured with a piezoelectric sensor; analysis in the frequency domain allows for calculation of a “NIVA value” that represents volume status. The aim of this report was to determine the effects of vasoactive agents on the venous waveform and calculated NIVA values. Design Porcine experimental model. Setting Operating theatre. Participants A piezoelectric sensor was secured over the surgically exposed saphenous vein in eight anesthetized pigs. Main outcome measures NIVA value, pulmonary capillary wedge pressure (PCWP), and mean arterial pressure prior to and post intravenous administration of 150–180 µg of phenylephrine or 100 µg of sodium nitroprusside. Results Phenylephrine led to a decrease in NIVA value (mean 9.2 vs. 4.6, p < 0.05), while sodium nitroprusside led to an increase in NIVA value (mean 9.5 vs. 11.9, p < 0.05). Mean arterial pressure increased after phenylephrine (p < 0.05) and decreased after sodium nitroprusside (p < 0.05). PCWP did not change significantly after phenylephrine (p = 0.25) or sodium nitroprusside (p = 0.06). Conclusions Vasoactive agents lead to changes in non-invasively obtained venous waveforms in euvolemic pigs, highlighting a potential limitation in the ability to NIVA to estimate static volume in this setting. Further studies are indicated to understand the effects of vasoactive agents in the setting of hypovolemia and hypervolemia.
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Affiliation(s)
- Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Devin Chang
- Department of Bioengineering, Vanderbilt University, Nashville, TN, USA
| | - Philip Leisy
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica Huston
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan Eagle
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Colleen Brophy
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bret D Alvis
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Prim DA, Lane BA, Ferruzzi J, Shazly T, Eberth JF. Evaluation of the Stress-Growth Hypothesis in Saphenous Vein Perfusion Culture. Ann Biomed Eng 2020; 49:487-501. [PMID: 32728831 DOI: 10.1007/s10439-020-02582-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/22/2020] [Indexed: 01/02/2023]
Abstract
The great saphenous vein (GSV) has served as a coronary artery bypass graft (CABG) conduit for over 50 years. Despite prevalent use, first-year failure rates remain high compared to arterial autograft options. Amongst other factors, vein graft failure can be attributed to material and mechanical mismatching that lead to apoptosis, inflammation, and intimal-medial hyperplasia. Through the implementation of the continuum mechanical-based theory of "stress-mediated growth and remodeling," we hypothesize that the mechanical properties of porcine GSV grafts can be favorably tuned for CABG applications prior to implantation using a prolonged but gradual transition from venous to arterial loading conditions in an inflammatory and thrombogenic deficient environment. To test this hypothesis, we used a hemodynamic-mimetic perfusion bioreactor to guide remodeling through stepwise incremental changes in pressure and flow over the course of 21-day cultures. Biaxial mechanical testing of vessels pre- and post-remodeling was performed, with results fit to structurally-motivated constitutive models using non-parametric bootstrapping. The theory of "small-on-large" was used to describe appropriate stiffness moduli, while histology and viability assays confirmed microstructural adaptations and vessel viability. Results suggest that stepwise transition from venous-to-arterial conditions results in a partial restoration of circumferential stretch and circumferential, but not axial, stress through vessel dilation and wall thickening in a primarily outward remodeling process. These remodeled tissues also exhibited decreased mechanical isotropy and circumferential, but not axial, stiffening. In contrast, only increases in axial stiffness were observed using culture under venous perfusion conditions and those tissues experienced moderate intimal resorption.
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Affiliation(s)
- David A Prim
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Brooks A Lane
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Jacopo Ferruzzi
- Biomedical Engineering Department, Boston University, Boston, MA, USA
| | - Tarek Shazly
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA.,Mechanical Engineering Department, University of South Carolina, Columbia, SC, USA
| | - John F Eberth
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA. .,Cell Biology and Anatomy Department (CBA), SOM, University of South Carolina (USC), Bldg.1, Rm. C-36, Columbia, SC, 29208, USA.
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Non-Invasive Venous waveform Analysis (NIVA) for volume assessment during complex cranial vault reconstruction: A proof-of-concept study in children. PLoS One 2020; 15:e0235933. [PMID: 32640004 PMCID: PMC7343152 DOI: 10.1371/journal.pone.0235933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background Non-Invasive Venous waveform Analysis (NIVA) is novel technology that captures and analyzes changes in venous waveforms from a piezoelectric sensor on the wrist for hemodynamic volume assessment. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction. Objective To present proof-of-concept results of a novel technology in the pediatric population. Methods The NIVA prototype was placed on each subject’s wrist, and venous waveforms were collected intraoperatively. Estimated blood loss and fluid/blood product administration were recorded in real time. Venous waveforms were analyzed into a NIVA value and then correlated, along with mean arterial pressure (MAP), to volume changes. Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in MAP or change in NIVA. Results Of 18 patients enrolled, 14 had usable venous waveforms, and there was a significant correlation between change in NIVA value and change in volume. Change in MAP did not correlate with change in volume. The concordance between change in MAP and change in volume was less than the concordance between change in NIVA and change in volume. Conclusion NIVA values correlate more closely to intravascular volume changes in pediatric craniofacial patients than MAP. This initial study suggests that NIVA is a potential safe, reliable, non-invasive quantitative method of measuring intravascular volume changes for children undergoing surgery.
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18
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Alvis BD, Polcz M, Miles M, Wright D, Shwetar M, Leisy P, Forbes R, Fissell R, Whitfield J, Eagle S, Brophy C, Hocking K. Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study. BMC Nephrol 2020; 21:194. [PMID: 32448178 PMCID: PMC7245891 DOI: 10.1186/s12882-020-01845-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Accurate assessment of volume status to direct dialysis remains a clinical challenge. Despite current attempts at volume-directed dialysis, inadequate dialysis and intradialytic hypotension (IDH) are common occurrences. Peripheral venous waveform analysis has recently been developed as a method to accurately determine intravascular volume status through algorithmic quantification of changes in the waveform that occur at different volume states. A noninvasive method to capture peripheral venous signals is described (Non-Invasive Venous waveform Analysis, NIVA). The objective of this proof-of-concept study was to characterize changes in NIVA signal with dialysis. We hypothesized that there would be a change in signal after dialysis and that the rate of intradialytic change in signal would be predictive of IDH. METHODS Fifty subjects undergoing inpatient hemodialysis were enrolled. A 10-mm piezoelectric sensor was secured to the middle volar aspect of the wrist on the extremity opposite to the access site. Signals were obtained fifteen minutes before, throughout, and up to fifteen minutes after hemodialysis. Waveforms were analyzed after a fast Fourier transformation and identification of the frequencies corresponding to the cardiac rate, with a NIVA value generated based on the weighted powers of these frequencies. RESULTS Adequate quality (signal to noise ratio > 20) signals pre- and post- dialysis were obtained in 38 patients (76%). NIVA values were significantly lower at the end of dialysis compared to pre-dialysis levels (1.203 vs 0.868, p < 0.05, n = 38). Only 16 patients had adequate signals for analysis throughout dialysis, but in this small cohort the rate of change in NIVA value was predictive of IDH with a sensitivity of 80% and specificity of 100%. CONCLUSIONS This observational, proof-of-concept study using a NIVA prototype device suggests that NIVA represents a novel and non-invasive technique that with further development and improvements in signal quality may provide static and continuous measures of volume status to assist with volume directed dialysis and prevent intradialytic hypotension.
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Affiliation(s)
- Bret D. Alvis
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, 422 MAB, 1211 21st Ave South, Nashville, TN 37212 USA
| | - Monica Polcz
- Vanderbilt University Medical Center, S111 Medical Center North, 21st Ave South, Medical Art Building 422, Nashville, TN 37212 USA
| | - Merrick Miles
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, 422 MAB, 1211 21st Ave South, Nashville, TN 37212 USA
| | - Donald Wright
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232 USA
| | - Mohammad Shwetar
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232 USA
| | - Phil Leisy
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, 422 MAB, 1211 21st Ave South, Nashville, TN 37212 USA
| | - Rachel Forbes
- Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN 37232 USA
| | - Rachel Fissell
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Ave South, MCN S-3223, Nashville, TN 37232 USA
| | - Jon Whitfield
- Volumetrix, LLC, 2126 21st Ave South, Nashville, TN 37212 USA
| | - Susan Eagle
- Vanderbilt University Medical Center, S111 Medical Center North, 21st Ave South, Medical Art Building 422, Nashville, TN 37212 USA
| | - Colleen Brophy
- Vanderbilt University Medical Center, S111 Medical Center North, 21st Ave South, Medical Art Building 422, Nashville, TN 37212 USA
| | - Kyle Hocking
- Vanderbilt University Medical Center, S111 Medical Center North, 21st Ave South, Medical Art Building 422, Nashville, TN 37212 USA
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Alvis BD, McCallister R, Polcz M, Lima JLO, Sobey JH, Brophy DR, Miles M, Brophy C, Hocking K. Non-Invasive Venous waveform Analysis (NIVA) for monitoring blood loss in human blood donors and validation in a porcine hemorrhage model. J Clin Anesth 2019; 61:109664. [PMID: 31786067 DOI: 10.1016/j.jclinane.2019.109664] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/30/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVE There is an unmet need for a non-invasive approach to diagnose hemorrhage early, before changes in vital signs occur. Non-Invasive Venous waveform Analysis (NIVA) uses a unique physiological signal (the peripheral venous waveform) to assess intravascular volume. We hypothesized changes in the venous waveform would be observed with blood loss in healthy adult blood donors and characterized hemorrhage using invasive monitoring in a porcine model. DESIGN Prospective observational study. SETTING American Red Cross donation center. PATIENTS 50 human blood donors and 12 non-donating controls; 7 Yorkshire pigs. INTERVENTIONS A venous waveform capturing prototype (NIVA device) was secured to the volar aspect of the wrist in human subjects. A central venous catheter was used to obtain hemodynamic indices and venous waveforms were obtained using the prototype NIVA device over the saphenous vein during 400 mL of graded hemorrhage in a porcine model. MEASUREMENTS Venous waveforms were transformed from the time to the frequency domain. The ratiometric power contributions of the cardiac frequencies were used to calculate a NIVA value representative of volume status. MAIN RESULTS A significant decrease in NIVA value was observed after 500 mL of whole blood donation (p < .05). A ROC curve for the ability of the NIVA to detect 500 mL of blood loss demonstrated an area under the curve (AUC) of 0.94. In the porcine model, change in NIVA value correlated linearly with blood loss and with changes in hemodynamic indices. CONCLUSIONS This study provides proof-of-concept for a potential application of NIVA in detection of blood loss. NIVA represents a novel physiologic signal for detection of early blood loss that may be useful in early triage and perioperative management.
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Affiliation(s)
- Bret D Alvis
- 422 MAB, 1211 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
| | - Reid McCallister
- S111 Medical Center North, 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
| | - Monica Polcz
- S111 Medical Center North, 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
| | | | - Jenna Helmer Sobey
- 2200 Children's Way Suite 3115, Vanderbilt University Medical Center, Nashville 37212, USA.
| | - Daniel R Brophy
- S111 Medical Center North, 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Merrick Miles
- 422 MAB, 1211 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
| | - Colleen Brophy
- S111 Medical Center North, 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
| | - Kyle Hocking
- S111 Medical Center North, 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
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20
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Alvis BD, Polcz M, Huston JH, Hopper TS, Leisy P, Mishra K, Eagle SS, Brophy CM, Lindenfeld J, Hocking KM. Observational Study of Noninvasive Venous Waveform Analysis to Assess Intracardiac Filling Pressures During Right Heart Catheterization. J Card Fail 2019; 26:136-141. [PMID: 31574315 DOI: 10.1016/j.cardfail.2019.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/06/2019] [Accepted: 09/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Outpatient monitoring and management of patients with heart failure (HF) reduces hospitalizations and health care costs. However, the availability of noninvasive approaches to assess congestion is limited. Noninvasive venous waveform analysis (NIVA) uses a unique physiologic signal, the morphology of the venous waveform, to assess intracardiac filling pressures. This study is a proof of concept analysis of the correlation between NIVA value and pulmonary capillary wedge pressure (PCWP) and the ability of the NIVA value to predict PCWP > 18 mmHg in subjects undergoing elective right heart catheterization (RHC). PCWP was also compared across common clinical correlates of congestion. METHODS AND RESULTS A prototype NIVA device, which consists of a piezoelectric sensor placed over the skin on the volar aspect of the wrist, connected to a data-capture control box, was used to collect venous waveforms in 96 patients during RHC. PCWP was collected at end-expiration by an experienced cardiologist. The venous waveform signal was transformed to the frequency domain (Fourier transform), where a ratiometric algorithm of the frequencies of the pulse rate and its harmonics was used to derive a NIVA value. NIVA values were successfully captured in 83 of 96 enrolled patients. PCWP ranged from 4-40 mmHg with a median of 13 mmHg. NIVA values demonstrated a linear correlation with PCWP (r = 0.69, P < 0.05). CONCLUSIONS This observational proof-of-concept study using a prototype NIVA device demonstrates a moderate correlation between NIVA value and PCWP in patients undergoing RHC. NIVA, thus, represents a promising developing technology for noninvasive assessment of congestion in spontaneously breathing patients.
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Affiliation(s)
- Bret D Alvis
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN.
| | - Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica H Huston
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Phil Leisy
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Kelly Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan S Eagle
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Colleen M Brophy
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
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Normal Saline solutions cause endothelial dysfunction through loss of membrane integrity, ATP release, and inflammatory responses mediated by P2X7R/p38 MAPK/MK2 signaling pathways. PLoS One 2019; 14:e0220893. [PMID: 31412063 PMCID: PMC6693757 DOI: 10.1371/journal.pone.0220893] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/25/2019] [Indexed: 12/12/2022] Open
Abstract
Resuscitation with 0.9% Normal Saline (NS), a non-buffered acidic solution, leads to increased morbidity and mortality in the critically ill. The goal of this study was to determine the molecular mechanisms of endothelial injury after exposure to NS. The hypothesis of this investigation is that exposure of endothelium to NS would lead to loss of cell membrane integrity, resulting in release of ATP, activation of the purinergic receptor (P2X7R), and subsequent activation of stress activated signaling pathways and inflammation. Human saphenous vein endothelial cells (HSVEC) incubated in NS, but not buffered electrolyte solution (Plasma-Lyte, PL), exhibited abnormal morphology and increased release of lactate dehydrogenase (LDH), adenosine triphosphate (ATP), and decreased transendothelial resistance (TEER), suggesting loss of membrane integrity. Incubation of intact rat aorta (RA) or human saphenous vein in NS but not PL led to impaired endothelial-dependent relaxation which was ameliorated by apyrase (hydrolyzes ATP) or SB203580 (p38 MAPK inhibitor). Exposure of HSVEC to NS but not PL led to activation of p38 MAPK and its downstream substrate, MAPKAP kinase 2 (MK2). Treatment of HSVEC with exogenous ATP led to interleukin 1β (IL-1β) release and increased vascular cell adhesion molecule (VCAM) expression. Treatment of RA with IL-1β led to impaired endothelial relaxation. IL-1β treatment of HSVEC led to increases in p38 MAPK and MK2 phosphorylation, and increased levels of arginase II. Incubation of porcine saphenous vein (PSV) in PL with pH adjusted to 6.0 or less also led to impaired endothelial function, suggesting that the acidic nature of NS is what contributes to endothelial dysfunction. Volume overload resuscitation in a porcine model after hemorrhage with NS, but not PL, led to acidosis and impaired endothelial function. These data suggest that endothelial dysfunction caused by exposure to acidic, non-buffered NS is associated with loss of membrane integrity, release of ATP, and is modulated by P2X7R-mediated inflammatory responses.
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Bonasso PC, Dassinger MS, McLaughlin B, Burford JM, Sexton KW. Fast Fourier Transformation of Peripheral Venous Pressure Changes More Than Vital Signs with Hemorrhage. Mil Med 2019; 184:318-321. [PMID: 30901407 PMCID: PMC6433096 DOI: 10.1093/milmed/usy303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
Vital signs are included in the determination of shock secondary to hemorrhage; however, more granular predictors are needed. We hypothesized that fast Fourier transformation (FFT) would have a greater percent change after hemorrhage than heart rate (HR) or systolic blood pressure (SBP). Using a porcine model, nine 17 kg pigs were hemorrhaged 10% of their calculated blood volume. Peripheral venous pressure waveforms, HR and SBP were collected at baseline and after 10% blood loss. FFT was performed on the peripheral venous pressure waveforms and the peak between 1 and 3 hertz (f1) corresponded to HR. To normalize values for comparison, percent change was calculated for f1, SBP, and HR. The mean percent change for f1 was an 18.8% decrease; SBP was a 3.31% decrease; and HR was a 0.95% increase. Using analysis of variance, FFT at f1 demonstrates a statistically significant greater change than HR or SBP after loss of 10% of circulating blood volume (p = 0.0023). Further work is needed to determine if this could be used in field triage to guide resuscitation.
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Affiliation(s)
- Patrick C Bonasso
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR
| | - Melvin S Dassinger
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR
| | - Brady McLaughlin
- University of Arkansas for Medical Sciences College of Medicine, 4301 W Markham St #550, Little Rock, AR
| | - Jeffrey M Burford
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St #550, Little Rock, AR
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Hocking KM, Alvis BD, Baudenbacher F, Boyer R, Brophy CM, Beer I, Eagle S. Peripheral i.v. analysis (PIVA) of venous waveforms for volume assessment in patients undergoing haemodialysis. Br J Anaesth 2019; 119:1135-1140. [PMID: 29028929 DOI: 10.1093/bja/aex271] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/13/2022] Open
Abstract
Background The assessment of intravascular volume status remains a challenge for clinicians. Peripheral i.v. analysis (PIVA) is a method for analysing the peripheral venous waveform that has been used to monitor volume status. We present a proof-of-concept study for evaluating the efficacy of PIVA in detecting changes in fluid volume. Methods We enrolled 37 hospitalized patients undergoing haemodialysis (HD) as a controlled model for intravascular volume loss. Respiratory rate (F0) and pulse rate (F1) frequencies were measured. PIVA signal was obtained by fast Fourier analysis of the venous waveform followed by weighing the magnitude of the amplitude of the pulse rate frequency. PIVA was compared with peripheral venous pressure and standard monitoring of vital signs. Results Regression analysis showed a linear correlation between volume loss and change in the PIVA signal (R2=0.77). Receiver operator curves demonstrated that the PIVA signal showed an area under the curve of 0.89 for detection of 20 ml kg-1 change in volume. There was no correlation between volume loss and peripheral venous pressure, blood pressure or pulse rate. PIVA-derived pulse rate and respiratory rate were consistent with similar numbers derived from the bio-impedance and electrical signals from the electrocardiogram. Conclusions PIVA is a minimally invasive, novel modality for detecting changes in fluid volume status, respiratory rate and pulse rate in spontaneously breathing patients with peripheral i.v. cannulas.
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Affiliation(s)
- K M Hocking
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | | | - F Baudenbacher
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - R Boyer
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - C M Brophy
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - I Beer
- Medical Affairs, Baxter International Inc., Deerfield, IL, USA
| | - S Eagle
- Department of Anesthesiology
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Bonasso PC, Sexton KW, Mehl SC, Golinko MS, Hayat MA, Wu J, Jensen MO, Smith SD, Burford JM, Dassinger MS. Lessons learned measuring peripheral venous pressure waveforms in an anesthetized pediatric population. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab0ea8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Bonasso PC, Sexton KW, Hayat MA, Wu J, Jensen HK, Jensen MO, Burford JM, Dassinger MS. Venous Physiology Predicts Dehydration in the Pediatric Population. J Surg Res 2019; 238:232-239. [PMID: 30776742 DOI: 10.1016/j.jss.2019.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/01/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND No standard dehydration monitor exists for children. This study attempts to determine the utility of Fast Fourier Transform (FFT) of a peripheral venous pressure (PVP) waveform to predict dehydration. MATERIALS AND METHODS PVP waveforms were collected from 18 patients. Groups were defined as resuscitated (serum chloride ≥ 100 mmol/L) and hypovolemic (serum chloride < 100 mmol/L). Data were collected on emergency department admission and after a 20 cc/kg fluid bolus. The MATLAB (MathWorks) software analyzed nonoverlapping 10-s window signals; 2.4 Hz (144 bps) was the most demonstrative frequency to compare the PVP signal power (mmHg). RESULTS Admission FFTs were compared between 10 (56%) resuscitated and 8 (44%) hypovolemic patients. The PVP signal power was higher in resuscitated patients (median 0.174 mmHg, IQR: 0.079-0.374 mmHg) than in hypovolemic patients (median 0.026 mmHg, IQR: 0.001-0.057 mmHg), (P < 0.001). Fourteen patients received a bolus regardless of laboratory values: 6 (43%) resuscitated and 8 (57%) hypovolemic. In resuscitated patients, the signal power did not change significantly after the fluid bolus (median 0.142 mmHg, IQR: 0.032-0.383 mmHg) (P = 0.019), whereas significantly increased signal power (median 0.0474 mmHg, IQR: 0.019-0.110 mmHg) was observed in the hypovolemic patients after a fluid bolus at 2.4 Hz (P < 0.001). The algorithm predicted dehydration for window-level analysis (sensitivity 97.95%, specificity 93.07%). The algorithm predicted dehydration for patient-level analysis (sensitivity 100%, specificity 100%). CONCLUSIONS FFT of PVP waveforms can predict dehydration in hypertrophic pyloric stenosis. Further work is needed to determine the utility of PVP analysis to guide fluid resuscitation status in other pediatric populations.
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Affiliation(s)
- Patrick C Bonasso
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Md Abul Hayat
- Department of Electrical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Jingxian Wu
- Department of Electrical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Hanna K Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Jeffrey M Burford
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Melvin S Dassinger
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Marques NR, De Riese J, Yelverton BC, McQuitty C, Jupiter D, Willmann K, Salter M, Kinsky M, Johnston WE. Diastolic Function and Peripheral Venous Pressure as Indices for Fluid Responsiveness in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2019; 33:2208-2215. [PMID: 30738752 DOI: 10.1053/j.jvca.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Identifying fluid responsiveness is critical to optimizing perfusion while preventing fluid overload. An experimental study of hypovolemic shock resuscitation showed the importance of ventricular compliance and peripheral venous pressure (PVP) on fluid responsiveness. The authors tested the hypothesis that reduced ventricular compliance measured using transesophageal echocardiography results in decreased fluid responsiveness after a fluid bolus. DESIGN Prospective observational study. SETTING Two-center, university hospital study. PARTICIPANTS The study comprised 29 patients undergoing elective coronary revascularization. INTERVENTION Albumin 5%, 7 mL/kg, was infused over 10 minutes to characterize fluid responders (>15% increase in stroke volume) from nonresponders. MEASUREMENTS AND MAIN RESULTS Invasive hemodynamics and the ratio of mitral inflow velocity (E-wave)/annular relaxation (e'), or E/e' ratio, were measured using transesophageal echocardiography to assess left ventricular (LV) compliance at baseline and after albumin infusion. Fifteen patients were classified as responders and 14 as nonresponders. The E/e' ratio in responders was 7.4 ± 1.9 at baseline and 7.1 ± 1.8 after bolus. In contrast, E/e' was significantly higher in nonresponders at baseline (10.7 ± 4.6; p = 0.04) and further increased after bolus (12.6 ± 5.5; p = 0.002). PVP was significantly greater in the nonresponders at baseline (14 ± 4 mmHg v 11 ± 3 mmHg; p = 0.02) and increased in both groups after albumin infusion. Fluid responsiveness was tested using the area under the receiver operating characteristic curve and was 0.74 for the E/e' ratio (95% confidence interval 0.55-0.93; p = 0.029) and 0.72 for the PVP (95% confidence interval 0.52-0.92; p = 0.058). CONCLUSION Fluid responders had normal LV compliance and lower PVP at baseline. In contrast, nonresponders had reduced LV compliance, which worsened after fluid bolus. E/e,' more than PVP, may be a useful clinical index to predict fluid responsiveness.
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Miles M, Alvis BD, Hocking K, Baudenbacher F, Guth C, Lindenfeld J, Brophy C, Eagle S. Peripheral Intravenous Volume Analysis (PIVA) for Quantitating Volume Overload in Patients Hospitalized With Acute Decompensated Heart Failure-A Pilot Study. J Card Fail 2018; 24:525-532. [PMID: 29777760 DOI: 10.1016/j.cardfail.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine the feasibility of peripheral intravenous volume analysis (PIVA) of venous waveforms for assessing volume overload in patients admitted to the hospital with acute decompensated heart failure (ADHF). METHODS Venous waveforms were captured from a peripheral intravenous catheter in subjects admitted for ADHF and healthy age-matched controls. Admission PIVA signal, brain natriuretic peptide, and chest radiographic measurements were related to the net volume removed during diuresis. RESULTS ADHF patients had a significantly greater PIVA signal on admission compared with the control group (P = .0013, n = 18). At discharge, ADHF patients had a PIVA signal similar to the control group. PIVA signal, not brain natriuretic peptide or chest radiographic measures, accurately predicted the amount of volume removed during diuresis (R2 = 0.781, n = 14). PIVA signal at time of discharge greater than 0.20, demonstrated 83.3% 120-day readmission rate. CONCLUSIONS This study demonstrates the feasibility of PIVA for assessment of volume overload in patients admitted to the hospital with ADHF.
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Affiliation(s)
- Merrick Miles
- Vanderbilt University Medical Center, Department of Anesthesiology, Division of Critical Care, Nashville, Tennessee
| | - Bret D Alvis
- Vanderbilt University Medical Center, Department of Anesthesiology, Division of Critical Care, Nashville, Tennessee.
| | - Kyle Hocking
- Vanderbilt University Medical Center, Department of Surgery, Nashville, Tennessee
| | - Franz Baudenbacher
- Vanderbilt University, Institute for Integrative Biosystems Research and Education (VIIBRE) Department of Engineering, Nashville, Tennessee
| | - Christy Guth
- Vanderbilt University Medical Center, Department of Surgery, Nashville, Tennessee
| | - Joann Lindenfeld
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology, Nashville, Tennessee
| | - Colleen Brophy
- Vanderbilt University Medical Center, Department of Surgery, Nashville, Tennessee
| | - Susan Eagle
- Vanderbilt University Medical Center, Department of Anesthesiology, Division of Cardiac & Thoracic Anesthesia, Nashville, Tennessee
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Bonasso PC, Dassinger MS, Jensen MO, Smith SD, Burford JM, Sexton KW. Optimizing peripheral venous pressure waveforms in an awake pediatric patient by decreasing signal interference. J Clin Monit Comput 2018; 32:1149-1153. [PMID: 29511972 DOI: 10.1007/s10877-018-0124-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/02/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this technological notes paper is to describe our institution's experience collecting peripheral venous pressure (PVP) waveforms using a standard peripheral intravenous catheter in an awake pediatric patient. PVP waveforms were collected from patients with hypertrophic pyloric stenosis. PVP measurements were obtained prospectively at two time points during the hospitalization: admission to emergency department and after bolus in emergency department. Data was collected from thirty-two patients. Interference in the PVP waveforms data collection was associated with the following: patient or device motion, system set-up error, type of IV catheter, and peripheral intravenous catheter location. PVP waveforms can be collected in an awake pediatric patient and adjuncts to decrease signal interference can be used to optimize data collection.
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Affiliation(s)
- Patrick C Bonasso
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, USA.
| | - Melvin S Dassinger
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, USA
| | - Samuel D Smith
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey M Burford
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
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What's New in Shock, October 2016? Shock 2016; 46:339-40. [PMID: 27635980 DOI: 10.1097/shk.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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