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Patient-Specific Monitoring and Trend Analysis of Model-Based Markers of Fluid Responsiveness in Sepsis: A Proof-of-Concept Animal Study

  • Liam MurphyEmail author
  • Shaun Davidson
  • J. Geoffrey Chase
  • Jennifer L. Knopp
  • Tony Zhou
  • Thomas Desaive
Original Article
First Online:
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Abstract

Total stressed blood volume (\(SBV_{\text{T}}\)) and arterial elastance (\(E_{\text{a}}\)) are two potentially important, clinically applicable metrics for guiding treatment in patients with altered hemodynamic states. Defined as the total pressure generating blood in the circulation, \(SBV_{\text{T}}\) is a potential direct measurement of tissue perfusion, a critical component in treatment of sepsis. \(E_{\text{a}}\) is closely related to arterial tone thus provides insight into cardiac efficiency. However, it is not clinically feasible or ethical to measure \(SBV_{\text{T}}\) in patients, so a three chambered cardiovascular system model using measured left ventricle pressure and volume, aortic pressure and central venous pressure is implemented to identify \(SBV_{\text{T}}\) and \(E_{\text{a}}\) from clinical data. \(SBV_{\text{T}}\) and \(E_{\text{a}}\) are identified from clinical data from six (6) pigs, who have undergone clinical procedures aimed at simulating septic shock and subsequent treatment, to identify clinically relevant changes. A novel, validated trend analysis method is used to adjudge clinically significant changes in state in the real-time \(E_{\text{a}}\) and \(SBV_{\text{T}}\) traces. Results matched hypothesised increases in \(SBV_{\text{T}}\) during fluid therapy, with a mean change of + 21% during initial therapy, and hypothesised decreases during endotoxin induced sepsis, with a mean change of − 29%. \(E_{\text{a}}\) displayed the hypothesised reciprocal behaviour with a mean changes of − 12 and + 30% during initial therapy and endotoxin induced sepsis, respectively. The overall results validate the efficacy of \(SBV_{\text{T}}\) in tracking changes in hemodynamic state in septic shock and fluid therapy.

Keywords

Stressed blood volume Arterial elastance Cardiovascular Fluid therapy 
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Notes

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© Biomedical Engineering Society 2019

Authors and Affiliations

  1. 1.Department of Mechanical EngineeringUniversity of CanterburyChristchurchNew Zealand
  2. 2.Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
  3. 3.Liege UniversityLiegeBelgium

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