Sepsis is a common, complex, life-threatening syndrome arising from serious infection. Early, tailored therapy is crucial to the outcome of sepsis, but reliable endpoints for therapy have proved elusive. This lack of reliable Statistical and signal-processing analyses of variability in the body's cardiovascular control system may prove useful in defining valid endpoints for early therapy of sepsis, as well as identifying patients at high risk for poor outcome from sepsis. Employing the highly detailed electronic medical record at Intermountain Healthcare, this proposal aims to study patterns in the variability of heart rate and arterial blood pressure in a large cohort of patients with severe sepsis and septic shock. This research hypothesizes that spectral and non-linear measures of cardiovascular variability like spectral power, sample entropy, and fractal exponents will predict recovery of cardiovascular homeostasis by 24 hours after presentation in septic patients. This research further hypothesizes that changes in cardiovascular variability in response to early therapies will improve our ability to predict recovery of cardiovascular homeostasis. Finally, this research hypothesizes that patterns in variability will predict immediate response to administration of vasopressor drugs or intravenous fluids. This research intends to lay the groundwork for improved bedside care of patients with sepsis as well as better understanding of mechanisms of disruption and restoration of homeostasis in patients with sepsis.

Public Health Relevance

This research seeks to identify hidden patterns in heart rate and blood pressure in patients with life-threatening infection, a condition called sepsis. These patterns should help us identify patients at risk for serious complications and help guide resuscitation of these critically ill individuals. This research should also significantly strengthen further research into the causes of sepsis, its genetic basis, and possible new treatments.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23GM094465-02
Application #
8144391
Study Section
Surgery, Anesthesiology and Trauma Study Section (SAT)
Program Officer
Dunsmore, Sarah
Project Start
2010-09-16
Project End
2015-08-31
Budget Start
2011-09-01
Budget End
2012-08-31
Support Year
2
Fiscal Year
2011
Total Cost
$129,438
Indirect Cost
Name
Ihc Health Services, Inc.
Department
Type
DUNS #
072955503
City
Salt Lake City
State
UT
Country
United States
Zip Code
84143
Tang, Yi; Sorenson, Jeff; Lanspa, Michael et al. (2017) Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study. BMC Anesthesiol 17:82
Beesley, Sarah J; Wilson, Emily L; Lanspa, Michael J et al. (2017) Relative Bradycardia in Patients With Septic Shock Requiring Vasopressor Therapy. Crit Care Med 45:225-233
Brown, Samuel M; Sorensen, Jeffrey; Lanspa, Michael J et al. (2016) Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock. BMC Infect Dis 16:551
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Lanspa, Michael J; Gutsche, Andrea R; Wilson, Emily L et al. (2016) Application of a simplified definition of diastolic function in severe sepsis and septic shock. Crit Care 20:243
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Rondina, Matthew T; Carlisle, McKenzie; Fraughton, Tamra et al. (2015) Platelet-monocyte aggregate formation and mortality risk in older patients with severe sepsis and septic shock. J Gerontol A Biol Sci Med Sci 70:225-31
Lanspa, Michael J; Pittman, Joel E; Hirshberg, Eliotte L et al. (2015) Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock. Crit Care 19:304
Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P et al. (2015) Long-term outcomes after severe shock. Shock 43:128-32

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