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 #
5K23GM094465-05
Application #
8728940
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
2014-09-01
Budget End
2015-08-31
Support Year
5
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Ihc Health Services, Inc.
Department
Type
DUNS #
City
Salt Lake City
State
UT
Country
United States
Zip Code
84143
Brown, Samuel M; Jones, Jason; Kuttler, Kathryn Gibb et al. (2016) Prospective evaluation of an automated method to identify patients with severe sepsis or septic shock in the emergency department. BMC Emerg Med 16:31
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
Brown, Samuel M; Grissom, Colin K; Moss, Marc et al. (2016) Nonlinear Imputation of Pao2/Fio2 From Spo2/Fio2 Among Patients With Acute Respiratory Distress Syndrome. Chest 150:307-13
Knox, Daniel B; Lanspa, Michael J; Kuttler, Kathryn G et al. (2015) Phenotypic clusters within sepsis-associated multiple organ dysfunction syndrome. Intensive Care Med 41:814-22
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
Nishida, Katsufumi; Lanspa, Michael J; Cloward, Tom V et al. (2015) Effects of positive airway pressure on patients with obstructive sleep apnea during acute ascent to altitude. Ann Am Thorac Soc 12:1072-8
Walkey, Allan J; Pencina, Karol M; Knox, Daniel et al. (2015) Five-Year Risk of Mechanical Ventilation in Community-Dwelling Adults: The Framingham-Intermountain Anticipating Life Support Study. J Am Geriatr Soc 63:2082-8
Brown, Samuel M; McBride, Glen; Collingridge, Dave S et al. (2015) Validation of the Intermountain patient perception of quality (PPQ) survey among survivors of an intensive care unit admission: a retrospective validation study. BMC Health Serv Res 15:155
Sevransky, Jonathan E; Checkley, William; Herrera, Phabiola et al. (2015) Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Crit Care Med 43:2076-84
Brown, Samuel M; Grissom, Colin K; Rondina, Matthew T et al. (2015) Polymorphisms in key pulmonary inflammatory pathways and the development of acute respiratory distress syndrome. Exp Lung Res 41:155-62

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