The pulmonary artery catheter is routinely employed for hemodynamic monitoring of critically ill patients. This catheter permits the estimation of cardiac output (CO) via thermodilution and left heart filling pressure (i.e., left atrial pressure (LAP)) through pulmonary capillary wedge pressure (PCWP). However, these measurements are only obtained intermittently as an operator is required. On the other hand, pulmonary artery pressure (PAP) is measured continuously and automatically with the catheter. A few investigators have therefore proposed analysis techniques to continuously monitor CO from a PAP waveform. However, these techniques were not able to overcome the highly complex wave and inertial effects that corrupt PAP waveforms and were thus unsuccessful. Moreover, even though LAP is also a significant determinant of PAP, none of these techniques provided a means to monitor LAP. We have developed a one of a kind technique for continuously and automatically monitoring both CO and LAP by mathematical analysis of a PAP waveform. In contrast to all previous, related attempts, our technique analyzes the waveform over time scales greater than a cardiac cycle in which the complex wave and inertial effects cease to be a factor. We have conducted initial testing of the technique in nine intensive care unit (ICU) patients, and our results are in agreement with thermodilution and PCWP measurements. We propose further development and evaluation of the technique based on a growing database of ICU patients including hundreds of annotated pulmonary artery catheterization data sets.
Specific Aim 1 is to optimize the mathematical analysis technique. We will refine the technique by optimally incorporating the long time scale PAP information in the analysis.
Specific Aim 2 is to validate the technique with respect to the standard ICU measurements. We will statistically compare the CO and LAP estimated by the technique with thermodilution and PCWP over all, and under each, of the patient conditions (e.g., therapy, disease).
Specific Aim 3 is to compare the performance of the technique to all other competing analysis techniques. We will implement all competing PAP waveform analysis techniques, optimize their performance, and likewise comprehensively evaluate and compare them. Successful achievement of these specific aims may ultimately lead to continuous and automatic monitoring of CO and LAP in ICUs and operating and recovery rooms and thereby benefit the clinical management of those patients with indications for pulmonary artery catheterization. ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HL080568-02
Application #
7229994
Study Section
Special Emphasis Panel (ZRG1-CICS (01))
Program Officer
Sopko, George
Project Start
2006-06-01
Project End
2009-05-31
Budget Start
2007-06-01
Budget End
2009-05-31
Support Year
2
Fiscal Year
2007
Total Cost
$106,064
Indirect Cost
Name
Michigan State University
Department
Engineering (All Types)
Type
Schools of Engineering
DUNS #
193247145
City
East Lansing
State
MI
Country
United States
Zip Code
48824
Reisner, A T; Xu, D; Ryan, K L et al. (2011) Monitoring non-invasive cardiac output and stroke volume during experimental human hypovolaemia and resuscitation. Br J Anaesth 106:23-30
Chen, Xiaoxiao; Sala-Mercado, Javier A; Hammond, Robert L et al. (2010) Dynamic control of maximal ventricular elastance via the baroreflex and force-frequency relation in awake dogs before and after pacing-induced heart failure. Am J Physiol Heart Circ Physiol 299:H62-9
Mukkamala, Ramakrishna; Xu, Da (2010) Continuous and less invasive central hemodynamic monitoring by blood pressure waveform analysis. Am J Physiol Heart Circ Physiol 299:H584-99
Chen, Xiaoxiao; Mukkamala, Ramakrishna; Sala-Mercado, Javier A et al. (2009) Dynamic control of maximal ventricular elastance in conscious dogs before and after pacing-induced heart failure. Conf Proc IEEE Eng Med Biol Soc 2009:5328-31
Sala-Mercado, Javier A; Chen, Xiaoxiao; Hammond, Robert L et al. (2009) Pilot canine investigation of the cardiopulmonary baroreflex control of ventricular contractility. Conf Proc IEEE Eng Med Biol Soc 2009:1852-5
Xu, Da; Olivier, N; Mukkamala, Ramakrishna (2009) Monitoring cardiac output and left atrial pressure by analysis of the right ventricular pressure waveform based on missing output identification. Conf Proc IEEE Eng Med Biol Soc 2009:4356-9
Xu, Da; Olivier, N Bari; Mukkamala, Ramakrishna (2009) Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs. J Appl Physiol 106:651-61
Xu, Da; Olivier, N Bari; Mukkamala, Ramakrishna (2009) Cardiac output and left atrial pressure monitoring by right ventricular pressure waveform analysis for potential implantable device application. IEEE Trans Biomed Eng 56:2335-9
Chen, Xiaoxiao; Mukkamala, Ramakrishna (2008) Selective quantification of the cardiac sympathetic and parasympathetic nervous systems by multisignal analysis of cardiorespiratory variability. Am J Physiol Heart Circ Physiol 294:H362-71
Reisner, A T; Xu, D; Ryan, K L et al. (2007) Comparison of cardiac output monitoring methods for detecting central hypovolemia due to lower body negative pressure. Conf Proc IEEE Eng Med Biol Soc 2007:955-8

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