Blood pressure waveform contour analysis for assessing peripheral resistance changes in sepsis

Background

This paper proposes a methodology for helping bridge the gap between the complex waveform information frequently available in an intensive care unit and the simple, lumped values favoured for rapid clinical diagnosis and management. This methodology employs a simple waveform contour analysis approach to compare aortic, femoral and central venous pressure waveforms on a beat-by-beat basis and extract lumped metrics pertaining to the pressure drop and pressure-pulse amplitude attenuation as blood passes through the various sections of systemic circulation.

Results

Validation encompasses a comparison between novel metrics and well-known, analogous clinical metrics such as mean arterial and venous pressures, across an animal model of induced sepsis. The novel metric O_fe?→?vc, the direct pressure offset between the femoral artery and vena cava, and the clinical metric, ΔMP, the difference between mean arterial and venous pressure, performed well. However, O_fe?→?vc reduced the optimal average time to sepsis detection after endotoxin infusion from 46.2 min for ΔMP to 11.6 min, for a slight increase in false positive rate from 1.8 to 6.2%. Thus, the novel O_fe?→?vc provided the best combination of specificity and sensitivity, assuming an equal weighting to both, of the metrics assessed.

Conclusions

Overall, the potential of these novel metrics in the detection of diagnostic shifts in physiological behaviour, here driven by sepsis, is demonstrated.

     

Model-free deconvolution techniques for estimating vascular transport functions

In this paper we present two methods which can be used to numerically deconvolve indicator dilution curves to obtain vascular transport functions. In the first method, direct algebraic deconvolution is made stable and practical by the damped least squares method. The second method involves a time-shift of the output curve which is based on the first and second moments of the input and output curves. This method is stable, computationally simple and can provide reasonable estimates of the transport function.     

Signal analysis of slit-scan contour data.

As a method for the preselection of alarms in gynecological cell samples, the Battelle Cytophotometry Research Group uses the slit-scan technique to obtain various cell parameters, such as the N/C ratio and the relative DNA content, from fluorescently stained cells, which are aligned one-dimensionally in the tape system designed at Battelle. The system developed at Battelle Institute analyzes all signals that exceed the background noise. As the first step in processing the slit-scan data, several threshold levels permit the separation of various artifacts. In subsequent steps, the nuclear peak is recognized, the nuclear boundaries are calculated, and seven cell parameters are determined. For the alarm detection at present only one parameter, DNA fluorescence, is used for these determinations. Visual assignment of these data to definite objects on the tape makes it possible to obtain frequency distributions of: (a) all recorded objects within the sample on the tape; (b) all signals that are classified as cells; and (c) all types of objects that preferentially cause alarms.     

Arterial anatomy of the face: an analysis of vascular territories and perforating cutaneous vessels.

The cutaneous arterial circulation of the face and scalp was investigated by using multiple anatomic techniques in fresh cadaver specimens. Selective ink injections, dissection and measurement of latex-hardened perforators, and radiographic examination of transverse sections of barium-injected specimens defined 11 vascular territories of the face and scalp. Three distinct patterns of arterial vascularization were observed: (1) small, densely populated musculocutaneous perforating arteries supply the anterior face (facial, infraorbital arteries), (2) large, sparsely populated fasciocutaneous perforators that occur in predictable locations supply the lateral region of the face (branches of the transverse facial, submental, and zygomatico-orbital arteries), and (3) small, densely populated fasciocutaneous perforators supply the scalp (occipital, superficial temporal, and posterior auricular arteries). The locations of the perforation sites of the transverse facial, zygomatico-orbital, supratrochlear, supraorbital, and superficial temporal arteries may be predicted statistically within 2-cm limits with 95 percent certainty for individuals in the general population. The results of this study provide the anatomic framework to potentially revise or improve current reconstructive or aesthetic procedures on the face based on known arteries.     

Preventing errors when estimating single channel properties from the analysis of current fluctuations.

The conductance, number, and mean open time of ion channels can be estimated from fluctuations in membrane current. To examine potential errors associated with fluctuation analysis, we simulated ensemble currents and estimated single channel properties. The number (N) and amplitude (i) of the underlying single channels were estimated using nonstationary fluctuation analysis, while mean open time was estimated using covariance and spectral analysis. Both excessive filtering and the analysis of segments of current that were too brief led to underestimates of i and overestimates of N. Setting the low-pass cut-off frequency of the filter to greater than five times the inverse of the effective mean channel open time (burst duration) and analyzing segments of current that were at least 80 times the effective mean channel open time reduced the errors to < 2%. With excessive filtering, Butterworth filtering gave up to 10% less error in estimating i and N than Bessel filtering. Estimates of mean open time obtained from the time constant of decay of the covariance, tau obs, at low open probabilities (Po) were much less sensitive to filtering than estimates of i and N. Extrapolating plots of tau obs versus mean current to the ordinate provided a method to estimate mean open time from data obtained at higher Po, where tau obs no longer represents mean open time. Bessel filtering gave the least error when estimating tau obs from the decay of the covariance function, and Butterworth filtering gave the least error when estimating tau obs from spectral density functions.     

Arterial versus venous changes in vascular capacitance during nitroprusside infusion: a vascular modelling study.

The distributions of nitroprusside (NP) induced changes in vascular capacitance, arterial versus venous, are unknown. We measured canine ileal arterial and venous pressures and total (isolated loop) vascular volumes (scintigraphy), before and during NP infusion. NP sufficient to decrease perfusion pressure by 30% increased total vascular volume to 111 +/- 3% (+/- SEM) of control (p < 0.01). Increasing flow to restore perfusion pressure increased volume 4% more (p < 0.01). Assuming a two-compartment model and on the basis of the literature data, changes in venous capacitance were estimated and compared with arterial capacitance. During constant-flow perfusion, NP increased venous volume by 10.0% (vs. 18.1%, arterial). When flow was increased to restore pressure, venous volume increased by another 3.7% (vs. 2.6%, arterial). Assuming an original arterial to venous volume ratio of 133/1033, the final, constant-pressure increase in venous volume was almost 4 times the arterial increase. In conclusion, the increase in vascular volume during NP infusion was due primarily to similar-magnitude, active increases in venous and arterial capacitances (i.e., rightward shifts in pressure-volume relations). However, as venous volume is so much larger than arterial, the NP-induced increase in venous volume was greater.     

Arterial pressure in humans during weightlessness induced by parabolic flights.

Results from our laboratory have indicated that, compared with those of the 1-G supine (Sup) position, left atrial diameter (LAD) and transmural central venous pressure increase in humans during weightlessness (0 G) induced by parabolic flights (R. Videbaek and P. Norsk. J. Appl. Physiol. 83: 1862-1866, 1997). Therefore, because cardiopulmonary low-pressure receptors are stimulated during 0 G, the hypothesis was tested that mean arterial pressure (MAP) in humans decreases during 0 G to values below those of the 1-G Sup condition. When the subjects were Sup, 0 G induced a decrease in MAP from 93 +/- 4 to 88 +/- 4 mmHg (P < 0.001), and LAD increased from 30 +/- 1 to 33 +/- 1 mm (P < 0.001). In the seated position, MAP also decreased from 93 +/- 6 to 87 +/- 5 mmHg (P < 0.01) and LAD increased from 28 +/- 1 to 32 +/- 1 mm (P < 0.001). During 1-G conditions with subjects in the horizontal left lateral position, LAD increased compared with that of Sup (P < 0.001) with no further effects of 0 G. In conclusion, MAP decreases during short-term weightlessness to below that of 1-G Sup simultaneously with an increase in LAD. Therefore, distension of the heart and associated central vessels during 0 G might induce the hypotensive effects through peripheral vasodilatation. Furthermore, the left lateral position in humans could constitute a simulation model of weightlessness.     

Linear regression analysis based on Buckley-James estimating equation.

In this note we consider the problem of drawing inference about the regression parameters in a linear model with survival data. A simple procedure based on the Buckley-James (1979, Biometrika 66, 429-436) estimating equation is proposed and illustrated with an example.     

Arterial pressure regulation during hemorrhage: homeostatic role of angiotensin II.

The role of the renin-angiotensin system in the maintenance of arterial pressure following hemorrhage was studied in conscious dogs. Hemorrhage (20 ml/kg body wt) decreased the mean arterial pressure, but compensatory mechanisms partially restored the arterial pressure toward normal. Plasma renin activity increased more than twofold following hemorrhage. To evaluate the role of endogenous angiotensin II in this compensatory response, a specific competitive antagonist of angiotensin II, 1-sarcosine-8-alanine-angiotensin II, was infused intravenously at 6.0 mug/kg min-1 for 30 min; the mean posthemorrhage arterial pressure decreased from 102 plus or minus 7 mmHg to 80 plus or minus 6 mmHg after 15 and 30 min of analog infusion (P less than 0.01 for both values). After a recovery period of 60 min, arterial pressure returned to pre-infusion levels. These results suggest that angiotensin II plays an important role in the short-term maintenance of arterial pressure following hemorrhage in the conscious animal.     

Biochemical properties of vascular endothelial cells.

Present knowledge in the field of vascular endothelial cells is reviewed. The role of endothelial cells in the synthesis of matrix proteins and glycosaminoglycans is described. Endothelial cells play a considerable role in the processes of coagulation and fibrinolysis. They also interact with neurotransmitters and vasomotoric substances, and participate in inflammation and immunological responses. They produce several different growth factors. Their role in lipoprotein metabolism is of special importance to research into atherosclerosis.