Objective: Pulse Wave Analysis (PWA) can give insights on cardiovascular biomechanical properties. The use of PWA in critically ill patients, such as septic shock patients, is still limited, despite it can provide complementary information on the cardiovascular effects of treatment to standard indices as defined by international guidelines. Previous works have highlighted how sepsis induces a severe cardiovascular derangement with altered arterial blood pressure waveform morphology, and how resuscitation according to standard hemodynamic targets is not able to restore the physiological functioning of the cardiovascular system. The aim of this work is to test the effectiveness of PWA in characterization of arterial waveforms collected from a swine experiment of polymicrobial septic shock and resuscitation with different drugs. Methods: Morphological features of aortic waveform were extracted by means of PWA techniques during the experiment, such as indices related to dicrotic notch and inflection point. Finally, all the PWA indices were used to compute a clustering classification (mini batch K-means) of the pigs according to the different phases of the experiment, to test if PWA features were able alone to to distinguish the different responses to the administered therapies. Results: PWA indices highlighted a different cardiovascular condition of the pigs in response to different treatments, despite mean hemodynamic values typically used to guide therapy administration were similar in all animals. The clustering algorithm was able to distinguish the different phases of the experiment and the different response of the animals based on the unique information derived from aortic PWA. Conclusion: PWA indices were highly informative even alone in the study of therapy response in septic shock. Significance: A complex pathological condition like septic shock needs an extensive monitoring without neglecting important information from commonly measured signals like arterial blood pressure. Future studies are needed to understand how the individual differences in the response to the therapy are associated to different cardiovascular conditions which may become specific therapy targets.
Pulse wave analysis as a tool for the evaluation of resuscitation therapy in septic shock
Campitelli, Riccardo;Ferrario, Manuela;Carrara, Marta
2023-01-01
Abstract
Objective: Pulse Wave Analysis (PWA) can give insights on cardiovascular biomechanical properties. The use of PWA in critically ill patients, such as septic shock patients, is still limited, despite it can provide complementary information on the cardiovascular effects of treatment to standard indices as defined by international guidelines. Previous works have highlighted how sepsis induces a severe cardiovascular derangement with altered arterial blood pressure waveform morphology, and how resuscitation according to standard hemodynamic targets is not able to restore the physiological functioning of the cardiovascular system. The aim of this work is to test the effectiveness of PWA in characterization of arterial waveforms collected from a swine experiment of polymicrobial septic shock and resuscitation with different drugs. Methods: Morphological features of aortic waveform were extracted by means of PWA techniques during the experiment, such as indices related to dicrotic notch and inflection point. Finally, all the PWA indices were used to compute a clustering classification (mini batch K-means) of the pigs according to the different phases of the experiment, to test if PWA features were able alone to to distinguish the different responses to the administered therapies. Results: PWA indices highlighted a different cardiovascular condition of the pigs in response to different treatments, despite mean hemodynamic values typically used to guide therapy administration were similar in all animals. The clustering algorithm was able to distinguish the different phases of the experiment and the different response of the animals based on the unique information derived from aortic PWA. Conclusion: PWA indices were highly informative even alone in the study of therapy response in septic shock. Significance: A complex pathological condition like septic shock needs an extensive monitoring without neglecting important information from commonly measured signals like arterial blood pressure. Future studies are needed to understand how the individual differences in the response to the therapy are associated to different cardiovascular conditions which may become specific therapy targets.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
