Estimation of pulse wave analysis indices from invasive arterial blood pressure only for a clinical assessment of wave reflection in a 5-day septic animal experiment

Wave separation analysis (WSA) is the gold standard to analyze the arterial blood pressure (ABP) waveform, decomposing it into a forward and a reflected wave. It requires ABP and arterial blood flow (ABF) measurement, and ABF is often unavailable in clinical settings. Therefore, methods to estimate ABF from ABP have been proposed, but they are not investigated in critical conditions. In this work, an autoregressive with exogenous input model was proposed as an original method to estimate ABF from the measured ABP. Its performance in assessing WSA indices to characterize the arterial tree was evaluated in critical conditions, i.e., during sepsis. The triangular and the personalized flow approximation and the multi-Gaussian ABP decomposition were compared to the proposed model. The results highlighted how the black-box modeling approach is superior to other flow estimation models when computing WSA indices in septic condition. This approach holds promise for overcoming challenges in clinical settings where ABF data are unavailable.