Continuous Cardiac Output & Filling Pressure Monitoring

Summary

Principal Investigator: Ramakrishna Mukkamala
Abstract: [unreadable] DESCRIPTION (provided by applicant): 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. [unreadable] [unreadable]
Funding Period: 2006-06-01 - 2009-05-31
more information: NIH RePORT

Top Publications

  1. pmc Monitoring non-invasive cardiac output and stroke volume during experimental human hypovolaemia and resuscitation
    A T Reisner
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
    Br J Anaesth 106:23-30. 2011
  2. pmc Continuous and less invasive central hemodynamic monitoring by blood pressure waveform analysis
    Ramakrishna Mukkamala
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, Michigan 48824 1226, USA
    Am J Physiol Heart Circ Physiol 299:H584-99. 2010
  3. pmc Dynamic control of maximal ventricular elastance via the baroreflex and force-frequency relation in awake dogs before and after pacing-induced heart failure
    Xiaoxiao Chen
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, USA
    Am J Physiol Heart Circ Physiol 299:H62-9. 2010
  4. pmc Dynamic control of maximal ventricular elastance in conscious dogs before and after pacing-induced heart failure
    Xiaoxiao Chen
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 2009:5328-31. 2009
  5. ncbi Monitoring cardiac output and left atrial pressure by analysis of the right ventricular pressure waveform based on missing output identification
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 2009:4356-9. 2009
  6. pmc Pilot canine investigation of the cardiopulmonary baroreflex control of ventricular contractility
    Javier A Sala-Mercado
    Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201 USA
    Conf Proc IEEE Eng Med Biol Soc 2009:1852-5. 2009
  7. ncbi Cardiac output and left atrial pressure monitoring by right ventricular pressure waveform analysis for potential implantable device application
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    IEEE Trans Biomed Eng 56:2335-9. 2009
  8. pmc Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    J Appl Physiol (1985) 106:651-61. 2009
  9. ncbi Towards automating the pulmonary artery catheter: a canine validation study
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 2007:994-7. 2007
  10. ncbi Comparison of cardiac output monitoring methods for detecting central hypovolemia due to lower body negative pressure
    A T Reisner
    Massachusetts General Hospital Dept of Emergency Medicine, Boston, MA 02114, USA
    Conf Proc IEEE Eng Med Biol Soc 2007:955-8. 2007

Scientific Experts

Detail Information

Publications12

  1. pmc Monitoring non-invasive cardiac output and stroke volume during experimental human hypovolaemia and resuscitation
    A T Reisner
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
    Br J Anaesth 106:23-30. 2011
    ..Multiple methods for non-invasive measurement of cardiac output (CO) and stroke volume (SV) exist. Their comparative capabilities are not clearly established...
  2. pmc Continuous and less invasive central hemodynamic monitoring by blood pressure waveform analysis
    Ramakrishna Mukkamala
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, Michigan 48824 1226, USA
    Am J Physiol Heart Circ Physiol 299:H584-99. 2010
    ..We conclude with suggestions for future research directions in the field and a description of some potential clinical applications of the techniques...
  3. pmc Dynamic control of maximal ventricular elastance via the baroreflex and force-frequency relation in awake dogs before and after pacing-induced heart failure
    Xiaoxiao Chen
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, USA
    Am J Physiol Heart Circ Physiol 299:H62-9. 2010
    ..0002 +/- 0.007 ml(-1) and -0.001 +/- 0.004 mmHg.ml(-1).(beats/min)(-1) (P < 0.1). E(max) is rapidly and significantly controlled at rest, but this modulation is virtually abolished in HF...
  4. pmc Dynamic control of maximal ventricular elastance in conscious dogs before and after pacing-induced heart failure
    Xiaoxiao Chen
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 2009:5328-31. 2009
    ..These results are consistent with known physiology and previous studies and provide perhaps the first quantitative information on the dynamic control of E(max) during normal closed-loop operation...
  5. ncbi Monitoring cardiac output and left atrial pressure by analysis of the right ventricular pressure waveform based on missing output identification
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 2009:4356-9. 2009
    ..3% and 1.9 mmHg, respectively. With further successful testing, the technique may potentially be employed with an established implantable device for chronic monitoring of vital hemodynamic variables...
  6. pmc Pilot canine investigation of the cardiopulmonary baroreflex control of ventricular contractility
    Javier A Sala-Mercado
    Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201 USA
    Conf Proc IEEE Eng Med Biol Soc 2009:1852-5. 2009
    ..Our major finding is that the cardiopulmonary baroreflex responds to an increase (decrease) in CVP by increasing (decreasing) E(max) via the beta-sympathetic nervous system...
  7. ncbi Cardiac output and left atrial pressure monitoring by right ventricular pressure waveform analysis for potential implantable device application
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    IEEE Trans Biomed Eng 56:2335-9. 2009
    ..With further successful testing, the new technique may potentially be employed with an established implantable device for chronic monitoring of essential hemodynamic variables...
  8. pmc Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    J Appl Physiol (1985) 106:651-61. 2009
    ..7 mmHg. On future successful human testing, the technique may potentially be employed for continuous hemodynamic monitoring in critically ill patients with pulmonary artery catheters...
  9. ncbi Towards automating the pulmonary artery catheter: a canine validation study
    Da Xu
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 2007:994-7. 2007
    ..With further successful testing, the technique may ultimately be employed so as to effectively automate the pulmonary artery catheter...
  10. ncbi Comparison of cardiac output monitoring methods for detecting central hypovolemia due to lower body negative pressure
    A T Reisner
    Massachusetts General Hospital Dept of Emergency Medicine, Boston, MA 02114, USA
    Conf Proc IEEE Eng Med Biol Soc 2007:955-8. 2007
    ....
  11. ncbi Selective quantification of the cardiac sympathetic and parasympathetic nervous systems by multisignal analysis of cardiorespiratory variability
    Xiaoxiao Chen
    Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Am J Physiol Heart Circ Physiol 294:H362-71. 2008
    ..Overall, these predictions were better than those provided by the traditional high-frequency (HF) power, LF-to-HF ratio, and normalized LF power of HR variability...
  12. ncbi Continuous cardiac output and left atrial pressure monitoring by pulmonary artery pressure waveform analysis
    Zhenwei Lu
    Dept of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
    Conf Proc IEEE Eng Med Biol Soc 1:214-7. 2006
    ..2% and an overall LAP error of 15.8%. With further testing, the technique may ultimately be employed so as to permit, for the first time, continuous CO and LAP monitoring in critically ill patients...