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Khanna AK, Garcia JO, Saha AK, Harris L, Baruch M, Martin RS. Agreement between cardiac output estimation with a wireless, wearable pulse decomposition analysis device and continuous thermodilution in post cardiac surgery intensive care unit patients. J Clin Monit Comput 2024; 38:139-146. [PMID: 37458916 DOI: 10.1007/s10877-023-01059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/07/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE Pulse Decomposition Analysis (PDA) uses integration of the systolic area of a distally transmitted aortic pulse as well as arterial stiffness estimates to compute cardiac output. We sought to assess agreement of cardiac output (CO) estimation between continuous pulmonary artery catheter (PAC) guided thermodilution (CO-CCO) and a wireless, wearable noninvasive device, (Vitalstream, Caretaker Medical, Charlottesville, VA), that utilizes the Pulse Decomposition Analysis (CO-PDA) method in postoperative cardiac surgery patients in the intensive care unit. METHODS CO-CCO measurements were compared with post processed CO-PDA measurements in prospectively enrolled adult cardiac surgical intensive care unit patients. Uncalibrated CO-PDA values were compared for accuracy with CO-CCO via a Bland-Altman analysis considering repeated measurements and a concordance analysis with a 10% exclusion zone. RESULTS 259.7 h of monitoring data from 41 patients matching 15,583 data points were analyzed. Mean CO-CCO was 5.55 L/min, while mean values for the CO-PDA were 5.73 L/min (mean of differences +- SD 0.79 ± 1.11 L/min; limits of agreement - 1.43 to 3.01 L/min), with a percentage error of 37.5%. CO-CCO correlation with CO-PDA was moderate (0.54) and concordance was 0.83. CONCLUSION Compared with the CO-CCO Swan-Ganz, cardiac output measurements obtained using the CO-PDA were not interchangeable when using a 30% threshold. These preliminary results were within the 45% limits for minimally invasive devices, and pending further robust trials, the CO-PDA offers a noninvasive, wireless solution to complement and extend hemodynamic monitoring within and outside the ICU.
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Affiliation(s)
- Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, School of Medicine, Wake Forest University, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
- Outcomes Research Consortium, Cleveland, OH, USA.
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Julio O Garcia
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amit K Saha
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
- Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Lynnette Harris
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
- Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | | | - R Shayn Martin
- Department of Surgery, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Gratz I, Baruch M, Awad A, McEniry B, Allen I, Seaman J. A new continuous noninvasive finger cuff device (Vitalstream) for cardiac output that communicates wirelessly via bluetooth or Wi-Fi. BMC Anesthesiol 2023; 23:180. [PMID: 37231335 DOI: 10.1186/s12871-023-02114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The new noninvasive Vitalstream (VS) continuous physiological monitor (Caretaker Medical LLC, Charlottesville, Virginia), allows continuous cardiac output by a low pump-inflated, finger cuff that pneumatically couples arterial pulsations via a pressure line to a pressure sensor for detection and analysis. Physiological data are communicated wirelessly to a tablet-based user interface via Bluetooth or Wi-Fi. We evaluated its performance against thermodilution cardiac output in patients undergoing cardiac surgery. METHODS We compared the agreement between thermodilution cardiac output to that obtained by the continuous noninvasive system during cardiac surgery pre and post-cardiac bypass. Thermodilution cardiac output was performed routinely when clinically indicated by an iced saline cold injectate system. All comparisons between VS and TD/CCO data were post-processed. In order to match the VS CO readings to the averaged discrete TD bolus data, the averaged CO readings of the ten seconds of VS CO data points prior to a sequence of TD bolus injections was matched. Time alignment was based on the medical record time and the VS time-stamped data points. The accuracy against reference TD measurements was assessed via Bland-Altman analysis of the CO values and standard concordance analysis of the ΔCO values (with a 15% exclusion zone). RESULTS Analysis of the data compared the accuracy of the matched measurement pairs of VS and TD/CCO VS absolute CO values with and without initial calibration to the discrete TD CO values, as well as the trending ability, i.e., ΔCO values of the VS physiological monitor compared to those of the reference. The results were comparable with other non-invasive as well as invasive technologies and Bland-Altman analyses showed high agreement between devices in a diverse patient population. The results are significant regarding the goal of expanding access to effective, wireless and readily implemented fluid management monitoring tools to hospital sections previously not covered because of the limitations of traditional technologies. CONCLUSION This study demonstrated that the agreement between the VS CO and TD CO was clinically acceptable with a percent error (PE) of 34.5 to 38% with and without external calibration. The threshold for an acceptable agreement between the VS and TD was considered to be below 40% which is below the threshold recommended by others.
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Affiliation(s)
- Irwin Gratz
- Cooper University Hospital, Camden, NJ, USA.
| | | | - Ahmed Awad
- Cooper University Hospital, Camden, NJ, USA
| | | | - Isabel Allen
- University of California, San Francisco, CA, USA
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Cimr D, Studnicka F, Fujita H, Cimler R, Slegr J. Application of mechanical trigger for unobtrusive detection of respiratory disorders from body recoil micro-movements. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106149. [PMID: 34015736 DOI: 10.1016/j.cmpb.2021.106149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
Background and Objectives Automatic detection of breathing disorders plays an important role in the early signalization of respiratory diseases. Measuring methods can be based on electrocardiogram (ECG), sound, oximetry, or respiratory analysis. However, these approaches require devices placed on the human body or they are prone to disturbance by environmental influences. To solve these problems, we proposed a heart contraction mechanical trigger for unobtrusive detection of respiratory disorders from the mechanical measurement of cardiac contractions. We designed a novel method to calculate this mechanical trigger purely from measured mechanical signals without the use of ECG. Methods The approach is a built-on calculation of the so-called euclidean arc length from the signals. In comparison to previous researches, this system does not require any equipment attached to a person. This is achieved by locating the tensometers on the bed. Data from sensors are fused by the Cartan curvatures method to beat-to-beat vector input for the Convolutional neural network (CNN) classifier. Results In sum, 2281 disordered and 5130 normal breathing samples was collected for analysis. The experiments with use of 10-fold cross validation show that accuracy, sensitivity, and specificity reach values of 96.37%, 92.46%, and 98.11% respectively. Conclusions By the approach for detection, the system offers a novel way for a completely unobtrusive diagnosis of breathing-related health problems. The proposed solution can effectively be deployed in all clinical or home environments.
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Affiliation(s)
- Dalibor Cimr
- Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, Hradec Kralove 50003, Czech Republic
| | - Filip Studnicka
- Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, Hradec Kralove 50003, Czech Republic
| | - Hamido Fujita
- Faculty of Information Technology, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam; DaSCI Andalusian Institute of Data Science and Computational Intelligence, University of Granada, Granada, Spain; Regional Research Center, Iwate Prefectural University, Iwate, Japan.
| | - Richard Cimler
- Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, Hradec Kralove 50003, Czech Republic
| | - Jan Slegr
- Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, Hradec Kralove 50003, Czech Republic
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Cimr D, Studnicka F, Fujita H, Tomaskova H, Cimler R, Kuhnova J, Slegr J. Computer aided detection of breathing disorder from ballistocardiography signal using convolutional neural network. Inf Sci (N Y) 2020. [DOI: 10.1016/j.ins.2020.05.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gratz I, Deal E, Spitz F, Baruch M, Allen IE, Seaman JE, Pukenas E, Jean S. Continuous Non-invasive finger cuff CareTaker® comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery. BMC Anesthesiol 2017; 17:48. [PMID: 28327093 PMCID: PMC5361833 DOI: 10.1186/s12871-017-0337-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060–2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTaker® (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis. Methods A convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created. Results The correlation of systolic, diastolic, and mean arterial pressures were 0.92, 0.86, 0.91, respectively (p < 0.0001 for all the comparisons). The Bland-Altman comparison yielded a bias (as measured by overall mean difference) of −0.57, −2.52, 1.01 mmHg for systolic, diastolic, and mean arterial pressures, respectively with a standard deviation of 7.34, 6.47, 5.33 mmHg for systolic, diastolic, and mean arterial pressures, respectively (p < 0.001 for all comparisons). The polar plot indicates little bias between the two methods (90%/95% CI at 31.5°/52°, respectively, overall bias = 1.5°) with only a small percentage of points outside these lines. The 4Q plot indicates good concordance and no bias between the methods. Conclusions In this study, blood pressure measured using the non-invasive CT device was shown to correlate well with the arterial catheter measurements. Larger studies are needed to confirm these results in more varied settings. Most patients exhibited very good agreement between methods. Results were well within the limits established for the validation of automatic arterial pressure monitoring by the AAMI.
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Affiliation(s)
- Irwin Gratz
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Edward Deal
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Francis Spitz
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Martin Baruch
- Empirical Technologies Corporation, Charlottesville, Virginia, USA
| | - I Elaine Allen
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - Julia E Seaman
- Department of Pharmaceutical Chemistry, University of California, San Francisco, California, USA
| | - Erin Pukenas
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Smith Jean
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA.
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Validation of the pulse decomposition analysis algorithm using central arterial blood pressure. Biomed Eng Online 2014; 13:96. [PMID: 25005686 PMCID: PMC4105793 DOI: 10.1186/1475-925x-13-96] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/24/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is a significant need for continuous noninvasive blood pressure (cNIBP) monitoring, especially for anesthetized surgery and ICU recovery. cNIBP systems could lower costs and expand the use of continuous blood pressure monitoring, lowering risk and improving outcomes.The test system examined here is the CareTaker® and a pulse contour analysis algorithm, Pulse Decomposition Analysis (PDA). PDA's premise is that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses that are due to the left ventricular ejection and reflections and re-reflections from only two reflection sites within the central arteries.The hypothesis examined here is that the model's principal parameters P2P1 and T13 can be correlated with, respectively, systolic and pulse pressures. METHODS Central arterial blood pressures of patients (38 m/25 f, mean age: 62.7 y, SD: 11.5 y, mean height: 172.3 cm, SD: 9.7 cm, mean weight: 86.8 kg, SD: 20.1 kg) undergoing cardiac catheterization were monitored using central line catheters while the PDA parameters were extracted from the arterial pulse signal obtained non-invasively using CareTaker system. RESULTS Qualitative validation of the model was achieved with the direct observation of the five component pressure pulses in the central arteries using central line catheters. Statistically significant correlations between P2P1 and systole and T13 and pulse pressure were established (systole: R square: 0.92 (p < 0.0001), diastole: R square: 0.78 (p < 0.0001). Bland-Altman comparisons between blood pressures obtained through the conversion of PDA parameters to blood pressures of non-invasively obtained pulse signatures with catheter-obtained blood pressures fell within the trend guidelines of the Association for the Advancement of Medical Instrumentation SP-10 standard (standard deviation: 8 mmHg(systole: 5.87 mmHg, diastole: 5.69 mmHg)). CONCLUSIONS The results indicate that arterial blood pressure can be accurately measured and tracked noninvasively and continuously using the CareTaker system and the PDA algorithm. The results further support the physical model that all of the features of the pressure pulse envelope, whether in the central arteries or in the arterial periphery, can be explained by the interaction of the left ventricular ejection pressure pulse with two centrally located reflection sites.
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Evaluation of blood flow velocity waveform in common carotid artery using multi-branched arterial segment model of human arteries. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baruch MC, Warburton DER, Bredin SSD, Cote A, Gerdt DW, Adkins CM. Pulse Decomposition Analysis of the digital arterial pulse during hemorrhage simulation. NONLINEAR BIOMEDICAL PHYSICS 2011; 5:1. [PMID: 21226911 PMCID: PMC3025935 DOI: 10.1186/1753-4631-5-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/12/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND Markers of temporal changes in central blood volume are required to non-invasively detect hemorrhage and the onset of hemorrhagic shock. Recent work suggests that pulse pressure may be such a marker. A new approach to tracking blood pressure, and pulse pressure specifically is presented that is based on a new form of pulse pressure wave analysis called Pulse Decomposition Analysis (PDA). The premise of the PDA model is that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses, the first of which is due to the left ventricular ejection from the heart while the remaining component pressure pulses are reflections and re-reflections that originate from only two reflection sites within the central arteries. The hypothesis examined here is that the PDA parameter T13, the timing delay between the first and third component pulses, correlates with pulse pressure.T13 was monitored along with blood pressure, as determined by an automatic cuff and another continuous blood pressure monitor, during the course of lower body negative pressure (LBNP) sessions involving four stages, -15 mmHg, -30 mmHg, -45 mmHg, and -60 mmHg, in fifteen subjects (average age: 24.4 years, SD: 3.0 years; average height: 168.6 cm, SD: 8.0 cm; average weight: 64.0 kg, SD: 9.1 kg). RESULTS Statistically significant correlations between T13 and pulse pressure as well as the ability of T13 to resolve the effects of different LBNP stages were established. Experimental T13 values were compared with predictions of the PDA model. These interventions resulted in pulse pressure changes of up to 7.8 mmHg (SE = 3.49 mmHg) as determined by the automatic cuff. Corresponding changes in T13 were a shortening by -72 milliseconds (SE = 4.17 milliseconds). In contrast to the other two methodologies, T13 was able to resolve the effects of the two least negative pressure stages with significance set at p < 0.01. CONCLUSIONS The agreement of observations and measurements provides a preliminary validation of the PDA model regarding the origin of the arterial pressure pulse reflections. The proposed physical picture of the PDA model is attractive because it identifies the contributions of distinct reflecting arterial tree components to the peripheral pressure pulse envelope. Since the importance of arterial pressure reflections to cardiovascular health is well known, the PDA pulse analysis could provide, beyond the tracking of blood pressure, an assessment tool of those reflections as well as the health of the sites that give rise to them.
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Affiliation(s)
- Martin C Baruch
- Empirical Technologies Corporation, PO Box 8175, 3046A Berkmar Drive, Charlottesville, Virginia, 22906, USA
| | - Darren ER Warburton
- Cardiovascular Physiology Laboratory, 6108 Thunderbird Blvd, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Shannon SD Bredin
- Cardiovascular Physiology Laboratory, 6108 Thunderbird Blvd, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Anita Cote
- Cardiovascular Physiology Laboratory, 6108 Thunderbird Blvd, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - David W Gerdt
- Empirical Technologies Corporation, PO Box 8175, 3046A Berkmar Drive, Charlottesville, Virginia, 22906, USA
| | - Charles M Adkins
- Empirical Technologies Corporation, PO Box 8175, 3046A Berkmar Drive, Charlottesville, Virginia, 22906, USA
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