Continuous Estimation of Acute Changes in Preload Using Epicardially Attached Accelerometers
| Autor: | Magnus Reinsfelt Krogh, Erik Fosse, Espen W. Remme, Ole-Johannes Grymyr, Ole Jakob Elle, Per Steinar Halvorsen, Jacob Bergsland |
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| Rok vydání: | 2020 |
| Předmět: |
Physics
Cardiac output Swine 0206 medical engineering Fluid responsiveness Biomedical Engineering Hemodynamics Blood Pressure Stroke Volume 02 engineering and technology Stroke volume Accelerometer 020601 biomedical engineering Pulse pressure Temporary Pacemaker Combinatorics Preload Cardiac motion Accelerometry Animals Fluid Therapy Humans Cardiac Output Cardiac Surgical Procedures |
| Zdroj: | IEEE transactions on bio-medical engineering. 68(7) |
| ISSN: | 1558-2531 |
| Popis: | Objective: A miniaturized accelerometer can be incorporated in temporary pacemaker leads which are routinely attached to the epicardium during cardiac surgery and provide continuous monitoring of cardiac motion during and following surgery. We tested if such a sensor could be used to assess volume status, which is essential in hemodynamically unstable patients. Methods: An accelerometer was attached to the epicardium of 9 pigs and recordings performed during baseline, fluid loading, and phlebotomy in a closed chest condition. Alterations in left ventricular (LV) preload alter myocardial tension which affects the frequency of myocardial acceleration associated with the first heart sound ( $f_{S1}$ ). The accuracy of $f_{S1}$ as an estimate of preload was evaluated using sonomicrometry measured end-diastolic volume (EDV $_{\text{SONO}}$ ). Standard clinical estimates of global end-diastolic volume using pulse index continuous cardiac output (PiCCO) measurements (GEDV $_{\text{PiCCO}}$ ) and pulmonary artery occlusion pressure (PAOP) were obtained for comparison. The diagnostic accuracy of identifying fluid responsiveness was analyzed for $f_{S1}$ , stroke volume variation (SVV $_{\text{PiCCO}}$ ), pulse pressure variation (PPV $_{\text{PiCCO}}$ ), GEDV $_{\text{PiCCO}}$ , and PAOP. Results: Changes in $f_{S1}$ correlated well to changes in EDV $_{\text{SONO}}$ ( $r^2=0.81$ , 95%CI: [0.68, 0.89]), as did GEDV $_{\text{PiCCO}}$ ( $r^2=0.59$ , 95%CI: [0.36, 0.76]) and PAOP ( $r^2=0.36$ , 95%CI: [0.01, 0.73]). The diagnostic accuracy [95%CI] in identifying fluid responsiveness was 0.79 [0.66, 0.94] for $f_{S1}$ , 0.72 [0.57, 0.86] for SVV $_{\text{PiCCO}}$ , and 0.63 (0.44, 0.82) for PAOP. Conclusion: An epicardially placed accelerometer can assess changes in preload in real-time. Significance: This novel method can facilitate continuous monitoring of the volemic status in open-heart surgery patients and help guiding fluid resuscitation. |
| Databáze: | OpenAIRE |
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