Estimation of Individual-specific Progression to Impending Cardiovascular Instability using Arterial Waveforms.

摘要

ACUTE UNCONTROLLED HEMORRHAGE with subsequent hemodynamic decompensation (i.e., early stage of hemorrhagic shock) is a leading cause of traumatic death, both domestically (7, 32) and on the battlefield (3, 19). Casualty survival rates increase when patients with ongoing hemorrhage are identified early and appropriate treatment is rendered (5, 33). Current methods for assessing the severity of hemorrhage during the early stages of compensation are severely limited, however, because they are based on standard vital signs (e.g., heart rate, systolic and diastolic blood pressure, electrocardiogram, respiratory rate, pulse oximetry). As a result, many clinicians have wrongly assumed that hypotension and other signs and symptoms of hemorrhagic shock mark the beginning of circulatory compromise, rather than the beginning of decompensation (11, 13, 26). Consequently, unrecognized volume loss during the early compensatory phase of hemorrhage can quickly lead to poor tissue perfusion, progressive acidosis, and sudden, unexpected hemodynamic hemodynamic decompensation, a condition that may lead to less effective interventions and potentially irreversible shock. As such, a profound need exists for advanced diagnostic approaches that identify the complex and dynamic nature of physiological compensation among individual patients at risk for hemorrhagic shock, well before they manifest unstable vital signs.