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Comparison of Invasive and Noninvasive Blood Pressure Measurements for Assessing Signal Complexity and Surgical Risk in Cardiac Surgical Patients.
Gibson, Lauren E; Henriques, Teresa S; Costa, Madalena D; Davis, Roger B; Mittleman, Murray A; Mathur, Pooja; Subramaniam, Balachundhar.
Afiliação
  • Gibson LE; From the Department of Anesthesia, Critical Care, and Pain Medicine, Center for Anesthesia Research & Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
  • Henriques TS; From the Department of Anesthesia, Critical Care, and Pain Medicine, Center for Anesthesia Research & Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
  • Costa MD; Margret and H.A. Rey Institute of Nonlinear Dynamics in Physiology and Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Davis RB; Margret and H.A. Rey Institute of Nonlinear Dynamics in Physiology and Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Mittleman MA; Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Mathur P; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
  • Subramaniam B; From the Department of Anesthesia, Critical Care, and Pain Medicine, Center for Anesthesia Research & Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Anesth Analg ; 130(6): 1653-1660, 2020 06.
Article em En | MEDLINE | ID: mdl-30399022
BACKGROUND: Continuous arterial blood pressure (ABP) is typically recorded by placement of an intraarterial catheter. Recently, noninvasive ABP monitors have been shown to be comparable in accuracy to invasive measurements. In a previous study, we showed that the fluctuations in beat-to-beat ABP measurements were not random variations but had a complex dynamical structure, and that ABP dynamical complexity was inversely associated with surgical risk estimated using the Society of Thoracic Surgeons (STS) index. Dynamical complexity is a mathematical construct that reflects the capacity of a physiological system to adapt to stimuli. The objectives of present study were to: (1) determine whether noninvasive beat-to-beat ABP measurements also exhibit a complex temporal structure; (2) compare the complexity of noninvasive versus invasive ABP time series; and (3) quantify the relationship between the complexity of noninvasive ABP time series and the STS risk scores. METHODS: Fifteen adult patients undergoing coronary artery bypass graft, valve, or combined coronary artery bypass graft/valve surgery were enrolled in this observational study. Preoperative ABP waveforms were simultaneously recorded for ≥15 minutes using a radial artery catheter (invasive) and a continuous noninvasive arterial pressure monitor. Beat-to-beat systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) time series were extracted from the continuous waveforms. Complexity was assessed using the multiscale entropy method. The Wilcoxon signed-rank test was used to compare the mean ranks of indices derived from invasive versus noninvasive ABP time series. Spearman correlation coefficients were used to quantify the relationship between invasive and noninvasive indices. Linear regression analysis was used to quantify the association between each of the complexity indices and the STS risk scores. RESULTS: Beat-to-beat fluctuations in noninvasive ABP measurements were not random but complex; however, their degree of complexity was lower than that of fluctuations in invasively obtained ABP signals (SBP: 7.05 vs 8.66, P < .001; DBP: 7.40 vs 8.41, P < .001; PP: 6.83 vs 8.82, P < .001; and MAP: 7.17 vs 8.68, P < .005). Invasive and noninvasive indices for MSEΣ·slope showed good correlation (rs) (0.53 for SBP, 0.79 for DBP, 0.42 for PP, 0.60 for MAP). The complexity of noninvasive ABP time series (-0.70 [-1.28 to -0.11]; P = .023 for DBP), like that of invasive time series (-0.94 [-1.52 to -0.35]; P = .004 for DBP), was inversely associated with estimated surgical risk in patients undergoing cardiovascular operations. CONCLUSIONS: Our results support the use of noninvasive ABP monitoring in computations of complexity-based indices that correlate with estimated surgical risk.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pressão Sanguínea / Determinação da Pressão Arterial / Procedimentos Cirúrgicos Cardíacos Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pressão Sanguínea / Determinação da Pressão Arterial / Procedimentos Cirúrgicos Cardíacos Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article