A Signal Processing Approach for Detection of Hemodynamic Instability before Decompensation

PLoS One. 2016 Feb 12;11(2):e0148544. doi: 10.1371/journal.pone.0148544. eCollection 2016.

Abstract

Advanced hemodynamic monitoring is a critical component of treatment in clinical situations where aggressive yet guided hemodynamic interventions are required in order to stabilize the patient and optimize outcomes. While there are many tools at a physician's disposal to monitor patients in a hospital setting, the reality is that none of these tools allow hi-fidelity assessment or continuous monitoring towards early detection of hemodynamic instability. We present an advanced automated analytical system which would act as a continuous monitoring and early warning mechanism that can indicate pending decompensation before traditional metrics can identify any clinical abnormality. This system computes novel features or bio-markers from both heart rate variability (HRV) as well as the morphology of the electrocardiogram (ECG). To compare their effectiveness, these features are compared with the standard HRV based bio-markers which are commonly used for hemodynamic assessment. This study utilized a unique database containing ECG waveforms from healthy volunteer subjects who underwent simulated hypovolemia under controlled experimental settings. A support vector machine was utilized to develop a model which predicts the stability or instability of the subjects. Results showed that the proposed novel set of features outperforms the traditional HRV features in predicting hemodynamic instability.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Biomarkers / analysis
  • Blood Pressure
  • Early Diagnosis
  • Electrocardiography / statistics & numerical data
  • Healthy Volunteers
  • Heart Failure / diagnosis*
  • Heart Failure / physiopathology
  • Heart Rate
  • Hemodynamics*
  • Humans
  • Hypovolemia / diagnosis*
  • Hypovolemia / physiopathology
  • Monitoring, Physiologic / instrumentation
  • Monitoring, Physiologic / methods*
  • Patient-Specific Modeling / statistics & numerical data*
  • Support Vector Machine

Substances

  • Biomarkers

Grants and funding

Initial work of this project was funded by: U.S. Army Medical Research and Material Command Combat Casualty Care Research Program, Grant: 05-0033-02: KN KW. The authors had no role in the design of experimental setup and data collection for the LBNP study. The LBNP study was designed and data was collected by USASR which partially funded the project in the early stages.