Hemodynamic monitoring remains the cornerstone of therapy for the perioperative high-risk surgical and critically ill patients. Multiple monitors that measure cardiac output and stroke volume are currently available on the market; these monitors can be broadly classified as: invasive, minimally invasive, and non-invasive. Ultrasonography may provide a non- invasive, cost-effective tool for monitoring volume status, and thus cardiac output assessment, to the critical care armamentarium. This thesis describes a clinical study, data analysis and physiological modelling activity carried on together with the Patient & Care Measurement department at Philips Research (Eindhoven, Netherlands). The main objective in this clinical evaluation was to study the possible correlation between hemodynamic parameters obtained from ultrasound imaging and intra-arterial blood pressure during open-heart surgery without invasive devices. The absence of invasive devices for the analysis of the hemodynamic monitoring and the recording during cardiac surgery are the two factors that mainly differ from previous studies in which the carotid US imaging was analysed. Nine mechanically ventilated adult patients (3 females and 6 males, age 66 ±13) scheduled for cardiac surgery, in the hospital of Eindhoven (Catharina Ziekenhuis) were recruited to participate in this study. The correlation analysis between flow estimated from US at the carotid with the CO and SV estimated from the arterial line calibrated with the all 3D TEE as reference showed no correlation with R2 equal to zero and not statistically significance (p-value > 0.05). The reasons for this lack of correlation could be related to many aspects: possible operator dependent errors using US hand-held probes, hemodynamic instability due to anaesthesia and surgery operation, mechanism of cerebral autoregulation and the demographic characteristics of each patient in particular the one regarding the body composition which is represented by the Body Mass Index (BMI). Despite this, we could say that this lack of correlation is also an important result, as it allows to highlight the possible limiting factors of the analysis and to propose possible corrections for future steps.
Il monitoraggio emodinamico rimane il fondamento sui cui si basa la terapia per i pazienti di interventi ad alto rischio e per pazienti in gravi condizioni. I dispostivi in grado di misurare la gittata cardiaca attualmente disponibili sul mercato sono molteplici e possono essere classificati come: invasivi, minimamente invasivi e non invasivi. L'ecografia può fornire uno strumento non invasivo ed economico per misurare lo stato del volume del paziente, permettendo quindi la valutazione della gittata cardiaca. Questa tesi descrive uno studio clinico, un'analisi dei dati e attività di modellizzazione fisiologica condotte insieme al Patient & Care Measurement department in Philips Research (Eindhoven, Paesi Bassi). L'obiettivo principale di questa valutazione clinica era studiare la possibile correlazione tra i parametri emodinamici ottenuti dall'ecografia e la pressione arteriosa intra-arteriosa durante chirurgia a cuore aperto senza l’utilizzodi dispositivi invasivi. L'assenza di dispositivi invasivi per l'analisi del monitoraggio emodinamico e la registrazione dei dati durante l’operazione chirurgica sono i due fattori che differiscono principalmente dai precedenti studi in cui è stata analizzata l'imaging carotideo. Nove pazienti adulti ventilati meccanicamente (3 femmine e 6 maschi, 66 ± 13 anni) in programma per un intervento cardiaco, nell'ospedale di Eindhoven (Catharina Ziekenhuis) sono stati reclutati per partecipare a questo studio. L'analisi di correlazione tra flusso stimato tramita ecocardiografica in corrispondenza della carotide e i valori di gittata cardiaca stimata dai valori ottenuti dalla linea arteriosa e successivamente calibrati utilizzando come riferimento i valori ottenuti con l’analisi delle immagini 3D Ecocardiografiche transesofagee, non hanno mostrato alcuna correlazione con R2 uguale a zero e non statisticamente significativa (p value> 0,05). Le ragioni di questa mancanza di correlazione potrebbero essere legate a molti aspetti: possibili errori dipendenti dall'operatore che utilizzano sonde portatili, instabilità emodinamica dovuta all’ anestesia e intervento chirurgico, meccanismo di autoregolazione cerebrale e caratteristiche demografiche di ciascun paziente, in particolare quello relativo a la composizione corporea che è rappresentata dall'indice di massa corporea (BMI). Nonostante questo, si piò affermare che questa mancanza di correlazione è anche un risultato importante, in quanto consente di evidenziare i possibili fattori limitanti dell'analisi e di proporre possibili correzioni per i passi futuri.
Exploring the correlation between hemodynamic parameters obtained from ultrasound imaging and intra-arterial blood pressure during cardiac surgery
MANETTI, CLAUDIA ALESSANDRA
2018/2019
Abstract
Hemodynamic monitoring remains the cornerstone of therapy for the perioperative high-risk surgical and critically ill patients. Multiple monitors that measure cardiac output and stroke volume are currently available on the market; these monitors can be broadly classified as: invasive, minimally invasive, and non-invasive. Ultrasonography may provide a non- invasive, cost-effective tool for monitoring volume status, and thus cardiac output assessment, to the critical care armamentarium. This thesis describes a clinical study, data analysis and physiological modelling activity carried on together with the Patient & Care Measurement department at Philips Research (Eindhoven, Netherlands). The main objective in this clinical evaluation was to study the possible correlation between hemodynamic parameters obtained from ultrasound imaging and intra-arterial blood pressure during open-heart surgery without invasive devices. The absence of invasive devices for the analysis of the hemodynamic monitoring and the recording during cardiac surgery are the two factors that mainly differ from previous studies in which the carotid US imaging was analysed. Nine mechanically ventilated adult patients (3 females and 6 males, age 66 ±13) scheduled for cardiac surgery, in the hospital of Eindhoven (Catharina Ziekenhuis) were recruited to participate in this study. The correlation analysis between flow estimated from US at the carotid with the CO and SV estimated from the arterial line calibrated with the all 3D TEE as reference showed no correlation with R2 equal to zero and not statistically significance (p-value > 0.05). The reasons for this lack of correlation could be related to many aspects: possible operator dependent errors using US hand-held probes, hemodynamic instability due to anaesthesia and surgery operation, mechanism of cerebral autoregulation and the demographic characteristics of each patient in particular the one regarding the body composition which is represented by the Body Mass Index (BMI). Despite this, we could say that this lack of correlation is also an important result, as it allows to highlight the possible limiting factors of the analysis and to propose possible corrections for future steps.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/164857