A tool predicting future mean arterial blood pressure values improves the titration of vasoactive drugs

Görges, Matthias; Westenskow, Dwayne R.; Kück, Kai; Orr, Joseph A.

doi:10.1007/s10877-010-9238-0

Cited by 10 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using the model, nurses reached the desired mean arterial pressure in significantly less time (4.1 vs 10.2 minutes without the system), made fewer adjustments to the infusion rate (4 vs 6), and avoided inducing hypotension. 21 However, simulated data were used in this study, so it is unclear if the results translate into real-world practice and limit the generalizability of the findings. In another study, physiologic responses (heart rate, mean arterial pressure, and systolic and diastolic blood pressure) were predicted after titrations of vasoactive infusions.…”

Section: Discussionmentioning

confidence: 99%

“…There is also limited research into the accuracy of predicting physiological responses to vasoactive agents other than nitroglycerin. Görges and colleagues 21 evaluated whether an advisory system that predicts mean arterial pressure 5 minutes in the future enhances a clinician's ability to titrate sodium-nitroprusside infusions. They used published models to simulate the response of 100 individual patients to infusions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predicting Blood Pressure After Nitroglycerin Infusion Dose Titration in Critical Care Units

Kamboj,

Metcalfe,

Chu

et al. 2023

CIN: Computers, Informatics, Nursing

View full text Add to dashboard Cite

Critical care nurses use physiological indicators, such as blood pressure, to guide their decision-making regarding the titration of nitroglycerin infusions. A retrospective study was conducted to determine the accuracy of systolic blood pressure predictions during nitroglycerin infusions. Data were extracted from the publicly accessible eICU program database. The accuracy of a linear model, least absolute shrinkage and selection operator, ridge regression, and a stacked ensemble model trained using the AutoGluon-Tabular framework were investigated. A persistence model, where the future value in a time series is predicted as equal to its preceding value, was used as the baseline comparison for model accuracy. Internal-external validation was used to examine if heterogeneity among hospitals could contribute to model performance. The sample consisted of 827 patients and 2541 nitroglycerin dose titrations with corresponding systolic blood pressure measurements. The root-mean-square error on the test set for the stacked ensemble model developed using the AutoGluon-Tabular framework was the lowest of all models at 15.3 mm Hg, equating to a 22% improvement against the baseline. Internal-external validation revealed consistent accuracy across hospitals. Further studies are needed to determine the impact of using systolic blood pressure predictions to inform nurses' clinical decision-making regarding nitroglycerin infusion titration in critical care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predicting Blood Pressure After Nitroglycerin Infusion Dose Titration in Critical Care Units

Kamboj,

Metcalfe,

Chu

et al. 2023

CIN: Computers, Informatics, Nursing

View full text Add to dashboard Cite

show abstract

“…Finally, the oscillation observed in the highly norepinephrine-responsive patients may result in part from the intrinsic time-delay of the system; in this set of simulations drip adjustments were delayed by 12 s of simulated time to represent lag in the infusion line, and an additional 5–10 s for the drug to be ‘circulated’ in the patient model and reach receptor sites. In clinical practice it is obviously impossible to remove these delays between rate changes and effect-site concentration changes, and they may well be longer than 17–22 s. While we have shown the controller is stable with longer delays (up to 60 s) [21], it may be possible to identify the specific delay and patient responsiveness during operation and adjust therapy accordingly [22].…”

Section: Discussionmentioning

confidence: 99%

“…Since the previous publication [21], the derived measure of ‘mean MAP over time’ in the data module has been replaced with ‘filtered MAP’. This measure is MAP run through an infinite-impulse response low-pass filter (IIRLPF) using the same methodology as Görges and colleagues in their report of an online system identification methodology [22]. Compared to mean MAP, the IIRLPF value remains robust to noise in the input data, but more rapidly trends change in MAP value compared to a straight time-averaged value.…”

Section: Methodsmentioning

confidence: 99%

Closed-loop vasopressor control: in-silico study of robustness against pharmacodynamic variability

Rinehart

Joosten

et al. 2018

J Clin Monit Comput

View full text Add to dashboard Cite

Initial feasibility of a novel closed-loop controller created by our group for closed-loop control of vasopressor infusions has been previously described. In clinical practice, vasopressor potency may be affected by a variety of factors including other pharmacologic agents, organ dysfunction, and vasoplegic states. The purpose of this study was therefore to evaluate the effectiveness of our controller in the face of large variations in drug potency, where ‘effective’ was defined as convergence on target pressure over time. We hypothesized that the controller would remain effective in the face up to a tenfold variability in drug response. To perform the robustness study, our physiologic simulator was used to create randomized simulated septic patients. 250 simulated patients were managed by the closed-loop in each of 7 norepinephrine responsiveness conditions: 0.1 ×, 0.2 ×, 0.5 ×, 1 ×, 2 ×, 5 ×, and 10 × expected population response to drug dose. Controller performance was evaluated for each level of norepinephrine response using Varvel’s criteria as well as time-out-of-target. Median performance error and median absolute performance error were less than 5% in all response levels. Wobble was below 3% and divergence remained negative (i.e. the controller tended to converge towards the target over time) in all norepinephrine response levels, but at the highest response level of 10 × the value approached zero, suggesting the controller may be approaching instability. Response levels of 0.1 × and 0.2 × exhibited significantly higher time-out-of-target in the lower ranges (p < 0.001) compared to the 1 × response level as the controller was slower to correct the initial hypotension. In this simulation study, the closed-loop vasopressor controller remained effective in simulated patients exhibiting 0.1 to 10 × the expected population drug response.

show abstract

“…A trend of predicted MAP, based on the vasoactive drug infusion rate, is shown to indicate therapy support of MAP. 20 However, the MAP component was not evaluated in this study.…”

Section: Methodsmentioning

confidence: 97%

A Far-View Intensive Care Unit Monitoring Display Enables Faster Triage

Görges

Kück

Koch

et al. 2011

Dimensions of Critical Care Nursing

Self Cite

View full text Add to dashboard Cite

Although nurses perform the majority of the clinical tasks in an intensive care unit, current patient monitors were not designed to support a nurse's workflow. Nurses constantly triage patients, deciding which patient is currently in the most need of care. To make this decision, nurses must observe the patient's vital signs and therapeutic device information from multiple sources. To obtain this information, they often have to enter the patient's room. This study addresses 3 hypotheses. Information provided by far-view monitoring displays (1) reduces the amount of time to determine which patient needs care first, (2) increases the accuracy of assigning priority to the right patient, and (3) reduces nurses mental workload. We developed 2 far-view displays to be read from a distance of 3 to 5 m without entering the patient's room. Both display vital signs, trends, alarms, infusion pump status, and therapy support indicators. To evaluate the displays, nurses were asked to use the displays to decide which of 2 patients required their attention first. They made 60 decisions: 20 with each far-view display and 20 decisions with a standard patient monitor next to an infusion pump. Sixteen nurses (median age of 27.5 years with 2.75 years of experience) participated in the study. Using the 2 far-view displays, nurses more accurately and rapidly identified stable patients and syringe pumps that were nearly empty. Median decision times were 11.3 and 12.4 seconds for the 2 far-view displays and 17.2 seconds for the control display. The 2 far-view displays reduced median decision-making times by 4.8 to 5.9 seconds, increased accuracy in assignment of priority in 2 of 7 patient conditions, and reduced nurses' frustration with the triaging task. In a clinical setting, the proposed far-view display might reduce nurses' mental workload and thereby increase patient safety.

show abstract

A tool predicting future mean arterial blood pressure values improves the titration of vasoactive drugs

Abstract: Patient-specific drug sensitivity identifi- cation significantly improved the prediction of future MAP. By predicting and displaying the expected MAP 5 min in the future, the advisory system helped nurses titrate faster, reduced their perceived workload and might improve patient safety.

Cited by 10 publications

References 30 publications

Predicting Blood Pressure After Nitroglycerin Infusion Dose Titration in Critical Care Units

Predicting Blood Pressure After Nitroglycerin Infusion Dose Titration in Critical Care Units

Closed-loop vasopressor control: in-silico study of robustness against pharmacodynamic variability

A Far-View Intensive Care Unit Monitoring Display Enables Faster Triage

Contact Info

Product

Resources

About