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Arterial waveform morphomics during hemorrhagic shock

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The arterial pressure waveform is a composite of multiple interactions, and there may be more sensitive and specific features associated with hemorrhagic shock and intravascular volume depletion than systolic and/or diastolic blood pressure (BP) alone. The aim of this study was to characterize the arterial pressure waveform in differing grades of hemorrhage.

Methods

Ten anesthetized swine (70–90 kg) underwent a 40% controlled exponential hemorrhage. High-fidelity arterial waveform data were collected (500 Hz) and signal-processing techniques were used to extract key features. Regression modeling was used to assess the trend over time. Short-time Fourier transform (STFT) was utilized to assess waveform frequency and power spectrum density variance.

Results

All animals tolerated instrumentation and hemorrhage. The primary antegrade wave (P1) was relatively preserved while the renal (P2) and iliac (P3) reflection waves became noticeably attenuated during progressive hemorrhage. Several features mirrored changes in systolic and diastolic BP and plateaued at approximately 20% hemorrhage, and were best fit with non-linear sigmoidal regression modeling. The P1:P3 ratio continued to change during progressive hemorrhage (R2 = 0.51). Analysis of the first three harmonics during progressive hemorrhage via STFT demonstrated increasing variance with high coefficients of determination using linear regression in frequency (R2 = 0.70, 0.93, and 0.76, respectively) and power spectrum density (R2 = 0.90, 0.90, and 0.59, respectively).

Conclusions

In this swine model of volume-controlled hemorrhage, hypotension was a predominating early feature. While most waveform features mirrored those of BP, specific features such as the variance may be able to distinguish differing magnitudes of hemorrhage despite little change in conventional measures.

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Acknowledgements

This study was funded in part by a Grant from the Department of Defense; Grant No. W81XWH-16-1-0116.

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Authors and Affiliations

  1. R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Philip J. Wasicek, William A. Teeter, Shiming Yang, Peter Hu, William B. Gamble, Melanie R. Hoehn, Thomas M. Scalea & Jonathan J. Morrison

  2. Shock Trauma and Anesthesiology Research Center, University of Maryland, School of Medicine, Baltimore, MD, USA

    Shiming Yang, Peter Hu & Samuel M. Galvagno

Authors
  1. Philip J. Wasicek
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  2. William A. Teeter
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  3. Shiming Yang
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  9. Jonathan J. Morrison
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Corresponding author

Correspondence to Jonathan J. Morrison.

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Conflict of interest

Philip J. Wasicek declares that he has no conflict of interest. William A. Teeter declares that he has no conflict of interest. Shiming Yang declares that he has no conflict of interest. Peter Hu declares that he has no conflict of interest. William B. Gamble declares that he has no conflict of interest. Samuel M. Galvagno declares that he has no conflict of interest. Melanie R. Hoehn declares that he has no conflict of interest. Thomas M. Scalea declares that he has no conflict of interest. Jonathan J. Morrison declares that he has no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All the procedures performed in the current study that involved animals were in accordance with the ethical standards of the institution (University of Maryland) at which the current study was conducted.

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Wasicek, P.J., Teeter, W.A., Yang, S. et al. Arterial waveform morphomics during hemorrhagic shock. Eur J Trauma Emerg Surg 47, 325–332 (2021). https://doi.org/10.1007/s00068-019-01140-2

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  • DOI: https://doi.org/10.1007/s00068-019-01140-2

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