Identifying physiological measurements for medical monitoring: implications for autonomous health care in austere environments.
In a patient who has lost a significant amount of blood, avoiding cardiovascular collapse and impending circulatory shock depends on the ability to maintain adequate arterial blood pressure in the presence of significant central hypovolemia. Our analysis of hemodynamic, autonomic, and metabolic data obtained from healthy human subjects exposed to progressive reduction in central blood volume and supported by data from trauma patients provide evidence to support the following conclusions: 1. Because of autonomically-mediated compensatory mechanisms, standard vital signs can remain unchanged or change too late, when cardiovascular collapse is imminent. 2. Currently proposed closed-loop resuscitation and oxygen delivery systems controlled by arterial blood pressure and SpO2 may prove inadequate for early intervention decision-support. 3. Continuous capture of PP, ECG R-wave amplitude, indices of HRV, cardiac BRS, and/or muscle PO2 could improve the sensitivity of closed-loop resuscitation and oxygen delivery by providing earlier indications of clinical status.
Convertino
Victor A
VA
U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
Ryan
Kathy L
KL
D001341:Autonomic Nervous System / Q000503:physiopathology; D001794:Blood Pressure; D015924:Blood Pressure Monitors; D003661:Decision Support Techniques; D004562:Electrocardiography; D004867:Equipment Design; D005440:Fluid Therapy; D006339:Heart Rate; D006801:Humans; D020896:Hypovolemia / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D008887:Military Medicine; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D009132:Muscles / Q000503:physiopathology; D010092:Oximetry; D010100:Oxygen / Q000097:blood / Q000627:therapeutic use; D010101:Oxygen Consumption; D011674:Pulse; D019114:Remote Consultation; D012121:Respiration, Artificial; D012151:Resuscitation; D013026:Space Flight; D013318:Stroke Volume; D014481:United States; D018557:United States National Aeronautics and Space Administration; D014947:Wounds and Injuries / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy
D010100:Oxygen