J Clin Monit Comput - Reliable real-time calculation of heart-rate complexity in critically ill patients using multiple noisy waveform sources.

Tópicos

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Resumo

Heart-rate complexity (HRC) has been proposed as a new vital sign for critical care medicine. The purpose of this research was to develop a reliable method for determining HRC continuously in real time in critically ill patients using multiple waveform channels that also compensates for noisy and unreliable data. Using simultaneously acquired electrocardiogram (Leads I, II, V) and arterial blood pressure waveforms sampled at 360 Hz from 250 patients (over 375 h of patient data), we evaluated a new data fusion framework for computing HRC in real time. The framework employs two algorithms as well as signal quality indices. HRC was calculated (via the method of sample entropy), and equivalence tests were then performed. Bland-Altman plots and box plots of differences between mean HRC values were also obtained. Finally, HRC differences were analyzed by paired t tests. The gold standard for obtaining true means was manual verification of R waves and subsequent entropy calculations. Equivalence tests between mean HRC values derived from manually verified sequences and those derived from automatically detected peaks showed that the "Fusion" values were the least statistically different from the gold standard. Furthermore, the fusion of waveform sources produced better error density distributions than those derived from individual waveforms. The data fusion framework was shown to provide in real-time a reliable continuously streamed HRC value, derived from multiple waveforms in the presence of noise and artifacts. This approach will be validated and tested for assessment of HRC in critically ill patients.

Resumo Limpo

heartrat complex hrc propos new vital sign critic care medicin purpos research develop reliabl method determin hrc continu real time critic ill patient use multipl waveform channel also compens noisi unreli data use simultan acquir electrocardiogram lead ii v arteri blood pressur waveform sampl hz patient h patient data evalu new data fusion framework comput hrc real time framework employ two algorithm well signal qualiti indic hrc calcul via method sampl entropi equival test perform blandaltman plot box plot differ mean hrc valu also obtain final hrc differ analyz pair t test gold standard obtain true mean manual verif r wave subsequ entropi calcul equival test mean hrc valu deriv manual verifi sequenc deriv automat detect peak show fusion valu least statist differ gold standard furthermor fusion waveform sourc produc better error densiti distribut deriv individu waveform data fusion framework shown provid realtim reliabl continu stream hrc valu deriv multipl waveform presenc nois artifact approach will valid test assess hrc critic ill patient

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