IEEE J Biomed Health Inform - Prediction of Hemodynamic Response to Epinephrine via Model-Based System Identification.

Tópicos

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Resumo

In this study, we present a system identification approach to the mathematical modeling of hemodynamic responses to vasopressor-inotrope agents. We developed a hybrid model called the latency-dose-response-cardiovascular (LDC) model that incorporated (i) a low-order lumped latency model to reproduce the delay associated with the transport of vasopressor-inotrope agent and the onset of physiological effect, (ii) phenomenological dose-response models to dictate the steady-state inotropic, chronotropic and vasoactive responses as a function of vasopressor-inotrope dose, and (iii) a physiological cardiovascular model to translate the agent's actions into the ultimate response of blood pressure. We assessed the validity of the LDC model to fit vasopressor-inotrope dose-response data using data collected from five piglet subjects during variable epinephrine infusion rates. The results suggested that the LDC model was viable in modeling the subjects' dynamic responses: after tuning the model to each subject, the r2 values for measured versus model-predicted mean arterial pressure were consistently higher than 0.73. The results also suggested that inter-subject variability in the dose-response models, rather than the latency models, had significantly more impact on the model's predictive capability: fixing the latency model to population-averaged parameter values resulted in r2 values higher than 0.57 between measured versus model-predicted mean arterial pressure, while fixing the dose-response model to population-averaged parameter values yielded non-physiological predictions of mean arterial pressure. We conclude that the dose-response relationship must be individualized, whereas a population-averaged latency-model may be acceptable with minimal loss of model fidelity.

Resumo Limpo

studi present system identif approach mathemat model hemodynam respons vasopressorinotrop agent develop hybrid model call latencydoseresponsecardiovascular ldc model incorpor loword lump latenc model reproduc delay associ transport vasopressorinotrop agent onset physiolog effect ii phenomenolog doserespons model dictat steadyst inotrop chronotrop vasoact respons function vasopressorinotrop dose iii physiolog cardiovascular model translat agent action ultim respons blood pressur assess valid ldc model fit vasopressorinotrop doserespons data use data collect five piglet subject variabl epinephrin infus rate result suggest ldc model viabl model subject dynam respons tune model subject r valu measur versus modelpredict mean arteri pressur consist higher result also suggest intersubject variabl doserespons model rather latenc model signific impact model predict capabl fix latenc model populationaverag paramet valu result r valu higher measur versus modelpredict mean arteri pressur fix doserespons model populationaverag paramet valu yield nonphysiolog predict mean arteri pressur conclud doserespons relationship must individu wherea populationaverag latencymodel may accept minim loss model fidel

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