Pulse Morphology Visualization and Analysis With Applications in Cardiovascular Pressure Signals

We present a new analysis and visualization method for studying the functional relationship between the pulse morphology of pressure signals and time or signal metrics such as heart rate, pulse pressure, and means of pressure signals, such as arterial blood pressure and central venous pressure. The pulse morphology is known to contain potentially useful clinical information, but it is difficult to study in the time domain without the aid of a tool such as the method we present here. The primary components of the method are established signal processing techniques, nonparametric regression, and an automatic beat detection algorithm. Some of the insights that can be gained from this are demonstrated through the analysis of intracranial pressure signals acquired from patients with traumatic brain injuries. The analysis indicates the point of transition from low-pressure morphology consisting of three distinct peaks to a high-pressure morphology consisting of a single peak. In addition, we demonstrate how the analysis can reveal distinctions in the relationship between morphology and several signal metrics for different patients.

[1]  R. Panerai Assessment of cerebral pressure autoregulation in humans - a review of measurement methods , 1998, Physiological measurement.

[2]  B. Matta,et al.  Intracranial hypertension: what additional information can be derived from ICP waveform after head injury? , 2004, Acta Neurochirurgica.

[3]  J. Pickard,et al.  Significance of intracranial pressure waveform analysis after head injury , 2005, Acta Neurochirurgica.

[4]  John C. Chaney,et al.  Minimally invasive hemodynamic monitoring for the intensivist: Current and emerging technology , 2002, Critical care medicine.

[5]  P Hemyari,et al.  Brain injuries among infants, children, adolescents, and young adults. , 1990, American journal of diseases of children.

[6]  J. Cohn,et al.  Age-related abnormalities in arterial compliance identified by pressure pulse contour analysis: aging and arterial compliance. , 1999, Hypertension.

[7]  H. Portnoy,et al.  Systems analysis of intracranial pressure. Comparison with volume-pressure test and CSF-pulse amplitude analysis. , 1980, Journal of neurosurgery.

[8]  K. H. Wesseling,et al.  Editorial II Continuous cardiac output by pulse contour analysis , 2001 .

[9]  T. Luerssen Intracranial pressure: current status in monitoring and management. , 1997, Seminars in pediatric neurology.

[10]  J. Cohn,et al.  Noninvasive pulse wave analysis for the early detection of vascular disease. , 1995, Hypertension.

[11]  J P Blanks,et al.  CSF pulsatility in hydrocephalus: respiratory effect on pulse wave slope as an indicator of intracranial compliance. , 1990, Neurological research.

[12]  M. Aboy,et al.  Methodological considerations in the evaluation of the duration of action of antihypertensive therapy using ambulatory blood pressure monitoring. , 2005, Blood pressure monitoring.

[13]  J G Pipe,et al.  Pulse waveform analysis of arterial compliance: relation to other techniques, age, and metabolic variables. , 2000, American journal of hypertension.

[14]  D. Wyper,et al.  Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. , 1979, Journal of neurology, neurosurgery, and psychiatry.

[15]  D. John Doyle,et al.  Analysis of intracranial pressure , 2005, Journal of Clinical Monitoring.

[16]  M. Aboy,et al.  A novel algorithm to estimate the pulse pressure variation index /spl Delta/PP , 2004, IEEE Transactions on Biomedical Engineering.

[17]  Reinhard Friedl,et al.  Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability , 2002, Critical care medicine.

[18]  P. Kochanek,et al.  Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. , 2003, Critical care medicine.

[19]  J. Pickard,et al.  Monitoring and interpretation of intracranial pressure , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[20]  K. Wesseling,et al.  Continuous cardiac output by pulse contour analysis? , 2001, British journal of anaesthesia.

[21]  N. Linton,et al.  Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. , 2001, British journal of anaesthesia.

[22]  T S Richmond,et al.  Intracranial pressure monitoring. , 1993, AACN clinical issues in critical care nursing.

[23]  A. Liebold,et al.  Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients. , 1999, British journal of anaesthesia.

[24]  R. Grossman,et al.  Intracranial pressure waveform indices in transient and refractory intracranial hypertension , 1995, Journal of Neuroscience Methods.

[25]  M Woolner Monitoring intracranial pressure. , 1984, Nursing research.

[26]  G. McVeigh,et al.  Evaluation of mechanical arterial properties: clinical, experimental and therapeutic aspects. , 2002, Clinical science.

[27]  H. Reichenspurner,et al.  Less invasive, continuous hemodynamic monitoring during minimally invasive coronary surgery. , 1999, The Annals of thoracic surgery.

[28]  T. Ellis,et al.  Residual Pulse Morphology Visualization and Analysis in Pressure Signals , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[29]  H. Portnoy,et al.  Cerebrospinal fluid pulse wave form analysis during hypercapnia and hypoxia. , 1981, Neurosurgery.

[30]  N. Lundberg,et al.  Continuous recording and control of ventricular fluid pressure in neurosurgical practice. , 1962, Acta psychiatrica Scandinavica. Supplementum.

[31]  James McNames,et al.  An effective color scale for simultaneous color and gray-scale publications , 2006, IEEE Signal Process. Mag..

[32]  A. K. Prasad,et al.  Intracranial pressure waveform analysis: computation of pressure transmission and waveform shape indicators. , 1998, Neurological research.

[33]  Miller,et al.  Systems analysis of cerebrovascular pressure transmission: an observational study in head-injured patients. , 1990, Journal of neurosurgery.

[34]  N. T. Smith,et al.  A computer module for the continuous monitoring of cardiac output in the operating theatre and the ICU. , 1976, Acta anaesthesiologica Belgica.

[35]  H. Portnoy,et al.  Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation. , 1982, Journal of neurosurgery.