Group Title: Critical Care
Title: Compliance or failure and improvement or deterioration diagnosis of patients from performance diagrams
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 Material Information
Title: Compliance or failure and improvement or deterioration diagnosis of patients from performance diagrams
Series Title: Critical Care
Physical Description: Archival
Creator: Kunig,H. E.
Kunig,S. V.
Gallagher,T. J.
Stene,J. K.
Pinsky,M. R.
Publication Date: 2000
General Note: Start pageP12
General Note: M3: 10.1186/cc732
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Bibliographic ID: UF00100072
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: Open Access:
Resource Identifier: issn - 1364-8535


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ation of hemodynamic parameters between sepsis and
severe heart failure succeeds by means of CI, EF(P), PP*
and SBP*. (3) A remarkable deviation of performance

parameters from basal values signals a cardiocirculatory
deterioration, which should be analyzed by conventionally
measured hemodynamic parameters at present.

P12 Compliance or failure and improvement or deterioration diagnosis of patients from performance

HE Kunig, SV Kunig, L Engelmann*, U Pilz*, J Otto*, L Mende*, E Huettemannt, TJ Gallagher*, J Elledge-Nauman*,
JK Stenes, P Tassani#, U Jaenicke**, H Patricktt and MR Pinsky**
Dept. Bioengineering, University of Washington, Seattle, USA; *Dept. Int. Care Med. University of Leipzig; tDept. Crit. Care
Med., University of Jena; *Dept. Crit. Care Med., University of Florida, USA; Dept. Crit. Care Med., Pennsylvania State
University, USA; #German Heart Center, Munich; **Dept. Anesth., University of Munich, Germany; 1Dept. Crit. Care Med.,
Jefferson Med. College, Philadelphia, USA; *Dep. Crit. Care Med., University of Pittsburgh USA.

Introduction: Blood pressure and heart rate data dis-
played in a performance diagram (PD) may diagnose
accurately compliance or failure and improvement or dete-
rioration while traditional hemodynamics would indicate a
patient to be stable.

Materials and methods: A PD plots the parameters pres-
sure efficiency (EF[P]) versus time in an upper graph and
arterial pulse pressure (PP*), systolic pressure (SBP*),
and diastolic pressure (DBP*) versus time in a lower
graph. EF(P)=PP*/SBP* in analogy to the volume ejection
fraction EF(V)=SV/EDV, where SV=stroke volume and
EDV=end-diastolic volume. The asterisk (*) indicates con-
version of events per beat into events per time and stan-
dardization to body surface area (BSA), f. e.,
PP*=(PPxHR)/BSA, analogous to the conversion of SV to
cardiac index (CI), where CI=(SV*HR)/BSA. PDs suggest:
(1) compliance when all parameters equal or exceed
normal values (N), (2) failure without immediate danger of
death when normal values of EF(P),or SBP*, or DBP* are
not maintained, (3) failure with immediate danger of death
(critical illness), when normal PP* is not maintained, (4)

deterioration or improvement when the trend of two suc-
cessive measurements departs from, or points towards,
the normal values. Data from 213 patients were retrospec-
tively analyzed using standard statistical methods includ-
ing sensitivity and specificity determinations, binomial
scoring, and t-testing.

Results: Based on statistical analysis, PDs predicted
compliance and failure with a sensitivity of 94% and a
specificity of 84%. PDs also predicted improvement and
deterioration at P<0.01. As illustrated in the figures, tradi-
tional hemodynamics diagnoses a patient as stable as late
as 10 min before the occurrence of flash edema. The PD
diagnoses a failing and deteriorating patient as early as
2.5 h prior to occurrence of flash edema and diagnoses
the patient as critically ill 25 min prior to the occurrence of
the flash edema.

Discussion: This study suggests utility of PDs in accurately
diagnosing compliance or failure which would allow early
intervention and monitoring of the effects of intervention in
real time as compared to traditional hemodynamic evaluation.


Traditional Hemodynamics

30 1HR 30 2HR

0 DBPmmHg
A PPrmmrHg
30 IHR 30 2HR

Performance Diagram

S EF(P) %

0 30 1HR 30 2 HR 30
S SBP*mm Hg/(m2sec) DBP* mm Hg/(m sec)
F PP*mm Hg/(m2sec) flash edema

0 30 1 HR 30 2 HR 30

* HR1/mn

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