HEMODYNAMIC MONITOR PROVIDING ENHANCED CARDIAC OUTPUT MEASUREMENTS
A hemodynamic monitor implements an adaptive method that optimally estimates scaling and offset calibration parameters by using a computationally efficient, iterative online method to minimize the mean square error between a high bandwidth arterial pressure cardiac output (APCO) measurement generated by a first physiological sensor affixed to a patient and a relatively low bandwidth continuous cardiac output (CCO) measurement generated by a second physiological sensor also affixed to the patient. When calibration parameters are used to adjust an APCO measurement, the combined APCO/CCO estimate provided by the hemodynamic monitor has accuracy comparable to a CCO measurement, but also tracks cardiac output dynamical variations that are outside of the CCO algorithm bandwidth.
1 . A method of hemodynamic monitoring of a patient to provide enhanced time varying cardiac output measurements, the method comprising:
measuring concurrently peripheral arterial pressure of the patient with a peripheral artery sensor and central blood flow in the patient with a pulmonary artery catheter using thermodilution;
deriving an arterial pressure cardiac output (APCO) of the patient based upon the measured peripheral arterial pressure and an APCO algorithm;
deriving a thermodilution based cardiac output of the patient based upon the measured central blood flow and a thermodilution based cardiac output algorithm, wherein the APCO has a higher bandwidth and a lower accuracy than the thermodilution based cardiac output;
calibrating with a processor the APCO based upon the thermodilution based cardiac output to produce an enhanced time varying cardiac output having a bandwidth greater than the thermodilution based cardiac output and an accuracy greater than the APCO; and
displaying the enhanced time varying cardiac output on an electrical visual display.
2 . The method of claim 1 , and further comprising transmitting data characterizing the enhanced time varying cardiac output to a remote computing system.
3 . The method of claim 1 , and further comprising calculating, based on the peripheral arterial pressure, at least one hemodynamic parameter selected from a group consisting of: stroke volume, stroke volume variation, systemic vascular resistance (SVR), and continuous blood pressure.
4 . The method of claim 1 , wherein the calibrating is based on a time-varying linear scaling and an offset calculated using a least mean-square error solution.
5 . The method of claim 21 , and further comprising time averaging measurement values of the sensed peripheral arterial pressure over a time window length corresponding to a periodicity of measurements by the pulmonary artery catheter using thermodilution.
6 . The method of claim 5 , and further comprising weighting the time averaged measurement values based on a standard deviation of the time averaged measurement values from each of the peripheral arterial pressure sensor and the pulmonary artery catheter.
7 . The method of claim 6 , wherein weighting the time averaged measurement values comprises:
characterizing, as being good measurement values, those time averaged measurement values that do not exceed the pre-defined standard deviation value, and weighting those good measurement values accordingly; and
characterizing, as being bad measurement values, those time averaged measurement values that exceed the pre-defined standard deviation value, and weighting those bad measurement values accordingly.
8 . The method of claim 5 , and further comprising weighting the time averaged measurement values based on a forgetting factor.
9 . The method of claim 1 wherein the thermodilution based cardiac output is a continuous cardiac output (CCO) and the thermodilution based cardiac output algorithm is a CCO algorithm.
10 . The method of claim 1 wherein the thermodilution based cardiac output is an injectate cardiac output (ICO) and the thermodilution based cardiac output algorithm is an ICO algorithm.