Model-based cardiovascular monitoring of acute pulmonary embolism in porcine trials

Introduction: Diagnosis and treatment of cardiac and circulatory dysfunction can be error-prone and relies heavily on clinical intuition and experience. Model-based approaches utilising measurements available in the Intensive care unit (ICU) can provide a clearer physiological picture of a patient’s cardiovascular status to assist medical staff with diagnosis and therapy decisions. This research tests a subject-specific cardiovascular system (CVS) modelling technique on measurements from a porcine model of acute pulmonary embolism (APE). Methods: Measurements were recorded in 5 pig trials, where autologous blood clots were inserted every two hours into the jugular vein to simulate pulmonary emboli. Of these measurements only a minimal set of clinically available or inferable data were used in the identification process (aortic and pulmonary artery pressure, stroke volume, heart rate, global end diastolic volume, and mitral and tricuspid valve closure times). The CVS model was fitted to 46 sets of data taken at 30 minute intervals (t=0, 30, 60, …, 270) during the induction of APE to identify physiological model parameters and their change over time in APE. Model parameters and outputs were compared to experimentally derived metrics and measurements not used in the identification method to validate the accuracy of the model and assess its diagnostic capability. Results: Modelled mean ventricular volumes and maximum ventricular pressures matched measured values with median absolute errors of 4.3% and 4.4%, which are less than experimental measurement noise (~10%). An increase in pulmonary vascular resistance, the main hemodynamic consequence of APE, was identified in all the pigs and related well to experimental values (R=0.68). Detrimental changes in reflex responses, such as decreased right ventricular contractility, were noticed in two pigs that died during the trial, diagnosing the loss of autonomous control. Increases in the ratio of the modelled right to left ventricular end diastolic volumes, signifying the leftward shift of the intra-ventricular septum seen in APE, compared well to the clinically measured index (R=0.88). Conclusions: Subject-specific CVS models can accurately and continuously diagnose and track acute disease dependent cardiovascular changes resulting from APE using readily available measurements. Human trials are underway to clinically validate these animal trial results

Generalisability of a virtual trials method for glycaemic control in intensive care

Elevated blood glucose (BG) concentrations (Hyperglycaemia) are a common complication in critically ill patients. Insulin therapy is commonly used to treat hyperglycaemia, but metabolic variability often results in poor BG control and low BG (hypoglycaemia).This paper presents a model-based virtual trial method for glycaemic control protocol design, and evaluates its generalisability across different populations.Model-based insulin sensitivity (SI) was used to create virtual patients from clinical data from three different ICUs in New Zealand, Hungary, and Belgium. Glycaemic results from simulation of virtual patients under their original protocol (self-simulation) and protocols from other units (cross-simulation) were compared.Differences were found between the three cohorts in median SI and inter-patient variability in SI. However, hour-to-hour intra-patient variability in SI was found to be consistent between cohorts. Self and cross-simulation results were found to have overall similarity and consistency, though results may differ in the first 24-48 hours due to different cohort starting BG and underlying SI.Virtual patients and the virtual trial method were found to be generalisable across different ICUs. This virtual trial method is useful for in silico protocol design and testing, given an understanding of the underlying assumptions and limitations of this method

Comparison of Covid-19 patient management and outcome in a tertiary care center during the first and second waves of the pandemic

Conclusion: In our hospital, the main therapeutic changes between W1 and W2 were use of steroids for hypoxemic patients and HFNO, while fewer patients received MV fort shorter durations and 4.7% of W2 patients were transferred to other hospitals in case of overcrowding. These changes were associated with a decrease in 30-day mortality, ICU admission and organ support, suggesting a better selection of patients requiring ICU, alleviating local overcrowding and likely improving quality of care and long-term recovery for survivors