Fourth-Order Blood Pressure Waves

Carroll, Gilbert C.

doi:10.1001/jama.1990.03440060102040

Cited by 12 publications

(10 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fourth-order blood pressure waves with regular periodicities of minutes to hours have been reported in critically ill patients by us and by others [2,3,4] ( Figure 1). Third-order blood pressure waves with periods of 10 to 160 seconds are associated with various pathological states, including variations in carotid artery pressure, decreased atmospheric pressure, hypoxia, hemorrhage, cold, endotoxin shock, increased intracranial pressure, Cheyne-Stokes respirations, and critical illness in a surgical patient.…”

supporting

confidence: 54%

“…[2] This finding has since been confirmed by others. [3,4] In the present report, hemodynamic data for critically ill surgical patients was continuously collected and visualized on a computer workstation to search for patterns not noted by standard monitoring. With this system, we observed low-frequency periodic oscillations in the cardiac output of ten patients, with regular periodicities of 4 to 280 minutes (average = 34 minutes).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Regular low frequency cardiac output oscillations observed in critically ill surgical patients

1997

View full text Add to dashboard Cite

A serendipitous finding during development of an automated “electronic flow chart” system to gather data on ICU patients [1] was the observation of low frequency oscillations in blood pressure that were not explained by systematic variability in the environment. [2] This finding has since been confirmed by others. [3,4] In the present report, hemodynamic data for critically ill surgical patients was continuously collected and visualized on a computer workstation to search for patterns not noted by standard monitoring. With this system, we observed low‐frequency periodic oscillations in the cardiac output of ten patients, with regular periodicities of 4 to 280 minutes (average = 34 minutes). The mortality rate in these patients was 40%, while the mortality was only 10.8% in 83 similarly monitored intensive care unit (ICU) patients who did not develop regular oscillations in cardiac output. Interestingly, these oscillatory patterns appear to be associated with inadequate resuscitation of increased metabolic rates. The mathematical definition of “chaos” refers to irregular behavior that appears to be random but is actually deterministic. [5] A surprising finding concerning transitions between states of apparent randomness and order in nonlinear systems is that many systems become more organized after being disturbed. Chaotic behavior in biological systems may represent a normal physiologic state, while the loss of chaotic behavior may herald a pathophysiologic state. [6] The mechanism of the regular low frequency oscillations in cardiac output remains to be determined, but the high mortality rate suggests that it is a pathophysiologic marker, perhaps due to inadequate oxygen delivery in under‐resuscitated shock. © 1997 John Wiley & Sons, Inc.

show abstract

supporting

confidence: 54%

mentioning

confidence: 99%

Regular low frequency cardiac output oscillations observed in critically ill surgical patients

1997

View full text Add to dashboard Cite

show abstract

“…For example, third-order blood pressure waves in patients with increased intracranial pressure have been attributed to a negative-feedback system that is unmasked during ischemia of respiratory and cardiac control nuclei in the brain stem. Fourth-order blood pressure waves with regular periodicities of minutes to hours have been reported in critically ill patients by us and by others [2,3,4] ( Figure 1). As is shown in the illustration, these regular low-period oscillations can often be eliminated by measures which improve oxygen delivery, such as a fluid bolus or the addition of an inotropic medication (causing an increase in the contractility of the heart).…”

supporting

confidence: 54%

Regular low frequency cardiac output oscillations observed in critically ill surgical patients

Seiver¹,

Daane²,

Kim³

1997

Complexity

View full text Add to dashboard Cite

A serendipitous finding during development of an automated "electronic flow chart" system to gather data on ICU patients [1] was the observation of low frequency oscillations in blood pressure that were not explained by systematic variability in the environment. [2] This finding has since been confirmed by others. [3,4] In the present report, hemodynamic data for critically ill surgical patients was continuously collected and visualized on a computer workstation to search for patterns not noted by standard monitoring. With this system, we observed low-frequency periodic oscillations in the cardiac output of ten patients, with regular periodicities of 4 to 280 minutes (average = 34 minutes). The mortality rate in these patients was 40%, while the mortality was only 10.8% in 83 similarly monitored intensive care unit (ICU) patients who did not develop regular oscillations in cardiac output. Interestingly, these oscillatory patterns appear to be associated with inadequate resuscitation of increased metabolic rates.The mathematical definition of "chaos" refers to irregular behavior that appears to be random but is actually deterministic.[5] A surprising finding concerning transitions between states of apparent randomness and order in nonlinear systems is that many systems become more organized after being disturbed. Chaotic behavior in biological systems may represent a normal physiologic state, while the loss of chaotic behavior may herald a pathophysiologic state. [6] The mechanism of the regular low frequency oscillations in cardiac output remains to be determined, but the high mortality rate suggests that it is a pathophysiologic marker, perhaps due to inadequate oxygen delivery in under-resuscitated shock. © 1997 John Wiley & Sons, Inc.

show abstract

“…Ultra-low frequency oscillations (0.00056-0.000093 Hz; periodicities of 30-180 min) in HR, MAP, SvO 2 , PA pressures, and electroencephalogram lasting 12 to 24 h have been documented in critically ill adult survivors with sepsis, tetanus, and status epilepticus, all of whom were mechanically ventilated (15)(16)(17). Commonalities between our case series and these reports include ultra low-frequency periodic oscillations in physiological variables, long duration, and disease states or therapy suspected to alter autonomic tone.…”

Section: Discussionmentioning

confidence: 99%

“…The physiological correlates for very low and ultra-low frequencies, however, remain unknown. Ultra-low frequency periodic oscillations have been observed in time series tracings of heart rate, blood pressure, mixed-venous oxygen saturation, pulmonary artery pressures, and electroencephalogram in critically ill adults, lasting 12 to 24 h (15)(16)(17). Examination of the characteristics of very low and ultra-low frequency oscillations in physiologic signals may contribute to our understanding of loss of complexity during critical illness.…”

Section: Introductionmentioning

confidence: 99%

Report of a Case Series of Ultra Low-Frequency Oscillations in Cardiac Output in Critically Ill Adults with Sepsis, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome

Seiver

Szaflarski²

2003

Shock

View full text Add to dashboard Cite

Healthy physiological systems exhibit irregular variability whereas diseased systems display decreased signal variability or greater regularity. The objective of this article is to report a case series of critically ill adults who displayed ultra low-frequency periodic sinusoidal oscillations in cardiac output (ULF-CO) that were discovered during a clinical study testing software for continuous physiological monitoring. Data were collected from 13 critically ill surgical and trauma patients who required continuous cardiac output monitoring. Physiologic data were collected from clinical monitors. The computerized time series of cases displaying CO oscillations were manually reviewed. Ten patients with sepsis or the systemic inflammatory response syndrome exhibited 18 episodes of ultra low-frequency periodic oscillations (ULF-CO) with frequencies ranging from 0.0028 to 0.000053 Hz (periods, 6 to 316 min). Intensive care unit mortality rate was 50%. The amplitude and coefficient of variation of cardiac output during ULF-CO ranged from 0.1-4.6 L and 3.9-14.3%, respectively. Duration of ULF-CO ranged from 4-108.1 h. ULF-CO could not be explained as a result of patterned artifact from measurement error or therapeutic intervention. ULF-CO may be a pathophysiologic marker that might serve the diagnosis, prognosis, and treatment of critical illness.

show abstract

Fourth-Order Blood Pressure Waves

Cited by 12 publications

References 3 publications

Regular low frequency cardiac output oscillations observed in critically ill surgical patients

Regular low frequency cardiac output oscillations observed in critically ill surgical patients

Regular low frequency cardiac output oscillations observed in critically ill surgical patients

Report of a Case Series of Ultra Low-Frequency Oscillations in Cardiac Output in Critically Ill Adults with Sepsis, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome

Contact Info

Product

Resources

About