Computational Physiology for Critical Care Monitoring
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Transcript of Computational Physiology for Critical Care Monitoring
January 18, 2008
Computational Physiology for Critical Care Monitoring
Stuart Russell, UC BerkeleyStuart Russell, UC BerkeleyJoint work with Joint work with Geoff ManleyGeoff Manley, Mitch Cohen, Kristan Staudenmayer, Diane , Mitch Cohen, Kristan Staudenmayer, Diane Morabito (UCSF), Norm Aleks, Nimar Arora, Shaunak Chatterjee (UCB)Morabito (UCSF), Norm Aleks, Nimar Arora, Shaunak Chatterjee (UCB)
January 18, 2008
Critical care $300B/yr in US, high morbidity/mortality
Goal: improve outcomes, reduce length of stay, do science
Approach: Large-scale data repository for worldwide research use
Currently 60GB, 16 ICU beds monitored 24/7, soon multi-institutional First release any day now ….
Data mining for outcome prediction, early warning, etc. Real-time model-based estimation of patient state (And systems physiology model-building)
January 18, 2008
Critical care state estimation Given
~140 initial presentation fields ~40 real-time sensor streams ~1500 asynchronous measures (blood, drugs, etc.)
Compute posterior probability distribution for ~100 (patho)physiological state variables
Method Patient-adaptive dynamic Bayesian network (DBN): stochastic models of physiology and sensor dynamics (c.f. Guyton et al., 1972, 354-variable nonlinear ODE)
Flexible across time scales, models, sensors (images, text, etc.) Can incorporate genetic factors (observed or unobserved)
January 18, 2008
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Brain
Neurotransmitters
Heart
Blood flow
Vasculature
January 18, 2008
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Brain
Neurotransmitters
Heart
Blood flow
Vasculature
January 18, 2008
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Blood [volume]
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Intracranial physiology
Tissues-NOS [perfusion]
GI/Liver [perfusion]
Blood [transu-dation]
Setpoint inputs from ANS, CNS,
intracranial, blood
Pulm. [intra-
thoracic press.]
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Blood [volume]
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Intracranial physiology
Tissues-NOS [perfusion]
GI/Liver [perfusion]
Blood [transu-dation]
Setpoint inputs from ANS, CNS,
intracranial, blood
Pulm. [intra-
thoracic press.]
January 18, 2008
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Blood [volume]
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Intracranial physiology
Tissues-NOS [perfusion]
MAP sensor model
GI/Liver [perfusion]
Heart rate sensor model
Central venous
pressure sensor model
Blood [transu-dation]
Setpoint inputs from ANS, CNS,
intracranial, blood
Pulm. [intra-
thoracic press.]
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Blood [volume]
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Intracranial physiology
Tissues-NOS [perfusion]
MAP sensor model
GI/Liver [perfusion]
Heart rate sensor model
Central venous
pressure sensor model
Blood [transu-dation]
Setpoint inputs from ANS, CNS,
intracranial, blood
Pulm. [intra-
thoracic press.]
January 18, 2008
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Blood [volume]
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Intracranial physiology
Tissues-NOS [perfusion]
MAP sensor model
GI/Liver [perfusion]
Heart rate sensor model
Central venous
pressure sensor model
PK [conc. of phenyl-
ephrine]
Blood [transu-dation]
Setpoint inputs from ANS, CNS,
intracranial, blood
Pulm. [intra-
thoracic press.]
Medullary cardiovascular center
Cardiac parasympathetic output
Cardiac sympathetic output
Card. M2 Card. β1 Card. β2 Vasc. α1 Vasc. α2 Vasc. β2
Heart rate
Cardiac contrac-
tility
Venous tone
Blood [volume]
Arterio-lar tone
Cardiac preload
Capillary pressure
Cardiac stroke
volume
Cardiac output
Vascular resistance
Mean arterial blood
pressure
Barorecep-tor
discharge
Intracranial physiology
Tissues-NOS [perfusion]
MAP sensor model
GI/Liver [perfusion]
Heart rate sensor model
Central venous
pressure sensor model
PK [conc. of phenyl-
ephrine]
Blood [transu-dation]
Setpoint inputs from ANS, CNS,
intracranial, blood
Pulm. [intra-
thoracic press.]