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Transcript of russell-icu.ppt
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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)
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January 18, 2008
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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)
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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)
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January 18, 2008
Human physiology v0.1
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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
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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
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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.]
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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.]
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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.]
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January 18, 2008
Real data are messy
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January 18, 2008
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January 18, 2008
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January 18, 2008
ALARM
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January 18, 2008
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January 18, 2008
Next Steps
Reduce ICU false alarms from >90% to <5%
Demonstrate clinically relevant inferences, e.g., Vascular stiffness Erroneous drug administration Pulmonary artery pressure (w/o catheter!)
Extend physiology model to all major systems
Multiscale: connect physiology to molecules