Abstract 16850: Machine Learning Based Estimation of Systolic and Diastolic Arterial Blood Pressure From the Electrocardiogram and Oxygen Saturation Waveforms

Introduction: Accurate, continuous blood pressure (BP) monitoring requires invasive equipment. We investigate the utility of a machine learning algorithm (ML) to estimate the systolic (sys) and diastolic (dia) BP from the electrocardiogram (ECG) and oxygen saturation (SpO2) signals. Methods: We identified over 2,000 hours (~9.2 M heart-beats), of 4 lead ECG, arterial BP, and SpO2 waveforms, from 82 random ICU patients, with various diagnoses. The ECG, BP and SpO2 waveforms were delineated using a wavelet-transform-based algorithm. Features extracted from the ECG and SpO2 signals were used as input to the ML model, while the sys/dia BP values of the corresponding BP signal (range: 0-250 mmHg), served as the gold standard. Using these features, we trained two independent Random Forest (RF) models to estimate the sys/dia BP values, and measured their performance over five-fold cross-validation. To identify the optimal window-length (# heart beats) in estimating sys/dia BP values, the entire process of extracting features and training/testing of RF models was performed for window-lengths of {1,5,6,7,8,9,10,11,12,13,14,15,20,30,50} heart-beats. Results: The root-mean-square error (RMSE) at each window-length is shown in the Figure. The lowest RMSE for both estimated sys/dia BP, 5.81±4.61 mmHg and 3.73±3.26 mmHg, respectively, was achieved at 14 heart-beats. The corresponding RMSE values using a one-beat length-window were 7.73±5.93 mmHg and 5.28±4.42 mmHg, respectively. This result indicates the ability to estimate the instantaneous BP values even on a beat-to-beat basis, with low-error. Conclusions: In comparison to prior studies, our novel ML model, to the best of our knowledge, has been trained over the largest amount of data. Our ML model can accurately estimate the sys/dia values of the arterial BP. Figure: RMSE values obtained while estimating the mean sys/dia BP, across different window-lengths.

A CLINICAL STUDY OF INTRATHECAL KETAMINE WITH ADRENALIN FOR LOWER ABDOMINAL SURGERIES

Background: This study was designed to evaluate the efficacy, onset and duration of sensory and motor blockade, occurrence of delirium reaction and other complications of Ketamine with Adrenaline given intrathecally. Methods: After informed and written consent, ASA Physical status I and II aged 18-60 years, of either sex randomly selected 100 Patients for elective lower abdominal surgeries were been enrolled after inclusion and exclusion criteria. Patients with severe systemic disease metabolic disorders, neurological, congenital or cardiovascular diseases were excluded from this study. Results: In the present study the maximum level achieved ranged from T6-T10. The time taken to achieve maximum sensory blockade ranged from 2-8 minutes. There were no significant changes in mean systolic and diastolic arterial blood pressure or pulse rate. Intra-operatively, nystagmus was seen in all patients. Sedation and delirium was seen in 72 patients and 2 patients respectively. Conclusion: We conclude that intra thecal ketamine with adrenaline produces a reliable anaesthesia, better operative conditions and patients comfort with minimal side effects in elective lower abdominal surgeries. Keywords: Anaesthesia, Ketamine, Adrenaline, Intrathecal.

FEATURES OF CENTRAL HEMODYNAMICS OF YOUNG ADULTS DEPENDING ON VARIATIONS OF ACTUAL HEART RATE

Indicators of systemic hemodynamics were evaluated. Those were blood pressure (BP), shock volume of the blood (SVB), peripheral vascular resistance (PVR), cardiac index (CI) and others. They were evaluated in 41 students. Their age was between 21 and 26 years. It was determined that the majority of central hemodynamics indicators importantly depend on the character of differences of actual frequency of heart rates and their meanings. The most important indicators of hemodynamics such as shock volume of the blood and heart index were lower and diastolic arterial blood pressure and peripheral vascular resistance were higher in people with heart rates higher than required normal heart rates. Important peculiarities of correlative interconnections between parameters of central hemodynemics depending on heart rates were revealed. The above peculiarities of hemodynemics depending on the character of differences of actual and normal heart rates confirm the importance of evaluation and understanding of such a simple parameter.

Evaluation of Metabolic Syndrome Risk Factors in Female Students

Many studies have shown that systolic and diastolic arterial blood pressure changes due tohigher weight in both school-age children and in adolescents. Abnormalities of thyroid functionmight be no less important factor in relation to metabolic syndrome. The objective of the studywas to determine the relationship of arterial blood pressure, glucose, adiponectin and thyroidfunction parameters to major risk factors of metabolic syndrome. The risk factors tested werebody mass index (BMI) and waist circumference in female students aged 18 to 25 years. Westudied 105 RSU Red Cross college students aged 18 to 25 years. We calculated their BMI, lungvital capacity (ml), thyroid changes by ultrasound (USG) (27 students) and ECG (79 students). Inaddition, we measured their waist and chest circumferences, and systolic and diastolic bloodpressure in both arms. We determined concentration of glucose, adiponectin, thyroid stimulatinghormone (TSH) and free thyroxine (FT4) in blood. Statistical analyses were performed using theSPSS 15.01 package software. There was a statistically significant positive correlation betweenthe arterial blood pressure, BMI and increase of the waist circumference in students (average age20.7 years). The average arterial blood pressure in students was normal. The age at the onset ofmenarche had a significant positive effect on diastolic arterial blood pressure (P = 0.009-0,017).An increase in blood glucose concentration was closely associated with BMI (P = 0.03) and waistcircumference (P = 0.045). However, adiponectin concentration was correlated with systolic (P =0.007-0.048) and diastolic (P = 0.002-0.003) blood pressure. Significant ECG changes werefound in 10% of the subjects, indicating cardiovascular changes in these young women. Thehigher the FT4 and TSH concentrations, the more frequently were observed changes in the ECGST-segment (P = 0.01-0,008). A significant relationship between diastolic blood pressure and theage at onset of menarche (P = 0.009-0.017) was found. Increased arterial blood pressure wasassociated with an increase in BMI, waist circumference and adiponectin concentration, while anincrease in blood glucose concentration was associated with increased BMI and waist circumference,but not with the adiponectin level. Changes in ECG and increased diastolic arterial bloodpressure in relation to menarche indicate a possible role of the endocrine system and genetic factorsin regulation of the main parameters of metabolic syndrome

Intensive Observation of Toxic Side Effects After Several-Year of Cyclosporin Treatment in Kidney Transplant Patient

In this work we are going to show results of intensive observation of adverse reactions of cyclosporine therapy during 18 months. The research was applied on 30 patients with kidney transplant. The medium time of kidney transplant survival was 9,7+/-2,3 years, with time span of 6 to 15 years. All the patients were subjects to several years' cyclosporine treatment, which was applied on a daily basis with a dosage of 2 to 5 mg/kg of body weight. The concentration of cyclosporine in blood was measured once a month. The concentration of cyclosporine in blood in 19 patients was in referent values of 122,50 nag/ml up to 280,50 nag/ml of blood. In 4 of the patients the concentration was heightened up to 370 to 538 nag/ml (X=766,37 nag/ml), and in 7 patients cyclosporine was below normal dosage down to 30,78 to 96,30 nag/ml in blood (x=77,12 nag/ml). We noticed these toxic side effects: increased values of systolic and diastolic arterial blood pressure in 5 patients, neurotoxic tremor effects in 4 patients, hyperplasia gingival and hirsute in 1 patient each.