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Precision critical care management of blood pressure in stroke patients using dynamic linear models

Liu, Yuzhe (2018) Precision critical care management of blood pressure in stroke patients using dynamic linear models. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

For stroke patients in the ICU, optimal blood pressure management remains an open area of research. Numerous observational studies and clinical trials on both ischemic and hemorrhagic stroke have resulted in conflicting evidence for the benefit of lowering blood pressure. A major limitation of these studies is their inability to account for and distinguish the effects of physician-initiated blood pressure treatment versus a patient's spontaneous blood pressure time course. We address this problem with the Acute Intervention Model of Blood Pressure (AIM-BP) framework: an individualized, human interpretable model of blood pressure management in the acute care setting. The framework consists of two components: one, a model of blood pressure homeostasis and the various effects that perturb it; and two, a parameter estimator that can learn clinically important model parameters on a patient by patient basis. By estimating the parameters of the AIM-BP model for a given patient, the effectiveness of antihypertensive medication can be quantified separately from the patient's spontaneous blood pressure trends. We hypothesize that the AIM-BP is a sufficient framework for estimating parameters of a homeostasis perturbation model of a stroke patient's blood pressure time course and the AIM-BP parameter estimator can do so more accurately and consistently than a state-of-the-art maximum likelihood estimation method. The first part of this hypothesis is proved mathematically, while the second is demonstrated using simulated clinical scenarios modeled on stroke patients from two ICU datasets. Finally, the ability of the AIM-BP framework to model real world patients is demonstrated using several examples from a UPMC dataset.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Liu, Yuzhey.liu@pitt.eduyul1020000-0003-2102-4848
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairGopalakrishnan, Vanathivanathi@pitt.edu
Committee MemberChou, Sherry H.Y.chouh@upmc.edu
Committee MemberLandsittel, Douglas P.dlp12@pitt.edu
Committee MemberVisweswaran, Shyamshv3@pitt.edu
Date: 28 August 2018
Date Type: Publication
Defense Date: 17 August 2018
Approval Date: 28 August 2018
Submission Date: 20 August 2018
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 142
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Biomedical Informatics
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: AIM-BP,stroke,dynamic linear model,blood pressure management
Related URLs:
Date Deposited: 28 Aug 2018 17:15
Last Modified: 28 Aug 2018 17:15
URI: http://d-scholarship.pitt.edu/id/eprint/35232

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