University of Twente Student Theses
Managing Hemodynamic Instability in Critical Care : A Patient-Specific Approach
Tak, K. van der (2025) Managing Hemodynamic Instability in Critical Care : A Patient-Specific Approach.
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| Abstract: | Hemodynamic instability is a common, life-threatening condition in the ICU, caused by deficits in preload, afterload, and/or contractility. Timely and effective fluid resuscitation or vasopressor therapy is critical, though their indiscriminate use carries risks. This thesis proposes a patient-specific, physiology-informed approach to managing hemodynamic instability, focusing on clinical decision-making, arterial pressure waveform (APW) analysis, and computational modeling. Research was conducted within the framework of the PACIFIC study, a prospective, observational cohort study in a tertiary ICU. The first study examined physicians’ rationale and goals in initiating or escalating therapy, revealing inconsistency and that only 45% of treatment goals within 15 minutes were met. This highlights the need for structured, physiology-based guidance. The second study analyzed APW morphology before and after therapy. Variations, especially in dicrotic notch morphology, suggest that APW features could guide individualized hemodynamic management. The third study used a patient-specific Windkessel model to estimate peripheral resistance and blood volume from APW data. While group trends aligned with expected effects, individual variability exposed modeling limitations, yet supported the model's potential for patient-specific insight in hemodynamic instability. Overall, this work lays a foundation for personalized hemodynamic management and highlights the technical physician’s vital role in critical care. |
| Item Type: | Essay (Master) |
| Faculty: | TNW: Science and Technology |
| Subject: | 44 medicine, 50 technical science in general |
| Programme: | Technical Medicine MSc (60033) |
| Link to this item: | https://purl.utwente.nl/essays/106388 |
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