Evaluation of ventricular-vascular coupling with critical care metrics: An in silico approach

Mean arterial pressure and cardiac output provide insufficient guidance for the management of intraoperative hypotension (IOH). In silico models offer additional insights into acute changes in hemodynamic parameters that may be encountered during IOH. A computational model (CM) generated parameters quantifying ventricular-vascular coupling, and pressure-volume construct across levels of aortic compliance (C_A ). We studied how a loss from normal-to-stiff C_A impacts critical care metrics of hemodynamics during vascular occlusion. Pulse pressure (PP), end-systolic pressure (P_es ), arterial compliance (Art-ca), arterial elastance (Art-ea), and dynamic arterial elastance (Eadyn), along mechanical efficiency (ME) were measured at five levels of C_A . A loss in C_A impacted all variables. During steady-state conditions, PP, P_es , and stroke work increased significantly as C_A decreased. Art-ca decreased and Art-ea increased similarly; Eadyn increased and ME decreased. During a decrease in preload across all C_A levels, arterial dynamics measures remained linear. The CM demonstrated that a loss in C_A impacts measures of arterial dynamics during steady-state and transient conditions and the model demonstrates that critical care metrics are sensitive to changes in C_A . While Art-ca and Art-ea were sensitive to changes in preload, Eadyn did not change.