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Endogenous sympathetic surge and arterial vasoconstriction maintain systemic arterial pressure (MAP ≥ 65 mmHg) despite a catastrophic collapse in stroke volume and cardiac output. By the time systemic hypotension manifests, severe lactic acidosis, tissue hypoxia, and multi-organ failure may already irreversible.
Titrating vasopressors solely to achieve arbitrary pressure numbers adversely elevates left ventricular afterload, escalating myocardial oxygen demand and worsening ventriculo-arterial uncoupling. Clinicians lack continuous bedside insight to guide inotrope and vasopressor use, fluid responsiveness, or escalation to mechanical circulatory support.
In major surgery, hypotension is associated with organ dysfunction but the relationship is weak and highly variable between individuals. Occult hypoperfusion can occur with "acceptable" blood pressure in some cases. Conversely, empiric fluid boluses or vasopressors given for transient pressure drops cause venous congestion, tissue edema, hypoperfusion and directly drive postoperative Acute Kidney Injury (AKI) and myocardial injury.
KymoMetrics addresses the narrow focus on (mean) blood pressure by making physiology accessible: Firstly, by extracting physiological information hidden in routine arterial and venous pressure waveforms. Secondly, by transforming the physiological data into actionable insights in a closed decision loop. We tackle the relevant questions: Why is the blood pressure low? How to correct the blood pressure? Is the intervention working?
Extracting physiological information from continuous arterial and central venous pressure data already available at the bedside.
Arterial and central venous pressure data are transduced continuously, yet most of the data are unused, information simply compressed into crude numbers (e.g., MAP ≥ 65 mmHg, CVP = 13 mmHg).
Continuous arterial blood pressure is decomposed into Otto Frank's elastic reservoir pressure (Pres) and wave-propagation excess pressure (Pex). Resolves true systemic compliance (τ = RC), characteristic impedance, forward compression wave energy (W1), and wave reflection intensity (Pb/Pf) to decouple vascular tone from cardiac contractility.
Central venous pressure is far more than a static hydrostatic number. Interrogating right atrial cycle morphology (a, c, v peaks and x, y descents) and right atrial PV loops provides real-time assessment of dynamic venous return impedance, right ventricular compliance, and fluid responsiveness—avoiding the risks of pulmonary artery catheters.
Advanced data analytics to turn extracted physiological information into diagnostic understanding and informed bedside decisions during shock management and high-risk surgery.
