PROJECT SUMMARY In the perioperative environment, precise understanding and monitoring of intravascular volume status is important. In pediatric patients, changes in vital signs (blood pressure and heart rate) often do not occur until significant blood loss and end-organ damage have ensued. Hemorrhage during surgery represents a major cause of pediatric perioperative morbidity, and early and adequate resuscitation improves survival. Unfortunately, clinical signs and current monitoring strategies are inconsistent in providing accurate, real-time assessment of volume status in pediatric patients. This proposal will develop the use of a unique physiologic signal, Non- Invasive Venous waveform Analysis (NIVA), for monitoring intravascular volume status for both hemorrhage and volume overload. Proof of concept data in humans and experimental animal models demonstrate that NIVA provides a reliable indication of intravascular volume status, supporting the premise of this proposal. This proposal will use an experimental piglet model of controlled hemorrhage, resuscitation, and volume overload to validate and refine the algorithm for waveform analysis. Additionally, the proposal will evaluate the application of the NIVA algorithm for pediatric patients undergoing complex cranial vault reconstruction to assess its ability to detect volume changes in the perioperative setting These studies will be used to mitigate risks associated with the use of NIVA and will lead to a better understanding of venous waveform analysis (for precise management of intravascular volume) and of venous hemodynamics (a largely under-studied part of the cardiovascular system) in the pediatric population.

NARRATIVE Non-invasive methods to determine intravascular volume status represents a large unmet need in the pediatric population. This project will develop the use of a novel physiologic signal, the venous waveform, to monitor volume changes in pediatric patients undergoing complex cranial vault surgery. This proposal will develop Non-Invasive venous Waveform Analysis (NIVA) as a new and innovative approach for use in pediatric patients to maintain optimal volume status during complex surgery (goal-directed fluid therapy), which has a high likelihood of ultimately decreasing hospital costs and reducing morbidity and mortality in pediatric patients undergoing complex surgery.