Computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in endotoxin-induced shock

BMC Anesthesiology

Technical Advance

Kazunori Uemura¹  Masaru Sugimachi¹  Toru Kawada¹  Meihua Li¹  Can Zheng¹ 

[1] Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, 565-8565, Suita, Japan;

关键词: Septic shock;    Hemodynamics;    Resuscitation;    Computer;    Closed-loop control;   

DOI  :  10.1186/s12871-017-0437-9

 received in 2017-04-03, accepted in 2017-10-16,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundHemodynamic resuscitation in septic shock requires aggressive fluid replacement and appropriate use of vasopressors to optimize arterial pressure (AP) and cardiac output (CO). Because responses to these drugs vary between patients and within patient over time, strict monitoring of patient condition and repetitive adjustment of drug dose are required. This task is time and labor consuming, and is associated with poor adherence to resuscitation guidelines. To overcome this issue, we developed a computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock, and evaluated the performance of the system in a canine model of endotoxin shock.MethodsOur system monitors AP, CO and central venous pressure, and computes arterial resistance (R), stressed blood volume (V) and Frank-Starling slope of left ventricle (S). The system controls R with noradrenaline (NA), and V with Ringer’s acetate solution (RiA), thereby controlling AP and CO. In 4 dogs, AP and CO were measured invasively. In another 4 dogs, AP and CO were measured less invasively using clinically acceptable modalities, aiming to make the system clinically feasible. In all 8 dogs, endotoxin shock was induced by injecting Escherichia coli lipopolysaccharide, which significantly decreased AP from 95 (91–108) to 43 (39–45) mmHg, and CO from 112 (104–142) to 62 (51–73) ml·min−1·kg−1. The system was then connected to the dogs, and activated. System performance was observed over a period of 4 h.ResultsOur system immediately started infusions of NA and RiA. Within 40 min, RiA increased V to target level, and NA maintained R at target level, while S was concomitantly increased. These resulted in restoration of AP to 70 (69–71) mmHg and CO to 130 (125–138) ml·min−1·kg−1. Median of absolute performance error, an index of precision of control, was small in AP [2.5 (2.1–4.5) %] and CO [2.4 (1.4–5.5) %], which were not increased even when the variables were measured less invasively.ConclusionsIn a canine model of endotoxin shock, our system automatically improved and maintained AP and CO at their target values with small performance error. Our system is potentially an attractive clinical tool for rescuing patients with septic shock.

【 授权许可】

CC BY   
© The Author(s). 2017