Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury
Abstract Background Volume expansion and vasopressors for the treatment of shock is an intensive process that requires frequent assessments and adjustments. Strict blood pressure goals in multiple physiologic states of shock (traumatic brain injury, sepsis, and hemorrhagic) have been associated with...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-07-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40635-022-00459-2 |
| _version_ | 1811219364947427328 |
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| author | Nathan T. P. Patel Eduardo J. Goenaga-Diaz Magan R. Lane M. Austin Johnson Lucas P. Neff Timothy K. Williams |
| author_facet | Nathan T. P. Patel Eduardo J. Goenaga-Diaz Magan R. Lane M. Austin Johnson Lucas P. Neff Timothy K. Williams |
| author_sort | Nathan T. P. Patel |
| collection | DOAJ |
| description | Abstract Background Volume expansion and vasopressors for the treatment of shock is an intensive process that requires frequent assessments and adjustments. Strict blood pressure goals in multiple physiologic states of shock (traumatic brain injury, sepsis, and hemorrhagic) have been associated with improved outcomes. The availability of continuous physiologic data is amenable to closed-loop automated critical care to improve goal-directed resuscitation. Methods Five adult swine were anesthetized and subjected to a controlled 30% estimated total blood volume hemorrhage followed by 30 min of complete supra-celiac aortic occlusion and then autotransfusion back to euvolemia with removal of aortic balloon. The animals underwent closed-loop critical care for 255 min after removal of the endovascular aortic balloon. The closed-loop critical care algorithm used proximal aortic pressure and central venous pressure as physiologic input data. The algorithm had the option to provide programmatic control of pumps for titration of vasopressors and weight-based crystalloid boluses (5 ml/kg) to maintain a mean arterial pressure between 60 and 70 mmHg. Results During the 255 min of critical care the animals experienced hypotension (< 60 mmHg) 15.3% (interquartile range: 8.6–16.9%), hypertension (> 70 mmHg) 7.7% (interquartile range: 6.7–9.4%), and normotension (60–70 mmHg) 76.9% (interquartile range: 76.5–81.2%) of the time. Excluding the first 60 min of the critical care phase the animals experienced hypotension 1.0% (interquartile range: 0.5–6.7%) of the time. Median intervention rate was 8.47 interventions per hour (interquartile range: 7.8–9.2 interventions per hour). The proportion of interventions was 61.5% (interquartile range: 61.1–66.7%) weight-based crystalloid boluses and 38.5% (interquartile range: 33.3–38.9%) titration of vasopressors. Conclusion This autonomous critical care platform uses critical care adjuncts in an ischemia–reperfusion injury model, utilizing goal-directed closed-loop critical care algorithm and device actuation. This description highlights the potential for this approach to deliver nuanced critical care in the ICU environment, thereby optimizing resuscitative efforts and expanding capabilities through cognitive offloading. Future efforts will focus on optimizing this platform through comparative studies of inputs, therapies, and comparison to manual critical care. |
| first_indexed | 2024-04-12T07:24:55Z |
| format | Article |
| id | doaj.art-60870850f685428ebfd69fd8f4783a54 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-12T07:24:55Z |
| publishDate | 2022-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-60870850f685428ebfd69fd8f4783a542022-12-22T03:42:13ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2022-07-0110111310.1186/s40635-022-00459-2Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injuryNathan T. P. Patel0Eduardo J. Goenaga-Diaz1Magan R. Lane2M. Austin Johnson3Lucas P. Neff4Timothy K. Williams5Department of Surgery, Wake Forest Baptist Medical CenterDivision of Cardiac Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of PhiladelphiaDepartment of Cardiothoracic Surgery, Wake Forest Baptist Medical CenterDivision of Emergency Medicine, University of UtahDepartment of Pediatric Surgery, Wake Forest Baptist Medical CenterDepartment of Vascular/Endovascular Surgery, Wake Forest Baptist Medical CenterAbstract Background Volume expansion and vasopressors for the treatment of shock is an intensive process that requires frequent assessments and adjustments. Strict blood pressure goals in multiple physiologic states of shock (traumatic brain injury, sepsis, and hemorrhagic) have been associated with improved outcomes. The availability of continuous physiologic data is amenable to closed-loop automated critical care to improve goal-directed resuscitation. Methods Five adult swine were anesthetized and subjected to a controlled 30% estimated total blood volume hemorrhage followed by 30 min of complete supra-celiac aortic occlusion and then autotransfusion back to euvolemia with removal of aortic balloon. The animals underwent closed-loop critical care for 255 min after removal of the endovascular aortic balloon. The closed-loop critical care algorithm used proximal aortic pressure and central venous pressure as physiologic input data. The algorithm had the option to provide programmatic control of pumps for titration of vasopressors and weight-based crystalloid boluses (5 ml/kg) to maintain a mean arterial pressure between 60 and 70 mmHg. Results During the 255 min of critical care the animals experienced hypotension (< 60 mmHg) 15.3% (interquartile range: 8.6–16.9%), hypertension (> 70 mmHg) 7.7% (interquartile range: 6.7–9.4%), and normotension (60–70 mmHg) 76.9% (interquartile range: 76.5–81.2%) of the time. Excluding the first 60 min of the critical care phase the animals experienced hypotension 1.0% (interquartile range: 0.5–6.7%) of the time. Median intervention rate was 8.47 interventions per hour (interquartile range: 7.8–9.2 interventions per hour). The proportion of interventions was 61.5% (interquartile range: 61.1–66.7%) weight-based crystalloid boluses and 38.5% (interquartile range: 33.3–38.9%) titration of vasopressors. Conclusion This autonomous critical care platform uses critical care adjuncts in an ischemia–reperfusion injury model, utilizing goal-directed closed-loop critical care algorithm and device actuation. This description highlights the potential for this approach to deliver nuanced critical care in the ICU environment, thereby optimizing resuscitative efforts and expanding capabilities through cognitive offloading. Future efforts will focus on optimizing this platform through comparative studies of inputs, therapies, and comparison to manual critical care.https://doi.org/10.1186/s40635-022-00459-2Closed-loopCritical careAutomatedIschemia reperfusionSwine |
| spellingShingle | Nathan T. P. Patel Eduardo J. Goenaga-Diaz Magan R. Lane M. Austin Johnson Lucas P. Neff Timothy K. Williams Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury Intensive Care Medicine Experimental Closed-loop Critical care Automated Ischemia reperfusion Swine |
| title | Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury |
| title_full | Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury |
| title_fullStr | Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury |
| title_full_unstemmed | Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury |
| title_short | Closed-loop automated critical care as proof-of-concept study for resuscitation in a swine model of ischemia–reperfusion injury |
| title_sort | closed loop automated critical care as proof of concept study for resuscitation in a swine model of ischemia reperfusion injury |
| topic | Closed-loop Critical care Automated Ischemia reperfusion Swine |
| url | https://doi.org/10.1186/s40635-022-00459-2 |
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