Closed-Loop Fluid Administration Compared to Anesthesiologist Management for Hemodynamic Optimization and Resuscitation During Surgery: An In Vivo Study
Closed-Loop Fluid Administration Compared to Anesthesiologist Management for Hemodynamic Optimization and Resuscitation During Surgery: An In Vivo Study
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DOI：
10.1213/ane.0b013e3182937d61
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发表时间：
2013-11-01
影响因子：
5.7
通讯作者：
Cannesson, Maxime
中科院分区：
文献类型：
--
作者：
Rinehart, Joseph;Lee, Christine;Cannesson, Maxime
背景：闭环系统被设计用来帮助医生在临床环境中维持各种生理变量的稳定性。在此背景下，我们最近对一种新型闭环流体管理系统进行了计算机测试，该系统旨在监测和优化心输出量和脉压变化。本研究的目的是评估这种新开发的系统在优化体内手术环境中血流动力学变量的有效性。方法：16头约克郡猪接受了两期出血方案，并由学习静脉复苏器闭环系统或麻醉师进行复苏。比较两组间血流动力学中位值及血流动力学变化。结果：与麻醉医师组相比，闭环组的心脏指数（每分钟每平方米升）和脑卒中容量指数（每平方米毫升）更高（3.7 [3.4-4.1]vs 3.5 [3.2-3.9]； 95% Wald置信区间为-0.5至-0.23;P < 0.0005和40 [34-45]vs 36 [31-38]； 95% Wald置信区间为-5.9至-3.1；P分别< 0.0005）。闭环组和麻醉师组的总给液量差异无统计学意义（3685 [3230-4418]vs 3253 [2735-3926] mL； 95%可信区间为-1651 ~ 431；P = 0.28）。闭环组动物在治疗过程中心脏指数和脑卒中容量指数的方差系数也较低（11% [10%-16%]vs 22%[18%-23%]，置信区间为0.8%-12.3%,P = 0.02, 11% [8%-16%] vs 17%[13%-21%]，置信区间为0.2%-11.4%,P = 0.04）。结论：在以往模拟工作的基础上进行的体内研究表明，本实验中使用的闭环流体管理系统可以在轻度和重度出血期间进行液体复苏，并能够在降低血流动力学变异性的同时保持高心输出量和卒中量。
BACKGROUND: Closed-loop systems have been designed to assist practitioners in maintaining stability of various physiologic variables in the clinical setting. In this context, we recently performed in silico testing of a novel closed-loop fluid management system that is designed for cardiac output and pulse pressure variation monitoring and optimization. The goal of the present study was to assess the effectiveness of this newly developed system in optimizing hemodynamic variables in an in vivo surgical setting.METHODS: Sixteen Yorkshire pigs underwent a 2-phase hemorrhage protocol and were resuscitated by either the Learning Intravenous Resuscitator closed-loop system or an anesthesiologist. Median hemodynamic values and variation of hemodynamics were compared between groups.RESULTS: Cardiac index (in liters per minute per square meter) and stroke volume index (in milliliters per square meter) were higher in the closed-loop group compared with the anesthesiologist group over the protocol (3.7 [3.4-4.1] vs 3.5 [3.2-3.9]; 95% Wald confidence interval, -0.5 to -0.23; P < 0.0005 and 40 [34-45] vs 36 [31-38]; 95% Wald confidence interval, -5.9 to -3.1; P < 0.0005, respectively). There was no significant difference in total fluid administration between the closed-loop and anesthesiologist groups (3685 [3230-4418] vs 3253 [2735-3926] mL; 95% confidence interval, -1651 to 431; P = 0.28). Closed-loop group animals also had lower coefficients of variance of cardiac index and stroke volume index during the protocol (11% [10%-16%] vs 22% [18%-23%]; confidence interval, 0.8%-12.3%; P = 0.02 and 11% [8%-16%] vs 17% [13%-21%]; confidence interval, 0.2%-11.4%; P = 0.04, respectively).CONCLUSION: This in vivo study building on previous simulation work demonstrates that the closed-loop fluid management system used in this experiment can perform fluid resuscitation during mild and severe hemorrhages and is able to maintain high cardiac output and stroke volume while reducing hemodynamic variability.