Computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in endotoxin-induced shock.
Computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in endotoxin-induced shock.
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DOI：
10.1186/s12871-017-0437-9
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发表时间：
2017-10-23
影响因子：
2.2
通讯作者：
Sugimachi M
中科院分区：
文献类型：
--
作者：
Uemura K;Kawada T;Zheng C;Li M;Sugimachi M
感染性休克的血流动力学复苏需要积极的液体补充和血管升压剂的适当使用，以优化动脉压(AP)和心输出量(CO)。由于对这些药物的反应在患者之间和患者内部随着时间的推移而有所不同，因此需要严格监测患者的病情并反复调整药物剂量。这项任务既耗时又费力，而且与对复苏指南的遵守不力有关。为了克服这一问题，我们开发了一种用于感染性休克自动血流动力学复苏的计算机控制的闭环药物输注系统，并在内毒素休克犬模型中评估了该系统的性能。我们的系统监测AP、CO和中心静脉压，并计算动脉阻力(R)、应力性血容量(V)和左心室Frank-Starling斜率(S)。该系统用去甲肾上腺素(NA)控制R，用林格氏醋酸盐溶液(RIA)控制V，从而控制AP和CO。对4只犬进行了AP和CO的侵入性测量。在另外4只狗中，使用临床可接受的方法对AP和CO进行较小的侵入性测量，旨在使该系统在临床上可行。8只犬均注射大肠杆菌脂多糖致内毒素休克，AP由95(91-108)降至43(39-45)mm Hg，CO由112(104-142)降至62(51-73)ml·min-−·kg-−-1。在4小时的时间内观察了系统的性能。我们的系统立即开始注入NA和RIA。在40分钟内，RIA使V升至目标水平，NA使R维持在目标水平，而S同时升高。结果AP恢复到70(69-71)mm Hg，CO恢复到130(12 5-138)ml·min−·kg−1。绝对操作误差的中位数在AP[2.5(2.1-4.5)%]和CO[2.4(1.4-5.5)%]较小，即使在测量变量较少的情况下也不增加。在内毒素休克犬模型中，我们的系统自动改进并将AP和CO维持在它们的目标值，并且性能误差很小。我们的系统可能是一种有吸引力的临床工具，用于抢救感染性休克患者。本文的在线版本(10.1186/s12871-0170437-9)包含补充材料，可供授权用户使用。
Hemodynamic 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. Our 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. Our 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. In 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. The online version of this article (10.1186/s12871-017-0437-9) contains supplementary material, which is available to authorized users.
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幸存的败血症运动：严重败血症和化粪池冲击管理的国际指南，2012年。
影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
33.6
作者：
GUYTON, AC
通讯作者：
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