Closed-loop resuscitation of burn shock
Closed-loop resuscitation of burn shock
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DOI：
10.1097/01.bcr.0000216512.30415.78
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发表时间：
2006-05-01
影响因子：
1.4
通讯作者：
Kramer, GC
中科院分区：
文献类型：
--
作者：
Hoskins, SL;Elgjo, GI;Kramer, GC
对烧伤休克的液体疗法进行调整，以建立尿量的目标水平。然而，调节输液速率的方法并没有定义。我们的目的是比较自动计算机控制的复苏与手动控制的烧伤复苏的性能。在氟烷麻醉下，对40% TBSA全层烧伤的绵羊进行复苏，通过闭环复苏（n = 10）或手动每小时调整输注速率（n = 11），在48小时内恢复并维持正常的绵羊尿量在1至2 ml/kg /小时的目标范围内。自动闭环复苏系统基于比例-积分-导数算法，根据连续监测和尿量变化调整输液速率。48小时内的平均尿量在目标范围内，闭环组的平均尿量为每小时1.9 +/- 0.5 ml/kg，技术组的平均尿量为每小时2.0 +/- 0.7 ml/kg。平均输注速率和输注量也相似。与对照组相比，闭环组尿量和输注速率的小时变化明显降低。技师组每小时测量目标达到41%，而闭环组为48% （P = .23）。技师组每小时尿量低于目标25%，而闭环组为16% （P = 0.02）。与人工每小时调整一次相比，烧伤后输注速率的自动闭环控制产生的尿量在目标范围内变化较小，低于目标值。闭环复苏可能比目前的复苏方案提供改进。
Fluid therapy for burn shock is adjusted to establish a target level of urinary output. However, the means for adjusting infusion rate are not defined. Our objective was to compare the performance of automated computer-controlled resuscitation with manual control for burn resuscitation. Sheep with a 40% TBSA full-thickness burn, administered under halothane anesthesia, were resuscitated to restore and maintain normal sheep urinary outputs in a target range of 1 to 2 ml/kg per hour over the course of 48 hours using closed-loop resuscitation (n = 10) or manual hourly adjustment of infusion rate (n = 11). The automated closed-loop resuscitation system is based on a proportional-integral-derivative algorithm, which adjusted infusion rate based on continuous monitoring and changes in urinary output. Mean urinary outputs over the course of 48 hours were in target range and were virtually identical at 1.9 +/- 0.5 ml/kg per hour for the closed-loop group and 2.0 +/- 0.7 ml/kg per hour for the technician group. Mean infusion rates and infused volumes also were similar. The closed-loop group exhibited significantly lower hourly variation for both urinary output and infusion rate compared hourly control. Hourly targets were achieved in 41% of the measurements in technician group compared with 48% for the closed-loop group (P = .23). Hourly urinary output in the technician group was undertarget by 25% as opposed to 16% with the closed-loop group (P = .02). Automated closed-loop control of infusion rates after burn injury produced urinary outputs in target ranges with less variation and less under target values than manual hourly adjustments. Closed-loop resuscitation may provide an improvement over current resuscitation regimens.