Closed-Loop Systems in Anesthesia: Is There a Potential for Closed-Loop Fluid Management and Hemodynamic Optimization?
Closed-Loop Systems in Anesthesia: Is There a Potential for Closed-Loop Fluid Management and Hemodynamic Optimization?
复制标题
DOI：
10.1213/ane.0b013e318230e9e0
复制
发表时间：
2012-01-01
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;Liu, Ngai;Cannesson, Maxime
闭环（自动化）控制器在现代生活的各个方面都有应用，从空调到航天。尽管这些系统实际上是普遍存在的，但由于生理系统的复杂性以及难以从患者获得可靠和有效的反馈数据，它们很少用于麻醉学。尽管存在这些挑战，闭环系统正在越来越多地被研究和改进用于医疗用途。最近的两项发展使液体管理成为闭环控制的候选者。首先，流体反应性的动态预测器的进一步描述和开发提供了用作控制变量以指导流体施用的强参数。其次，心输出量和其他血流动力学变量的无创监测的快速发展使得目标导向治疗适用于各种临床护理环境中的广泛患者。在这篇文章中，我们回顾了闭环控制器在临床护理中的历史，讨论了目前的理解和流体反应性的动态预测的局限性，并研究如何将这些变量纳入一个闭环流体管理系统。（Anesth Analg 2012; 114：130 - 43）
Closed-loop (automated) controllers are encountered in all aspects of modern life in applications ranging from air-conditioning to spaceflight. Although these systems are virtually ubiquitous, they are infrequently used in anesthesiology because of the complexity of physiologic systems and the difficulty in obtaining reliable and valid feedback data from the patient. Despite these challenges, closed-loop systems are being increasingly studied and improved for medical use. Two recent developments have made fluid administration a candidate for closed-loop control. First, the further description and development of dynamic predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be incorporated into a closed-loop fluid administration system. (Anesth Analg 2012; 114:130-43)