Automated closed-loop resuscitation of multiple hemorrhages: a comparison between fuzzy logic and decision table controllers in a sheep model.
Automated closed-loop resuscitation of multiple hemorrhages: a comparison between fuzzy logic and decision table controllers in a sheep model.
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多次出血的自动闭环复苏：绵羊模型中模糊逻辑和决策表控制器的比较。
DOI：
10.1186/s40696-016-0029-0
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Kramer GC
中科院分区：
文献类型：
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作者：
Marques NR;Ford BJ;Khan MN;Kinsky M;Deyo DJ;Mileski WJ;Ying H;Kramer GC
出血性休克是军事环境中创伤相关死亡的主要原因。对战斗伤员的连续性外科治疗可能会被推迟，在战场上可能需要挽救生命的液体复苏。因此，改进的复苏策略对于长期的现场和途中护理至关重要。我们开发了一种自动闭环控制系统，能够滴定液体输注到目标终点。我们使用该系统来比较决策表算法（DT）和模糊逻辑控制器（FL）的性能，以挽救和维持平均动脉压（MAP）在目标水平在血管造影。模糊逻辑使控制算法能够模仿人类的专业知识。我们假设FL控制器将比DT算法更有效，更高效，响应更严格，结构化的方式。10只清醒的绵羊接受25 ml/kg的出血方案，分3次单独采血。在首次出血开始后30分钟开始使用乳酸林格氏液进行自动复苏。终点靶点为MAP。通过双尾t检验和α = 0.05评估组差异。在整个研究过程中，两组均将MAP维持在相似的水平。然而，DT组需要的液体显著多于FL组，分别为1745 ± 552 ml（42 ± 11 ml/kg）和978 ± 397 ml（26 ± 11 ml/kg）（p = 0.03）。FL控制器比DT算法更有效，并且可以提供减少流体负载的手段。两种策略的效果没有差异。自动闭环复苏可以恢复和维持多出血休克模型的血压。
Hemorrhagic shock is the leading cause of trauma-related death in the military setting. Definitive surgical treatment of a combat casualty can be delayed and life-saving fluid resuscitation might be necessary in the field. Therefore, improved resuscitation strategies are critically needed for prolonged field and en route care. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages. Fuzzy logic empowered the control algorithm to emulate human expertise. We hypothesized that the FL controller would be more effective and more efficient than the DT algorithm by responding in a more rigid, structured way. Ten conscious sheep were submitted to a hemorrhagic protocol of 25 ml/kg over three separate bleeds. Automated resuscitation with lactated Ringer’s was initiated 30 min after the first hemorrhage started. The endpoint target was MAP. Group differences were assessed by two-tailed t test and alpha of 0.05. Both groups maintained MAP at similar levels throughout the study. However, the DT group required significantly more fluid than the FL group, 1745 ± 552 ml (42 ± 11 ml/kg) versus 978 ± 397 ml (26 ± 11 ml/kg), respectively (p = 0.03). The FL controller was more efficient than the DT algorithm and may provide a means to reduce fluid loading. Effectiveness was not different between the two strategies. Automated closed-loop resuscitation can restore and maintain blood pressure in a multi-hemorrhage model of shock.