Closed-loop control of fluid therapy for treatment of hypovolemia
Closed-loop control of fluid therapy for treatment of hypovolemia
复制标题
DOI：
10.1097/ta.0b013e31816bf517
复制
发表时间：
2008-04-01
影响因子：
--
通讯作者：
Mitchell, Charles E.
中科院分区：
文献类型：
--
作者：
Kramer, George C.;Kinsky, Michael P.;Mitchell, Charles E.
正在开发闭环算法和复苏系统，以控制低血容量早期复苏期间的IV输注速率。尽管有几个不同的生理变量被建议作为指导液体治疗的终点，但血压仍然是失血性休克和容量负荷治疗反应的初始评估中最常用的变量。闭环算法使用控制器功能来改变与血压相反的输注速率。在清醒绵羊中的研究表明：（1）目标血压的小幅降低可导致容量需求的显著降低;（2）非线性算法可降低复苏期间内出血增加的风险;（3）发现基于比例积分、模糊逻辑或非线性决策表的算法控制功能同样可以恢复和维持血压。与非线性决策表相比，比例积分和模糊逻辑算法降低了平均流体体积要求;（4）针对不同流体的具体损伤机理和体积膨胀特性，构建了几种算法。闭环系统正在从动物研究转化为患者研究。未来的智能复苏系统将受益于新的无创血压监测技术和计算机控制的高流量静脉泵的发展。
Closed-loop algorithms and resuscitation systems are being developed to control IV infusion rate during early resuscitation of hypovolemia. Although several different physiologic variables have been suggested as an endpoint to guide fluid therapy, blood pressure remains the most used variable for the initial assessment of hemorrhagic shock and the treatment response to volume loading. Closed-loop algorithms use a controller function to alter infusion rate inversely to blood pressure. Studies in hemorrhaged conscious sheep suggest that: (1) a small reduction in target blood pressure can result in a significant reduction in volume requirement; (2) nonlinear algorithms may reduce the risk of increased internal bleeding during resuscitation; (3) algorithm control functions based on proportional-integral, fuzzy logic, or nonlinear decision tables were found to restore and maintain blood pressure equally well. Proportional-integral and fuzzy logic algorithms reduced mean fluid volume requirements compared with the nonlinear decision table; and (4) several algorithms have been constructed to the specific mechanism of injury and the volume expansion properties of different fluids. Closed-loop systems are undergoing translation from animal to patient studies. Future smart resuscitation systems will benefit from new noninvasive technologies for monitoring blood pressure and the development of computer controlled high flow intravenous pumps.