Design and In Silico Evaluation of a Closed-Loop Hemorrhage Resuscitation Algorithm With Blood Pressure as Controlled Variable
Design and In Silico Evaluation of a Closed-Loop Hemorrhage Resuscitation Algorithm With Blood Pressure as Controlled Variable
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DOI：
10.1115/1.4052312
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发表时间：
2022-02-01
影响因子：
1.7
通讯作者：
Hahn, Jin-Oh
中科院分区：
文献类型：
--
作者：
Alsalti, Mohammad;Tivay, Ali;Hahn, Jin-Oh
本文涉及以血压（BP）为控制变量的闭环出血复苏算法的设计和严格的计算机模拟评估。一个集总参数控制设计模型，容量复苏输入血容量（BV）和BP响应的开发和实验验证。然后，三种替代的自适应控制算法被开发使用的控制设计模型：（i）模型参考自适应控制（MRAC）与BP反馈，（ii）复合自适应控制（CAC）与BP反馈，（iii）CAC与BV和BP反馈。据我们所知，这是第一个工作，以证明基于模型的控制设计出血复苏与现成的BP作为反馈。这些闭环控制算法的疗效进行了比较评估，以及与经验的专家知识为基础的算法的基础上创建的100个现实的虚拟患者使用一个完善的生理模型的心血管（CV）血流动力学。计算机模拟评估结果表明，自适应控制算法在BP设定点跟踪的准确性和鲁棒性方面优于基于知识的算法：平均中位性能误差（MDPE）和中位绝对性能误差（MDAPE）分别显著小于>99%和> 91%，并且它们的个体间变异性也显著小于>88%和> 94%。待体内评价，基于模型的控制设计可能会提高闭环出血复苏的医疗自主性。
This paper concerns the design and rigorous in silico evaluation of a closed-loop hemorrhage resuscitation algorithm with blood pressure (BP) as controlled variable. A lumped-parameter control design model relating volume resuscitation input to blood volume (BV) and BP responses was developed and experimentally validated. Then, three alternative adaptive control algorithms were developed using the control design model: (i) model reference adaptive control (MRAC) with BP feedback, (ii) composite adaptive control (CAC) with BP feedback, and (iii) CAC with BV and BP feedback. To the best of our knowledge, this is the first work to demonstrate model-based control design for hemorrhage resuscitation with readily available BP as feedback. The efficacy of these closed-loop control algorithms was comparatively evaluated as well as compared with an empiric expert knowledge-based algorithm based on 100 realistic virtual patients created using a well-established physiological model of cardiovascular (CV) hemodynamics. The in silico evaluation results suggested that the adaptive control algorithms outperformed the knowledge-based algorithm in terms of both accuracy and robustness in BP set point tracking: the average median performance error (MDPE) and median absolute performance error (MDAPE) were significantly smaller by >99% and >91%, and as well, their interindividual variability was significantly smaller by >88% and >94%. Pending in vivo evaluation, model-based control design may advance the medical autonomy in closed-loop hemorrhage resuscitation.