Closed-Loop- and Decision-Assist-Guided Fluid Therapy of Human Hemorrhage.
Closed-Loop- and Decision-Assist-Guided Fluid Therapy of Human Hemorrhage.
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DOI：
10.1097/ccm.0000000000002593
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发表时间：
2017-10
影响因子：
8.8
通讯作者：
Kinsky MP
中科院分区：
文献类型：
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作者：
Hundeshagen G;Kramer GC;Ribeiro Marques N;Salter MG;Koutrouvelis AK;Li H;Solanki DR;Indrikovs A;Seeton R;Henkel SN;Kinsky MP
我们试图评估自动化终点定向复苏系统的功效、效率和生理后果，并将其与基于公式的推注复苏进行比较。实验性人类出血和复苏临床研究实验室健康志愿者受试者（n=7）经历出血并在单独的访视中经历随机液体复苏方案1）基于配方的推注复苏（BR）2）半自主（决策辅助，DA）液体施用和3）完全自主（闭环，CL）复苏。在出血和复苏期间监测血流动力学参数、容量变化、液体平衡和心功能。根据复苏效果和效率比较治疗方式。所有入路均在60分钟内达到目标血压。出血后，（BR：30 ml/kg，DA：5.6±3 ml/kg，CL：4.2± 2 ml/kg，p<0.001），血浆容量，血管外容量（BR：17± 4 ml/kg，DA：3± 1 ml/kg，CL：-0.3 ~0.3ml/kg，p<0.001），体重和尿量在DA和CL下保持稳定，在推注复苏下显著增加。在推注复苏下平均动脉压最初进一步降低（-10 mmHg，p<0.001），并且在20分钟时BR下低于CL（BR：57± 2 mmHg CL：69± 4 mmHg，p=0.036）。胶体渗透压（BR：19.3± 2 mmHg DA，CL：24±0.4mmHg，p<0.05）和血红蛋白浓度在推注液体后显著降低。我们定义了决策辅助和闭环复苏在人类出血中的有效性。与基于公式的推注复苏相比，半自主和自主方法在目标导向的出血复苏中更有效。它们为避免过度复苏及其不良临床后遗症提供了有利条件。决策辅助和闭环复苏算法是用于受限环境和资源有限区域的有前途的技术解决方案。
We sought to evaluate the efficacy, efficiency and physiological consequences of automated, end-point directed resuscitation systems and compare them to formula-based bolus resuscitation. Experimental human hemorrhage and resuscitation Clinical Research Laboratory Healthy volunteers Subjects (n=7) were subjected to hemorrhage and underwent a randomized fluid resuscitation scheme on separate visits 1) formula-based bolus resuscitation (BR) 2) semi-autonomous (decision-assist, DA) fluid administration and 3) fully autonomous (closed-loop, CL) resuscitation. Hemodynamic parameters, volume shifts, fluid balance, and cardiac function were monitored during hemorrhage and resuscitation. Treatment modalities were compared based on resuscitation efficacy and efficiency. All approaches achieved target BP by 60 min. Following hemorrhage, the total amount of infused fluid (BR: 30ml/kg, DA: 5.6±3 ml/kg, CL: 4.2±2ml/kg, p<0.001), plasma volume, extravascular volume (BR: 17±4ml/kg, DA: 3±1ml/kg, CL: -0.3±0.3ml/kg, p<0.001), body weight and urinary output remained stable under DA and CL and were significantly increased under bolus resuscitation. Mean arterial pressure initially decreased further under bolus resuscitation (-10mmHg, p<0.001) and was lower under BR than CL at 20min (BR: 57±2mmHg CL: 69±4mmHg, p=0.036). Colloid-osmotic pressure (BR: 19.3±2mmHg DA, CL: 24±0.4mmHg, p<0.05) and hemoglobin concentration were significantly decreased after bolus fluid administration. We define efficacy of decision-assist and closed-loop resuscitation in human hemorrhage. In comparison to formula-based bolus resuscitation, both semiautonomous and autonomous approaches were more efficient in goal-directed resuscitation of hemorrhage. They provide favorable conditions for the avoidance of over-resuscitation and its adverse clinical sequelae. Decision-assist and closed-loop resuscitation algorithms are promising technological solutions for constrained environments and areas of limited resources.