Personalised Simulation Technologies for Optimising Treatment in the Intensive Care Unit: Realising Industrial and Medical Applications

在英国，每年大约有142,000人被送入重症监护病房（ICU）。这些患者中很大一部分患有危及生命的肺部疾病，需要机械通气；该组患者的死亡率约为35%，即使存活下来也可能在出院后持续数年。因此，重症肺病具有巨大的经济影响，是普通民众痛苦的重大负担。尽管进行了多年的研究，但我们对危重疾病的理解和个性化治疗的能力仍缺乏进展。传统的临床研究方法（使用随机临床试验）成本高昂，而且往往没有定论，而且在重症监护（诊断、生存、成本效益）方面的改善令人失望。因此，为这一患者群体开发更有效的个性化治疗方法将对国家和全球产生重大影响。在这个项目中，我们将开发个性化和优化ICU治疗的新方法。我们将与我们的业务和临床合作伙伴密切合作，将我们的高保真建模技术从研究实验室转移到ICU，以便实现实时，个性化的患者模拟，以指导危重疾病的治疗。这种方法为病人护理提供了潜在的“低成本”改进，因为它基于更智能的策略和技术，可以利用和优化多种干预措施，而不需要昂贵的新药物或设备。通过大规模整合来自常规患者监测的传入数据流，我们的技术将允许我们建立个体患者生理的匹配模拟。由此产生的个性化床边模拟将允许临床医生测试计划的干预措施，并估计患者的重要参数，否则将无法获得。除了被动行动外，该技术还将主动建议优化的治疗策略，以期改善患者的治疗效果。该技术将持续扫描患者的治疗和生理数据，寻找管理方面的潜在改进，并通过将其应用于个性化模拟和评估结果来测试拟议的治疗策略。重症监护治疗的个性化优化提供了改善患者预后和减少在重症监护病房接受机械通气的天数的机会，并且在减少患者痛苦和医疗保健支出方面具有巨大影响的潜力。我们将通过与我们的商业伙伴美敦力（世界上最大的独立医疗技术开发公司，以及领先的呼吸机制造商）和我们的临床合作伙伴Luigi Camporata教授密切合作，使这一潜力成为现实，Luigi Camporata教授是盖伊和圣托马斯NHS基金会信托（英国领先的危重疾病治疗研究中心之一）的重症医学顾问。

In the UK, approximately 142,000 people are admitted to Intensive Care Units (ICU) each year. A large proportion of these patients have life-threatening pulmonary illness and require mechanical ventilation; the mortality rate in this group is around 35%, and even survival may bring ongoing suffering lasting years after discharge. Critical pulmonary disease thus has enormous financial impact and represents a significant burden of suffering for the general population. Despite years of research, there has been a lack of progress in our understanding of critical illness and in our ability to personalise treatment. Traditional clinical research approaches (using randomised clinical trials) have been costly and often inconclusive, and have provided disappointing improvements in critical care (diagnosis, survival, cost-effectiveness). The development of more effective personalised treatments for this patient population would therefore have significant national and global impact. In this project, we will develop novel methods for personalising and optimising the therapy delivered in the ICU. We will work closely with our business and clinical partners to transfer our high-fidelity modelling technologies from the research lab to the ICU, in order that real-time, personalised, patient simulation can be achieved with the aim of guiding the treatment of critical illness. This approach offers potentially "low-cost" improvements in patient-care, since it is based on smarter strategies and technologies that exploit and optimise multiple interventions, without requiring expensive new pharmaceuticals or devices. Using large-scale integration of incoming data streams from routine patient monitoring, our technology will allow us to establish a matched simulation of an individual patient's physiology. The resulting personalised bedside simulation will allow clinicians to test planned interventions and to estimate vital parameters in the patient that would otherwise be inaccessible. In addition to acting passively, the technology will proactively advise on optimised treatment strategies that are expected to improve patient outcome. The technology will scan the patient's treatment and physiological data continually, seeking potential improvements in management, and testing proposed treatment strategies by applying them to the personalised simulation and assessing outcome.Personalised optimisation of critical care treatment offers the opportunity to improve patient outcomes and reduce days spent receiving mechanical ventilation in the intensive care unit, and has the potential for enormous impact in terms of reducing patient suffering and healthcare expenditure. We will make this potential a reality by working closely with our business partner Medtronic (the world's largest standalone medical technology development company, and a leading ventilator manufacturer) and with our clinical partner Prof. Luigi Camporata, a consultant in intensive care medicine at Guy's and St Thomas' NHS Foundation Trust (one of the UK's leading centres for research on the treatment of critical illness).