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Evaluation of a novel closed-loop fluid-administration system based on dynamic predictors of fluid responsiveness an in silico simulation study.doc

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Evaluation of a novel closed-loop fluid-administration system based on dynamic predictors of fluid responsiveness an in silico simulation study

Rinehartetal.CriticalCare2011,15:R278 /content/15/6/R278 RESEARCH OpenAccess Evaluationofanovelclosed-loopfluid- administrationsystembasedondynamic predictorsoffluidresponsiveness:aninsilico simulationstudy JosephRinehart1,BrentonAlexander1,YannickLeManach2,3,ChristophKHofer4,BenoitTavernier5,ZeevNKain1 andMaximeCannesson1* Abstract Introduction:Dynamicpredictorsoffluidresponsivenesshavemadeautomatedmanagementoffluid resuscitationmorepractical.Wepresentinitialsimulationdataforanovelclosed-loopfluid-managementalgorithm (LIR,LearningIntravenousResuscitator). Methods:Theperformanceoftheclosed-loopalgorithmwastestedinthreephasesbyusingapatientsimulator includingapulse-pressurevariationoutput.Inthefirstphase,LIRwastestedinthreedifferenthemorrhage scenariosandcomparedwithnomanagement.Inthesecondphase,wecomparedLIRwith20practicing anesthesiologistsforthemanagementofasimulatedhemorrhagescenario.Inthethirdphase,LIRwastested underconditionsofnoiseandartifactinthedynamicpredictor. Results:Inthefirstphase,weobservedasignificantdifferencebetweentheunmanagedandtheLIRgroupsin moderatetolargehemorrhagesinheartrate(76±8versus141±29beats/min),meanarterialpressure(91±6 versus59±26mmHg),andcardiacoutput(CO;(6.4±0.9versus3.2±1.8L/min)(P0.005forallcomparisons). Inthesecondphase,LIRintervenedsignificantlyearlierthanthepractitioners(16.0±1.3minutesversus21.5±5.6 minutes;P0.05)andgavemoretotalfluid(2,675±244mlversus1,968±644ml;P0.05).ThemeanCOwas higherintheLIRgroupthaninthepractitionergroup(5.9±0.2versus5.2±0.6L/min;P0.05).Finally,inthe thirdphase,despitetheadditionofnoisetothepulse-pressurevariationvalue,nosignificantdifferencewasfound acrossconditionsinmean,final,orminimumCO. Conclusion:ThesedatademonstratethatLIRisaneffectivevolumetricresuscitatorinsimulatedhemorrhage scenariosandimprovedphysicianmanagementofthesimulatedhemorrhages. Introduction clinicians for myriad applications [1-3], but a key Automationisubiquitousinmodernlifebuthistorically requirement for proper function i