scholarly journals P2738Development of closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
K. Uemura ◽  
T. Kawada ◽  
C. Zheng ◽  
M. Li ◽  
M. Sugimachi
Keyword(s):  
Septic Shock ◽  
Closed Loop ◽  
Drug Infusion ◽  
Infusion System

scholarly journals Computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in endotoxin-induced shock

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Kazunori Uemura ◽  
Toru Kawada ◽  
Can Zheng ◽  
Meihua Li ◽  
Masaru Sugimachi
Keyword(s):  
Closed Loop ◽  
Drug Infusion ◽  
Computer Controlled ◽  
Infusion System

P4605Landiolol, a beta-blocker, optimizes cardiac energetics and peripheral microhemodynamics better than ivabradine while reducing heart rate at hemodynamic resuscitation of experimental septic shock

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Uemura ◽  
T Kawada ◽  
T Nishikawa ◽  
C Zheng ◽  
L Meihua ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Low Dose ◽  
Dose Range ◽  
Endotoxin Shock ◽  
Acetate Solution ◽  
Cardiac Energetics ◽  
Drug Infusion ◽  
Computer Controlled ◽  
Infusion System

Abstract Background Septic shock is associated with sympathetic over-activation characterized by tachycardia, which is associated with poor survival. Though several kinds of drugs are available to reduce heart rate (HR), it is not clear which drug should be used to reduce HR effectively in initial hemodynamic resuscitation in septic shock. Purpose The aim of this study was to experimentally investigate comparative effects of landiolol (a β-blocker) and ivabradine (an If-channel inhibitor) on initial hemodynamic resuscitation in a canine model of endotoxin shock. Methods We used 19 anesthetized dogs. Seven dogs were allocated to control (CT) group, six dogs to landiolol (BB) group, and six dogs to ivabradine (IVA) group. In all the groups, endotoxin shock was induced by intravenous infusion of Escherichia coli lipopolysaccharide (4 mg/kg) over 1 h. After induction of endotoxin shock, we started hemodynamic resuscitation to restore mean arterial pressure (AP) and cardiac output (CO) by infusing noradrenaline (NA) and Ringer acetate solution (RiA). Dose of NA and RiA were automatically titrated with use of a computer-controlled drug infusion system that we developed previously. Hemodynamic resuscitation was continued for 4 h. During resuscitation, the BB group was given landiolol infusion at a low-dose range (1–10 μg/kg/min, manually titrated), while the IVA group was given ivabradine at 0.25 mg/kg bolus-injected every 2 h. Results The drug infusion system automatically restored AP to 70 mmHg and CO to greater than 90% of baseline level in all the groups. The restored AP and CO were not significantly different among the three groups (Figure A, B). There were no significant differences in the computer-controlled infusion rate of NA and cumulated volume of RiA infused among the three groups (Figure C). During the first 2 h of resuscitation, HR was significantly reduced in the BB and IVA groups in comparison to the CT group (Figure D). However, only in the BB group, cardiac oxygen consumption was significantly lower than that in the CT group (Figure E). Blood lactate level decreased significantly after hemodynamic resuscitation only within the BB group (Figure F). Figure 1 Conclusions In the initial hemodynamic resuscitation of septic shock, both low-dose landiolol infusion and ivabradine injection may be used to reduce HR. However, to optimize cardiac energetics and peripheral microhemodynamics, low-dose landiolol infusion may be preferable to ivabradine injection. Acknowledgement/Funding This work was supported by JSPS KAKENHI Grant Number 15K01307, 18K12126.

scholarly journals A REVIEW ON PATIENT-CONTROLLED ANALGESIA INFUSION SYSTEM

2017 ◽  
Vol 10 (13) ◽  
pp. 117
Author(s):  
Usha Rani Shola ◽  
Neela Narayanan V
Keyword(s):  
Intelligent Systems ◽  
Continuous Monitoring ◽  
Patient Monitoring ◽  
Quality Care ◽  
Infusion Pump ◽  
Care Process ◽  
Patient Controlled Analgesia ◽  
Drug Infusion ◽  
Infusion System ◽  
Pump Infusion

PCA is a patient-controlled analgesia infusion pump, which is used to infuse the medicine into the patients after surgery. It contains a syringe with pain medicine to infuse that is prescribed by the physician. The drugs used for pain control are high-alert medicines, since overmedication may cause death to the patients. These types of unbearable events may happen due to medical errors, prescription errors, adverse events (AEs), etc. Hence, it requires a precautionary attention or continuous monitoring for PCA pump infusion patients. However, always physicians or nurses may not monitor a patient continuously. To provide safety to the patient, the PCA pump needs a smart care process to alert the physician. This study represents the survey on PCA pump errors, AEs, and solutions for it to avoid them. The solution will automatically alert the infusion-related situation of the patients, those are taking the intravenous drug infusion at different procedure rooms in the hospitals. Moreover, it increases the safety to infusion pump with advances of decision-making in health, patient monitoring, alert notification to nursing, and productivity. This quality care can be achieved by integrating the PCA pump with other intelligent systems.  

Closed-loop Control of Anesthesia Using Bispectral Index

2002 ◽  
Vol 96 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Anthony R. Absalom ◽  
Nicholas Sutcliffe ◽  
Gavin N. Kenny
Keyword(s):  
Bispectral Index ◽  
Closed Loop ◽  
Control Variable ◽  
Adult Patients ◽  
Closed Loop Control ◽  
Loop Control ◽  
Set Point ◽  
Target Controlled Infusion ◽  
Performance Error ◽  
Infusion System

Background The Bispectral Index (BIS) is an electroencephalogram-derived measure of anesthetic depth. A closed-loop anesthesia system was built using BIS as the control variable, a proportional-integral-differential control algorithm, and a propofol target-controlled infusion system as the control actuator. Closed-loop performance was assessed in 10 adult patients. Methods Ten adult patients scheduled to undergo elective hip or knee surgery were enrolled. An epidural cannula was inserted, and 0.5% bupivacaine was used to provide anesthesia to T8 before general anesthesia was induced using the propofol target-controlled infusion system under manual control. After the start of surgery, when anesthesia was clinically adequate, automatic control of anesthesia was commenced using the BIS as the control variable. Adequacy of anesthesia during closed-loop control was assessed clinically and by calculating the median performance error, the median absolute performance error, and the mean offset of the control variable. Results The median performance error and the median absolute performance error were 2.2 and 8.0%, respectively. Mean offset of the BIS from the set point was 0.9. Cardiovascular parameters were stable during closed-loop control. Operating conditions were adequate in all patients but one, who began moving after 45 min of stable anesthesia. No patients reported awareness or recall of intraoperative events. In three patients, there was oscillation of the measured BIS around the set point. Conclusions The system was able to provide clinically adequate anesthesia in 9 of 10 patients. Further studies are required to determine whether control performance can be improved by alterations to the gain factors or by using an effect site-targeted, target-controlled infusion propofol system.

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