Automated infusion of vasoactive and inotropic drugs to control arterial and pulmonary pressures during cardiac surgery

OBJECTIVE:To evaluate the feasibility of a closed-loop system for simultaneous control of systemic arterial and pulmonary artery blood pressures during cardiac surgery. DESIGN:Feasibility study. SETTING:The cardiac surgery operating room. PATIENTS:The performance of the multiple-drug closed-loop sys...

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Bibliographic Details
Published in:	Critical care medicine Vol. 27; no. 12; pp. 2792 - 2798
Main Authors:	Hoeksel, Sebastiaan A. A. P, Blom, Johannes A, Jansen, Jozef R. C, Maessen, Josephus G, Schreuder, Jan J
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-12-1999 Lippincott
Subjects:	Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antihypertensive Agents - administration & dosage Biological and medical sciences Cardiac Surgical Procedures Cardiotonic Agents - administration & dosage Computers Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Equipment Design Feasibility Studies Female Hemodynamics Humans Hypertension - drug therapy Hypotension - drug therapy Infusion Pumps Intensive care medicine Intraoperative Complications - drug therapy Male Medical sciences Middle Aged Heart Human Closed loop Drug combination Vasodilator agent Lung Check Intraoperative β-Adrenergic receptor agonist Systemic Computer control Chemotherapy Treatment Surgery Arterial pressure Hemodynamics
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Summary:	OBJECTIVE:To evaluate the feasibility of a closed-loop system for simultaneous control of systemic arterial and pulmonary artery blood pressures during cardiac surgery. DESIGN:Feasibility study. SETTING:The cardiac surgery operating room. PATIENTS:The performance of the multiple-drug closed-loop system was evaluated during cardiac surgery in 30 patients who required treatment with more than one vasoactive or inotropic drug. INTERVENTIONS:A multiple-drug closed-loop system integrated five single-drug blood pressure controllers. Arterial hypertension was controlled using sodium nitroprusside or nitroglycerin, arterial hypotension was controlled using noradrenaline or dobutamine, and pulmonary hypertension was controlled using nitroglycerin. The anesthesiologist selected target pressures and single-drug blood pressure controllers. The multiple-drug closed-loop system had a set of priority rules that automatically activated from the selected single-drug controllers the optimum single-drug controller for each hemodynamic state. Drug infusion rates of the nonactive controllers were kept constant. The initial knowledge that was used to construct the priority rules was obtained from standard anesthetic protocols on perioperative management of cardiac surgical patients. A supervisory computer program defined the actions to be taken in cases of infusion pump problems, invalid pressure measurements, and during unexpected increases and decreases in systemic arterial pressure. MEASUREMENTS AND MAIN RESULTS:The activation of single-drug controllers by the priority rules was accurate and fast. On average, a different single-drug controller was activated once every 7.2 mins. As a measure of variability, the average deviation of mean arterial pressure and mean pulmonary artery pressure from their target values was evaluated and was 8.6 ± 4.0 and 4.4 ± 4.0 mm Hg, respectively, before cardiopulmonary bypass and 8.0 ± 3.6 and 2.4 ± 0.9 mm Hg, respectively, after cardiopulmonary bypass. None of the single-drug controllers showed any signs of unstable response. CONCLUSION:Closed-loop control of both arterial and pulmonary pressures using multiple drugs is feasible during cardiac surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-3493 1530-0293
DOI:	10.1097/00003246-199912000-00031