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Control/Tracking Number: 15-A-1779-IARS

Activity: Abstracts
Current Date/Time: 10/24/2014 10:55:54 PM
CLOSED LOOP RESUSCITATION OF AN OVINE MULTI HEMORRHAGE MODEL USING FUZZY LOGIC, PROPORTIONAL INTEGRAL
AND DECISION TABLE CONTROLLERS

Author Block: AUTHORS: N. Ribeiro Marques1, B. Ford1, M. Kinsky1, M. Khan1, M. Salter1, H. Ying2, G. Kramer1;
AFFILIATION:1Anesthesiology, University of Texas Medical Branch, Galveston, TX, 2Electrical and Computer Engineering, Wayne State
University, Detroit, MI.
Abstract:
Background: Hemorrhagic shock often occurs in the first hours after major trauma and is a leading cause of trauma-related mortality.
Prompt hemostasis and restoration of adequate blood volume and blood pressure for end-organ perfusion are the treatments of choice.1
Arterial blood pressure (ABP) is often the best endpoint variable to guide early resuscitation. Different ABP target are needed to ensure
cerebral perfusion pressure after traumatic brain injury2 or hypotensive resuscitation of an internal uncontrolled bleeding3. In the present
study we compared the performance of three closed loop algorithms that directed infusion of fluids to restore and maintain mean arterial
pressure to a target level. We conducted a performance comparison of closed-loop fluid resuscitation of a hemorrhaged sheep model using
a decision table (DT), proportional-integral (PI) controller and fuzzy logic (FL) controller. The primary objective was to assess effectiveness,
the ability to maintain blood pressure on target, and efficiency, the amount of fluid required.
Methods: Studies were performed on 15 conscious sheep. Animals were instrumented with femoral artery and vein catheters, flow probe
on the common pulmonary artery, and central venous catheter on external jugular vein. Seven days later the animals were submitted to a
hemorrhagic protocol of 35 ml/kg over three separate bleeds. All events are referenced to the start of the first hemorrhage, T = 0 minutes.
The first hemorrhage of 25 ml/kg was performed over 15 minutes (T = 0 to 15 min). Closed-loop resuscitation was started at T = 30
minutes. The second and third bleeds were 5 ml/kg over 5 minutes starting at T = 50 and T = 70 minutes, respectively. The fluid
resuscitation was implemented for 3 automated closed-loop treatments (5 sheep per group): DT, PI controller and FL controller. All
algorithms were designed to restore and maintain a MAP of 80 mmHg by controlling the infusion rate of Lactated Ringer's.
Results: FL and PI algorithms restored MAP before the second hemorrhage and only FL group was able to increase MAP to target before
and after the third hemorrhage. DT effectiveness was unsatisfactory and was not able to restore MAP at any time during the study, Figure
1. However, the better control with FL and PI came at the cost of greater volume requirements. FL was more efficient than PI, utilizing less
fluid and improving MAP. The total volume infused was 26 ml/kg for FL, 30 ml/kg for PI and 22 ml/kg for DT. The percentage of time that
MAP was within 5, 10, 15, and 20 mmHg from target was greater for FL and PI groups, Figure 2.
Conclusion: Continuous assessment of ABP and adjustment every 5 second of the infusion rate using either FL or PI algorithm were
effective at restoring MAP during a multi-hemorrhage model.
References: 1- Early fluid resuscitation in severe trauma. BMJ 2012;345:e5752. 2-Guidelines for prehospital management of traumatic
brain injury, 2nd edition. Brain trauma foundation2nd edition, 2007. 3- Fluid resuscitation in trauma patients: what should we know? Curr
Opin Crit Care 2014;20:444-450.
:

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Affirmations (Complete):
* The author has read and understands the IARS instructions for Submitting Abstracts.
: Yes
* The study was approved by the appropriate IRB or other local review board.
: Yes
* For studies involving human subjects, written informed consent was obtained from all subjects, a legal surrogate, the parents
or legal guardians for minor subjects, or the requirement for written informed consent was waived by the IRB.
: Not Applicable
* For studies involving animals, investigations performed in vertebrate animals were approved by the appropriate IRB for animal
research (e.g., Institutional Animal Care and Use Committee). Specify experimental animal in the abstract title.
: Yes
* The author certifies that he or she is the owner of the abstract or otherwise possesses the rights to grant to the IARS the right
to use this material. The author retains copyright to the abstract.
: Yes
* If the abstract is selected for presentation, the authors grant to the IARS a nonexclusive, perpetual, royalty-free right to publish
the abstract electronically online and via any other technology now existing or later developed.
: Yes
* Prior to the 2015 IARS Annual Meeting the information in the abstract will not be published in an indexed journal.
: Yes

Category (Complete): Technology, Computing and Simulation, Equipment Monitoring

Keyword (Complete): Fluid resuscitation

Status: Incomplete
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