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Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery.

Abstract：

BACKGROUND:Vasopressor agents are used to prevent intraoperative hypotension and ensure adequate perfusion. Vasopressors are usually administered as intermittent boluses or manually adjusted infusions, but this practice requires considerable time and attention. We have developed a closed-loop vasopressor (CLV) controller to correct hypotension more efficiently. Here, we conducted a proof-of-concept study to assess the feasibility and performance of CLV control in surgical patients. METHODS:Twenty patients scheduled for elective surgical procedures were included in this study. The goal of the CLV system was to maintain MAP within 5 mm Hg of the target MAP by automatically adjusting the rate of a norepinephrine infusion using MAP values recorded continuously from an arterial catheter. The primary outcome was the percentage of time that patients were hypotensive, as defined by a MAP of 5 mm Hg below the chosen target. Secondary outcomes included the total dose of norepinephrine, percentage of time with hypertension (MAP>5 mm Hg of the chosen target), raw percentage "time in target" and Varvel performance criteria. RESULTS:The 20 subjects (median age: 64 years [52-71]; male (35%)) underwent elective surgery lasting 154 min [124-233]. CLV control maintained MAP within ±5 mm Hg of the target for 91.6% (85.6-93.3) of the intraoperative period. Subjects were hypotensive for 2.6% of the intraoperative period (range, 0-8.4%). Additional performance criteria for the controller included mean absolute performance error of 2.9 (0.8) and mean predictive error of 0.5 (1.0). No subjects experienced major complications. CONCLUSIONS:In this proof of concept study, CLV control minimised perioperative hypotension in subjects undergoing moderate- or high-risk surgery. Further studies to demonstrate efficacy are warranted. TRIAL REGISTRY NUMBER:NCT03515161 (ClinicalTrials.gov).

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Joosten A,Alexander B,Duranteau J,Taccone FS,Creteur J,Vincent JL,Cannesson M,Rinehart J

doi

10.1016/j.bja.2019.04.064

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

430-438

issue

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(19)30443-X

journal_volume

123

pub_type

杂志文章

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Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery.