Automated control of postoperative hypertension: A prospective, randomized multicenter study

Cosgrove, Delos M.; Petre, John; Waller, John L.; Roth, Jonathan V.; Shepherd, Carol; Cohn, Lawrence H.

doi:10.1016/0003-4975(89)90117-3

Cited by 31 publications

(4 citation statements)

References 12 publications

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“…These were: † A combined PD controller and self-tuning regulator which uses least-squares to estimate the response to SNP as an ARMAX model and implements a minimum variance control law (as in [6]) with infusion constraints (as in [7]) and an additional on-line dead time detection method (as in [5]) to cater for variable system delays. Although a detailed description of the IVAC Titrator device is not available in the literature, this architecture was deemed similarnotwithstanding any supervisory algorithms-to that used in the Titrator approach on the basis of available publications [16,29]. † The MMAC architecture of [8], which employs seven candidate models selected with a prediction error method, seven PI controllers, and a bank of Smith's predictors for delay compensation.…”

Section: Patient-model Matching and Controller Selectionmentioning

confidence: 99%

“…However, it enjoyed very little success and was soon withdrawn from the market [15]. It is remarkable that although clinical trials have shown that automatic control has the potential to www.ietdl.org deliver superior outcomes to manual control [16][17][18], operator-based open-loop control of drug infusion still remains the current standard of care in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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Robust control design for automatic regulation of blood pressure

Malagutti

Dehghani

Kennedy

2013

IET Control Theory & Applications

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The problem of automatic administration of vasoactive drugs to a patient can be treated as a regulation problem of a system, which is characterised by large parametric uncertainty, non-Gaussian disturbances and unmodelled dynamics, yet carries strict requirements in terms of robustness and performance. A number of approaches have been proposed in the past to tackle this problem, particularly for the postoperative management of blood pressure in cardiac surgery patients. We describe the design of a robust multiple-model adaptive control (RMMAC) architecture and investigate whether this can overcome some issues observed with earlier methods. Key features of RMMAC are robust optimal controller design using an iterative μ synthesis algorithm and improved system estimation. Simulation results indicate that RMMAC is capable of avoiding transient instability and delivering performance in the face of significant parameter changes over time and large disturbances including non-zero-mean signals. The findings support further research into RMMAC as a potentially viable approach to the design of safer automatic closed-loop drug administration technologies capable of operating under challenging clinical conditions such as may arise in an intraoperative setting.

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Section: Patient-model Matching and Controller Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robust control design for automatic regulation of blood pressure

Malagutti

Dehghani

Kennedy

2013

IET Control Theory & Applications

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“…A variety of approaches to blood pressure control by closed-loop SNP infusion have been proposed over the past three decades (see [4] for a review). While the potential benefits of such a technology remain undisputed, however, it is notable that only one of these designs ever reached commercial production in the early 1990s, and that the resulting device enjoyed such little success that it was discontinued soon after being marketed [5], despite seemingly promising results in premarket clinical trials [6].…”

Section: Introductionmentioning

confidence: 99%

A Robust Multiple-Model Adaptive Control System for Automatic Delivery of a Vasoactive Drug

Malagutti

Dehghani²,

Kennedy³

2012

Biomedical Engineering / 765: Telehealth / 766: Assistive Technologies

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Automatic closed-loop administration of sodium nitroprusside for the regulation of blood pressure in patients experiencing acute hypertension has been the subject of intense research over the last three decades. Yet, to date, manual administration of vasoactive drugs by a human operator remains the standard of care in the clinical setting. This manuscript describes a novel control approach for this application based on Robust Multiple-Model Adaptive Control (RMMAC). The RMMAC architecture features robust controllers designed with µ synthesis and Kalman filtering for system estimation. The new system was coupled with a mathematical model of a patient's response to drug infusion and tested in computational simulations. The results indicate that the RMMAC approach has the potential to deliver robust performance even in challenging operating conditions, with mean arterial pressure remaining within the specified target range over 99% of the time.

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“…S EVERAL investigators have demonstrated that for the management of postoperative systemic hypertension in cardiac surgical patients, computer control of vasodilator infusion rates results in more stable hemodynamic profiles when compared with manual control (1–4). Chitwood et al (5) demonstrated in a large multi‐center trial that the more stable hemodynamic profiles obtained by computer control improve patient outcome for the postoperative cardiac surgical patient.…”

mentioning

confidence: 99%