Closed-Loop Controlled Fluid Administration Systems: A Comprehensive Scoping Review

Avital, Guy; Snider, Eric J.; Berard, David; Vega, Saul J.; Torres, Sofia I. Hernandez; Convertino, Víctor A.; Salinas, José; Boice, Emily N.

doi:10.3390/jpm12071168

Cited by 12 publications

(4 citation statements)

References 84 publications

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“…This is further exacerbated during mass casualty scenarios, in which medical personnel are overburdened and cannot properly manage resuscitation of multiple casualties. As a result, automated fluid resuscitation controllers are being developed with different degrees of automation and decision engines based on clinical or animal fluid therapy datasets [ 33 ]. Troubleshooting these controllers for optimal performance and subsequent comparison between controller logics can be a time- and resource-intensive task.…”

Section: Discussionmentioning

confidence: 99%

An Automated Hardware-in-Loop Testbed for Evaluating Hemorrhagic Shock Resuscitation Controllers

et al. 2022

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Hemorrhage remains a leading cause of death, with early goal-directed fluid resuscitation being a pillar of mortality prevention. While closed-loop resuscitation can potentially benefit this effort, development of these systems is resource-intensive, making it a challenge to compare infusion controllers and respective hardware within a range of physiologically relevant hemorrhage scenarios. Here, we present a hardware-in-loop automated testbed for resuscitation controllers (HATRC) that provides a simple yet robust methodology to evaluate controllers. HATRC is a flow-loop benchtop system comprised of multiple PhysioVessels which mimic pressure-volume responsiveness for different resuscitation infusates. Subject variability and infusate switching were integrated for more complex testing. Further, HATRC can modulate fluidic resistance to mimic arterial resistance changes after vasopressor administration. Finally, all outflow rates are computer-controlled, with rules to dictate hemorrhage, clotting, and urine rates. Using HATRC, we evaluated a decision-table controller at two sampling rates with different hemorrhage scenarios. HATRC allows quantification of twelve performance metrics for each controller configuration and scenario, producing heterogeneous results and highlighting the need for controller evaluation with multiple hemorrhage scenarios. In conclusion, HATRC can be used to evaluate closed-loop controllers through user-defined hemorrhage scenarios while rating their performance. Extensive controller troubleshooting using HATRC can accelerate product development and subsequent translation.

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Section: Discussionmentioning

confidence: 99%

An Automated Hardware-in-Loop Testbed for Evaluating Hemorrhagic Shock Resuscitation Controllers

et al. 2022

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“…Machine-learning methods have been proposed to support the automation of casualty treatment, such as closed-loop fluid resuscitation ( Kramer et al, 2008 ; Rinehart et al, 2013 ; Marques et al, 2017 ; Jin et al, 2018 ; Gholami et al, 2021 ; Alsalti et al, 2022 ; Avital et al, 2022 ). Although these treatments can potentially optimize fluid resuscitation for one casualty at a time, they do not address the simultaneous management of multiple casualties under resource-constrained conditions.…”

Section: Introductionmentioning

confidence: 99%

AI algorithm for personalized resource allocation and treatment of hemorrhage casualties

Jin,

Frock,

Nagaraja

et al. 2024

Front. Physiol.

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A deep neural network-based artificial intelligence (AI) model was assessed for its utility in predicting vital signs of hemorrhage patients and optimizing the management of fluid resuscitation in mass casualties. With the use of a cardio-respiratory computational model to generate synthetic data of hemorrhage casualties, an application was created where a limited data stream (the initial 10 min of vital-sign monitoring) could be used to predict the outcomes of different fluid resuscitation allocations 60 min into the future. The predicted outcomes were then used to select the optimal resuscitation allocation for various simulated mass-casualty scenarios. This allowed the assessment of the potential benefits of using an allocation method based on personalized predictions of future vital signs versus a static population-based method that only uses currently available vital-sign information. The theoretical benefits of this approach included up to 46% additional casualties restored to healthy vital signs and a 119% increase in fluid-utilization efficiency. Although the study is not immune from limitations associated with synthetic data under specific assumptions, the work demonstrated the potential for incorporating neural network-based AI technologies in hemorrhage detection and treatment. The simulated injury and treatment scenarios used delineated possible benefits and opportunities available for using AI in pre-hospital trauma care. The greatest benefit of this technology lies in its ability to provide personalized interventions that optimize clinical outcomes under resource-limited conditions, such as in civilian or military mass-casualty events, involving moderate and severe hemorrhage.

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“…In a broader sense, PCLCs are systems that receive information about the patient's physiological status, decide on an intervention according to the internal controller architecture, implement the intervention, and then receive updated information on the patient's status. 4 Importantly, PCLCs are capable of performing these steps without requiring operator intervention-hence the system forms a "closed loop" with the patient. At the heart of any PCLC is the control logic that determines how the system will respond to any given patient condition.…”

Section: Introductionmentioning

confidence: 99%

Adaptive closed‐loop resuscitation controllers for hemorrhagic shock resuscitation

et al. 2023

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Background After hemorrhage control, fluid resuscitation is the most important intervention for hemorrhage. Even skilled providers can find resuscitation challenging to manage, especially when multiple patients require care. In the future, attention‐demanding medical tasks like fluid resuscitation for hemorrhage patients may be reassigned to autonomous medical systems when availability of skilled human providers is limited, such as in austere military settings and mass casualty incidents. Central to this endeavor is the development and optimization of control architectures for physiological closed‐loop control systems (PCLCs). PCLCs can take many forms, from simple table look‐up methods to widely used proportional–integral–derivative or fuzzy‐logic control theory. Here, we describe the design and optimization of multiple adaptive resuscitation controllers (ARCs) that we have purpose‐built for the resuscitation of hemorrhaging patients. Study Design and Methods Three ARC designs were evaluated that measured pressure–volume responsiveness using different methodologies during resuscitation from which adapted infusion rates were calculated. These controllers were adaptive in that they estimated required infusion flow rates based on measured volume responsiveness. A previously developed hardware‐in‐loop test platform was used to evaluate the ARCs implementations across several hemorrhage scenarios. Results After optimization, we found that our purpose‐built controllers outperformed traditional control system architecture as embodied in our previously developed dual‐input fuzzy‐logic controller. Discussion Future efforts will focus on engineering our purpose‐built control systems to be robust to noise in the physiological signal coming to the controller from the patient as well as testing controller performance across a range of test scenarios and in vivo.

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Closed-Loop Controlled Fluid Administration Systems: A Comprehensive Scoping Review

Cited by 12 publications

References 84 publications

An Automated Hardware-in-Loop Testbed for Evaluating Hemorrhagic Shock Resuscitation Controllers

An Automated Hardware-in-Loop Testbed for Evaluating Hemorrhagic Shock Resuscitation Controllers

AI algorithm for personalized resource allocation and treatment of hemorrhage casualties

Adaptive closed‐loop resuscitation controllers for hemorrhagic shock resuscitation

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