Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic

Abstract

Introduction The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.

Clinical management for patients admitted to a critical care unit with severe sepsis or septic shock

“…The median age of patients in our study was 61.6, with a distribution skewed towards the left, meaning a large proportion of patients aged over 60. This is consistent with other studies related to patients with severe sepsis or septic shock requiring ICU care (Merouani et al, 2008;Miller et al, 2013) or emergency department admission (Gray et al, 2013;Tsapenko et al, 2013;Whittaker et al, 2013). The male-to-female ratio of patients was 2:1, slightly different from other studies, where the ratio is usually 1:1 (Gray et al, 2013;Hodgin and Moss, 2008;Merouani et al, 2008;Miller et al, 2013).…”

“…This is consistent with other studies related to patients with severe sepsis or septic shock requiring ICU care (Merouani et al, 2008;Miller et al, 2013) or emergency department admission (Gray et al, 2013;Tsapenko et al, 2013;Whittaker et al, 2013). The male-to-female ratio of patients was 2:1, slightly different from other studies, where the ratio is usually 1:1 (Gray et al, 2013;Hodgin and Moss, 2008;Merouani et al, 2008;Miller et al, 2013). One reason for this discrepancy may be the sample size, with only 100 patients (less than 2% of the total ICU admissions during the three-year study period) fulfilling the study criteria, while the sample size in other studies is usually very large (Gray et al, 2013;Miller et al, 2013).…”

“…In the present study, we calculated the duration of norepinephrine infusion in the ICU and found it to be 4234 minutes (70.5 hours). Very few studies mention the duration of norepinephrine infusion for such patients, and indeed we found only one, carried out in France in 2008, that used a computer-controlled syringe to titrate norepinephrine, based on a protocol, with a mean duration of 57.5 hours in the control group (Merouani et al, 2008). However, our study took place in a general public hospital while the French site was a university hospital.…”

A case of circulatory collapse during intravenous immunoglobulin therapy: A manageable adverse effect!

“…It was for this reason why this patient received norepinephrine and not epinephrine in the case of this circulatory collapse without tachycardia or cutaneous symptoms. However, in this case, we were able to halt norepinephrine treatment 8 hours later, whereas norepinephrine weaning is generally longer for septic shock than presented in our case report [8]. Moreover, a low dose of norepinephrine was used.…”

Safe Use of Vasopressin and Angiotensin II for Patients with Circulatory Shock

“…Newer alarms are capable of evaluating multiple variables and use novel techniques that eliminate artifact, detect trends and patterns, and utilize self‐adjusting thresholds. In addition, artificial intelligence approaches such as machine learning, neural networks, and fuzzy logic have been used successfully in the critical care setting . As our understanding of these systems increases, detection and prevention of select ADRs such as bradycardia, arrhythmias, cardiac function, and AKI (that rely on real‐time monitoring of patients) should also improve.…”