Precision Automated Critical Care Management: Closed-loop critical care for the treatment of distributive shock in a swine model of ischemia-reperfusion

Abstract

Precision Automated Critical Care Management (PACC-MAN) is a platform utilizing physiologic inputs and therapeutics to achieve precise crystalloid delivery, target hemodynamics, and equivalent resuscitation endpoints in a distributive shock swine model. #RESUSCITATION #SHOCK

Man Versus Machine: Provider Directed Versus Precision Automated Critical Care Management in a Porcine Model of Distributive Shock

“…1, http://links.lww.com/SHK/B917). The algorithm had the option to provide weight-based crystalloid boluses (1.5 mL/kg) and titration of norepinephrine for vasoactive support (34).…”

“…Twelve healthy, naive adult Yorkshire-cross swine, acclimated to the facility for at least 48 h, were fasted overnight, then premedicated with 5-7 mg/kg intramuscular tiletamine/zolazepam. The sample size was based on previous work that utilized the same injury model (34). General anesthesia was induced and maintained with 2% isoflurane, and animals were mechanically ventilated to maintain end-tidal CO 2 at 35-45 mm Hg.…”

“…Many have been described for various therapeutic interventions, such as burn resuscitation and blood pressure control under anesthesia (22)(23)(24)(25)(26)(27)(28)(29)(30). Our team continues to refine a closed-loop heuristicbased critical care algorithm, incorporating multiple hemodynamic and physiologic parameters to target resuscitation strategies in a highly reproducible distributive shock model (31)(32)(33)(34). This platform, called Precision Automated Critical Care Management (PACC-MAN), cohesively modulates vasopressor titration and crystalloid administration in response to real-time physiologic data and predetermined hemodynamic triggers.…”

“…This platform, called Precision Automated Critical Care Management (PACC-MAN), cohesively modulates vasopressor titration and crystalloid administration in response to real-time physiologic data and predetermined hemodynamic triggers. PACC-MAN's goal is to achieve a targeted and efficient approach to critical care management (34). Recent studies from our group demonstrated that our current, enhanced version of PACC-MAN precisely controls hemodynamics to achieve and maintain normotension while minimizing the risks associated with excessive fluid administration and vasopressor use (31,34,35).…”

“…PACC-MAN's goal is to achieve a targeted and efficient approach to critical care management (34). Recent studies from our group demonstrated that our current, enhanced version of PACC-MAN precisely controls hemodynamics to achieve and maintain normotension while minimizing the risks associated with excessive fluid administration and vasopressor use (31,34,35). By avoiding treatment delays and rapidly processing hemodynamic data, this system provides timely interventions and personalized critical care.…”