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Closed-loop resuscitation of burn shock.
Stephen L Hoskins1, Geir Ivar Elgjo, Jialung Lu
1Resuscitation Research Laboratory, Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas 77555-0801, USA.
Summary
Automated closed-loop resuscitation for burn shock in sheep demonstrated less variation and fewer under-target urinary outputs compared to manual fluid therapy. This computer-controlled method may improve burn resuscitation outcomes.
Area of Science:
- Medical Research
- Biomedical Engineering
- Critical Care Medicine
Background:
- Fluid resuscitation is critical for managing burn shock, aiming to maintain target urinary output.
- Current methods for adjusting infusion rates lack precise definition, leading to potential variability in patient care.
Purpose of the Study:
- To compare the efficacy of automated computer-controlled (closed-loop) resuscitation versus manual control in sheep with severe burns.
- To evaluate the impact of each resuscitation method on urinary output and fluid infusion rates over 48 hours.
Main Methods:
- Sheep with 40% TBSA full-thickness burns received fluid resuscitation under anesthesia.
- Resuscitation was managed using either a closed-loop system with a proportional-integral-derivative algorithm or manual hourly adjustments.
- Urinary output was monitored to maintain a target range of 1-2 ml/kg/hour.
Main Results:
- Both closed-loop and manual methods achieved similar mean urinary outputs within the target range.
- The closed-loop system showed significantly less hourly variation in urinary output and infusion rates.
- Under-target urinary output occurred less frequently with closed-loop resuscitation (16%) compared to manual control (25%).
Conclusions:
- Automated closed-loop resuscitation effectively controls fluid infusion rates for burn shock, achieving target urinary outputs with reduced variability.
- This advanced resuscitation strategy offers a potential improvement over traditional manual fluid management in burn care.