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Related Experiment Videos

Physician-Directed Versus Computerized Closed-Loop Control of Blood Pressure Using Phenylephrine in a Swine Model.

Nicole Ribeiro Marques1, William E Whitehead, Upendar R Kallu

  • 1From the *Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas; †Department of Mechanical Engineering, University of Houston, Houston, Texas; and ‡Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.

Anesthesia and Analgesia
|April 4, 2017
PubMed
Summary

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A closed-loop control (CLC) system for phenylephrine (PHP) infusion effectively maintained mean arterial pressure (MAP) in swine, matching physician performance. This automated system offers precise blood pressure management during anesthesia.

Area of Science:

  • Anesthesiology
  • Biomedical Engineering
  • Pharmacology

Background:

  • Vasopressors are crucial for managing perioperative hypotension.
  • A novel closed-loop control (CLC) system was developed to automatically titrate phenylephrine (PHP) for maintaining mean arterial pressure (MAP) during general anesthesia.
  • The system's efficacy was evaluated by comparing it to physician-controlled infusions.

Purpose of the Study:

  • To compare the performance of an automated CLC system with physicians in maintaining target MAP.
  • To assess if the CLC system reduces blood pressure variability and the required dose of phenylephrine.
  • To evaluate the precision of automated blood pressure control in an experimental setting.

Main Methods:

  • A crossover study design was employed using 6 swine under general anesthesia.

Related Experiment Videos

  • A normovolemic hypotensive challenge was induced using sodium nitroprusside.
  • Phenylephrine infusion rates were manually adjusted by physicians (MD) and autonomously by the CLC system every 3 seconds to achieve a predetermined MAP.

    • Main Results:

    • The CLC system maintained MAP within 5 mm Hg of the target for 93.5% of the time, compared to 72.4% for physicians (P = .054).
    • Time spent above the target MAP was significantly lower with CLC (2.1%) versus MD (25.8%) (P = .06).
    • No significant differences were found in control statistics, performance error, or total PHP dose between the CLC and MD interventions.

    Conclusions:

    • The CLC system demonstrated comparable performance to a focused anesthesiologist in controlling MAP via phenylephrine infusion.
    • Automated CLC infusion of phenylephrine provides tight blood pressure control during experimental vasodilation.
    • The CLC system represents a competent approach to automated blood pressure management in anesthesia.