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The need for closed-loop therapy

R R Mitchell

    Critical Care Medicine
    |December 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

    Nurses spend significant time adjusting blood pressure medication after heart surgery. A closed-loop control system could reduce this workload, offering a needed, accepted solution for managing acute hypertension.

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    Area of Science:

    • Cardiovascular Surgery
    • Intensive Care Medicine
    • Biomedical Engineering

    Background:

    • Acute hypertension is a common complication following cardiac surgery.
    • Managing blood pressure requires significant nursing resources, particularly for titrating vasoactive medications like sodium nitroprusside.
    • The manual adjustment of infusions can be time-consuming and potentially less precise than automated systems.

    Purpose of the Study:

    • To evaluate the need for a closed-loop blood pressure control system in post-cardiac surgery patients.
    • To estimate the nursing time dedicated to adjusting sodium nitroprusside infusions.
    • To assess the potential acceptance and utilization of automated blood pressure controllers.

    Main Methods:

    • A nationwide telephone survey of head nurses in post-surgical Intensive Care Units (ICUs) across nine institutions.

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  • Nurses provided estimates of time spent adjusting sodium nitroprusside infusion rates.
  • Calculations were based on nurse estimates and a hierarchical question-based assessment.

    • Main Results:

    • Nurses estimated spending 26% of patient infusion time adjusting sodium nitroprusside.
    • A more detailed assessment calculated average adjustment time at 16% of infusion time.
    • A closed-loop controller was projected to be used 40% of the time in a 1-to-1 nurse-patient setting.

    Conclusions:

    • A technically viable closed-loop blood pressure controller design exists for clinical application.
    • There is a current clinical need for such a controller to manage post-operative hypertension.
    • The clinical staff is likely to accept the implementation of an automated blood pressure management system.