Abstract
Background Hemorrhagic shock is the leading cause of trauma-related death in the military setting. Definitive surgical treatment of a combat casualty can be delayed and life-saving fluid resuscitation might be necessary in the field. Therefore, improved resuscitation strategies are critically needed for prolonged field and en route care. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages. Fuzzy logic empowered the control algorithm to emulate human expertise. We hypothesized that the FL controller would be more effective and more efficient than the DT algorithm by responding in a more rigid, structured way.MethodsTen conscious sheep were submitted to a hemorrhagic protocol of 25 ml/kg over three separate bleeds. Automated resuscitation with lactated Ringer’s was initiated 30 min after the first hemorrhage started. The endpoint target was MAP. Group differences were assessed by two-tailed t test and alpha of 0.05.ResultsBoth groups maintained MAP at similar levels throughout the study. However, the DT group required significantly more fluid than the FL group, 1745 ± 552 ml (42 ± 11 ml/kg) versus 978 ± 397 ml (26 ± 11 ml/kg), respectively (p = 0.03).ConclusionThe FL controller was more efficient than the DT algorithm and may provide a means to reduce fluid loading. Effectiveness was not different between the two strategies. Automated closed-loop resuscitation can restore and maintain blood pressure in a multi-hemorrhage model of shock.
Highlights
Hemorrhagic shock is the leading cause of trauma-related death in the military setting
The mean arterial pressure (MAP) responses during the first hemorrhage were similar between the groups, reaching a nadir of ± 6 mmHg and ± 14 mmHg for the fuzzy logic controller (FL) and decision table algorithm (DT) groups, respectively (p = 0.9)
Our findings suggest that hemodynamic derangement triggered by profound hemorrhagic shock can be corrected with fluid titration strategies using MAP as a target endpoint
Summary
Hemorrhagic shock is the leading cause of trauma-related death in the military setting. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages. Fuzzy logic empowered the control algorithm to emulate human expertise. Marques et al Disaster and Mil Med (2017) 3:1 the injury This therapy would limit over-resuscitation, and provide logistic advantages by minimizing the field supplies needed for combat casualty care. Automated closed-loop systems have the potential to enhance en route care, reducing caregiver time-effort and allowing the medic or corpsman to focus on other critical tasks and other casualties. One attractive approach to closed-loop controllers is using fuzzy logic control. Proper use of fuzzy logic control can significantly shorten product research and development time with reduced cost
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
