Hoskins Stephen L, Elgjo Geir Ivar, Lu Jialung, Ying Hao, Grady James J, Herndon David N, Kramer George C
Resuscitation Research Laboratory, Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas 77555-0801, USA.
J Burn Care Res. 2006 May-Jun;27(3):377-85. doi: 10.1097/01.BCR.0000216512.30415.78.
Fluid therapy for burn shock is adjusted to establish a target level of urinary output. However, the means for adjusting infusion rate are not defined. Our objective was to compare the performance of automated computer-controlled resuscitation with manual control for burn resuscitation. Sheep with a 40% TBSA full-thickness burn, administered under halothane anesthesia, were resuscitated to restore and maintain normal sheep urinary outputs in a target range of 1 to 2 ml/kg per hour over the course of 48 hours using closed-loop resuscitation (n = 10) or manual hourly adjustment of infusion rate (n = 11). The automated closed-loop resuscitation system is based on a proportional-integral-derivative algorithm, which adjusted infusion rate based on continuous monitoring and changes in urinary output. Mean urinary outputs over the course of 48 hours were in target range and were virtually identical at 1.9 +/- 0.5 ml/kg per hour for the closed-loop group and 2.0 +/- 0.7 ml/kg per hour for the technician group. Mean infusion rates and infused volumes also were similar. The closed-loop group exhibited significantly lower hourly variation for both urinary output and infusion rate compared hourly control. Hourly targets were achieved in 41% of the measurements in technician group compared with 48% for the closed-loop group (P = .23). Hourly urinary output in the technician group was undertarget by 25% as opposed to 16% with the closed-loop group (P = .02). Automated closed-loop control of infusion rates after burn injury produced urinary outputs in target ranges with less variation and less under target values than manual hourly adjustments. Closed-loop resuscitation may provide an improvement over current resuscitation regimens.
烧伤休克的液体治疗需进行调整以达到目标尿量水平。然而，调整输液速率的方法尚无明确规定。我们的目标是比较自动计算机控制复苏与手动控制在烧伤复苏中的表现。在氟烷麻醉下造成40%体表面积全层烧伤的绵羊，通过闭环复苏（n = 10）或手动每小时调整输液速率（n = 11）进行复苏，在48小时内恢复并维持绵羊正常尿量在1至2毫升/千克每小时的目标范围内。自动闭环复苏系统基于比例积分微分算法，根据尿量的持续监测和变化来调整输液速率。48小时内的平均尿量处于目标范围内，闭环组为1.9±0.5毫升/千克每小时，技术人员组为2.0±0.7毫升/千克每小时，二者几乎相同。平均输液速率和输液量也相似。与每小时控制相比，闭环组的尿量和输液速率的每小时变化显著更低。技术人员组在41%的测量中达到了每小时目标，而闭环组为48%（P = 0.23）。技术人员组的每小时尿量低于目标值25%，而闭环组为16%（P = 0.02）。烧伤后输液速率的自动闭环控制产生的尿量在目标范围内，与手动每小时调整相比，变化更小且低于目标值的情况更少。闭环复苏可能比当前的复苏方案有所改进。
