Rodgers Tina M, Berard David, Gonzalez Jose M, Vega Saul J, Gathright Rachel, Bedolla Carlos, Ross Evan, Snider Eric J
Organ Support and Automation Technologies Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA.
Bioengineering (Basel). 2024 Dec 20;11(12):1296. doi: 10.3390/bioengineering11121296.
Hemorrhage is a leading cause of preventable death in military and civilian trauma medicine. Fluid resuscitation is the primary treatment option, which can be difficult to manage when multiple patients are involved. Traditional vital signs needed to drive resuscitation therapy being unavailable without invasive catheter placement is a challenge. To overcome these obstacles, we propose using closed-loop fluid resuscitation controllers managed by non-invasive, intermittent signal sensor inputs to simplify their use in far-forward environments. Using non-invasive, intermittent sensor controllers will allow quicker medical intervention due to negating the need for an arterial catheter to be placed for pressure-guided fluid resuscitation. Two controller designs were evaluated in a swine hemorrhagic shock injury model, with each controller only receiving non-invasive blood pressure (NIBP) measurements simulated from invasive input signals every 60 s. We found that both physiological closed-loop controllers were able to effectively resuscitate subjects out of life-threatening hemorrhagic shock using only intermittent data inputs with a resuscitation effectiveness of at least 95% for each respective controller. We also compared this intermittent signal input to a NIBP cuff and to a deep learning model that predicts blood pressure from a photoplethysmography waveform. Each approach showed evidence of tracking blood pressure, but more effort is needed to refine these non-invasive input approaches. We conclude that resuscitation controllers hold promise to one day be capable of non-invasive sensor input while retaining their effectiveness, expanding their utility for managing patients during mass casualty or battlefield conditions.
出血是军事和民用创伤医学中可预防死亡的主要原因。液体复苏是主要的治疗选择，当涉及多个患者时，这可能难以管理。在没有进行有创导管置入的情况下，驱动复苏治疗所需的传统生命体征无法获取，这是一个挑战。为了克服这些障碍，我们建议使用由非侵入性间歇信号传感器输入管理的闭环液体复苏控制器，以简化其在前沿环境中的使用。使用非侵入性间歇传感器控制器将无需放置动脉导管进行压力引导的液体复苏，从而实现更快的医疗干预。在猪失血性休克损伤模型中评估了两种控制器设计，每个控制器仅每60秒接收一次从有创输入信号模拟的非侵入性血压（NIBP）测量值。我们发现，两种生理闭环控制器仅使用间歇数据输入就能有效地使受试者从危及生命的失血性休克中复苏，每个控制器的复苏有效性至少为95%。我们还将这种间歇信号输入与NIBP袖带以及从光电容积脉搏波预测血压的深度学习模型进行了比较。每种方法都显示出跟踪血压的证据，但需要更多努力来完善这些非侵入性输入方法。我们得出结论，复苏控制器有望有朝一日能够进行非侵入性传感器输入，同时保持其有效性，扩大其在大规模伤亡或战场条件下管理患者的效用。
