Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2008-12

AUTHORS

Mehdi Merouani, Bruno Guignard, François Vincent, Stephen W Borron, Philippe Karoubi, Jean-Philippe Fosse, Yves Cohen, Christophe Clec'h, Eric Vicaut, Carole Marbeuf-Gueye, Frederic Lapostolle, Frederic Adnet

ABSTRACT

INTRODUCTION: The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock. METHODS: Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation. RESULTS: Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01). CONCLUSIONS: Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion. TRIAL REGISTRATION: Trial registration: Clinicaltrials.gov NCT00763906. More... »

PAGES

r155

References to SciGraph publications

  • 1994-03. Fuzzy control in anesthesia in JOURNAL OF CLINICAL MONITORING AND COMPUTING
  • 2005-12. The Surviving Sepsis Campaign sepsis change bundles and clinical practice in CRITICAL CARE
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/cc7149

    DOI

    http://dx.doi.org/10.1186/cc7149

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1005390178

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/19068113


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        "description": "INTRODUCTION: The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.\nMETHODS: Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.\nRESULTS: Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01).\nCONCLUSIONS: Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.\nTRIAL REGISTRATION: Trial registration: Clinicaltrials.gov NCT00763906.", 
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    277 schema:name Department of Surgery (Emergency Medicine), University of Texas Health Science Center at San Antonio, Medical Drive, San Antonio, USA
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    279 https://www.grid.ac/institutes/grid.413780.9 schema:alternateName Hôpital Avicenne
    280 schema:name Service de Réanimation, Hôpital Avicenne, Rue de Stalingrad, 93000, Bobigny, France
    281 Université Paris 13, Hôpital Avicenne, Rue de Stalingrad,, Samu 93 – EA 3409, 93000, Bobigny, France
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    283 https://www.grid.ac/institutes/grid.414095.d schema:alternateName Hôpital Fernand-Widal
    284 schema:name Unité de Recherche Clinique, Hôpital Fernand Widal, Rue Ambroise Paré,Paris Cedex, 75475, France
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