Dataset Information

Automated closed-loop management of body temperature using forced-air blankets: preliminary feasibility study in a porcine model.

ABSTRACT:

Background

Management of a patient's body temperature is an important aspect of care that should be addressed by targeted temperature management (TTM). Often, non-invasive methods like forced-air blankets are used. Especially in the operating room this management may be a subsidiary and repetitive task requiring constant observation of the patient's body temperature and adaption using the limited set of available settings. Thus, automation of TTM is a feasible target to improve patient outcome and reduce caregiver workload.

Methods

A Philips IntelliVue MP 50 patient monitor with an arterial PiCCO catheter system was used to measure patient blood temperature. Thermal management was performed with a 3M Bair Hugger 755 warming unit with forced air blankets. The warming unit was extended by a computer interface to allow for remote and automated control. A proposed closed-loop algorithm reads the measured temperature and performs automated control of the 3M Bair Hugger. Evaluation was performed in an experimental intensive care setting for animal studies. Two fully automated trials are compared with two manual and two uncontrolled trials in the same study setting using six female pigs for prolonged observation times of up to 90 hours in each trial.

Results

The developed system and proposed algorithm allow more precise temperature management by keeping a set target temperature within a range of ±?0.5 °C in 88% of the observation time and within a range of ±?1.0 °C at all times. The proposed algorithm yielded better performance than did manual control or uncontrolled trials. It was able to adapt to individual patient needs as it is more dynamic than look-up table approaches with fixed settings for various temperatures.

Conclusions

Closed-loop TTM using non-invasive forced-air warming blankets was successfully tested in a porcine study with the proposed hardware interface and control algorithm. This automation can be beneficial for patient outcome and can reduce caregiver workload and patient risk in clinical settings. As temperature readings are most often available, existing devices like the 3M Bair Hugger can easily be expanded. However, even if clinical application is feasible, open questions regarding approval and certification of such automated systems within the current legal situation still need to be answered.

SUBMITTER: Peter J

PROVIDER: S-EPMC6029032 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Automated closed-loop management of body temperature using forced-air blankets: preliminary feasibility study in a porcine model.

Peter Jörg J Klingert Kathrin K Klingert Wilfried W Thiel Karolin K Königsrainer Alfred A Grasshoff Christian C Rosenstiel Wolfgang W Schenk Martin M

BMC anesthesiology 20180703 1

<h4>Background</h4>Management of a patient's body temperature is an important aspect of care that should be addressed by targeted temperature management (TTM). Often, non-invasive methods like forced-air blankets are used. Especially in the operating room this management may be a subsidiary and repetitive task requiring constant observation of the patient's body temperature and adaption using the limited set of available settings. Thus, automation of TTM is a feasible target to improve patient o ...[more]

PMID: 29969995

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Project description:BACKGROUND:Hypothermia is associated with many adverse clinical outcomes in pediatric patients, and thus, it is important to find an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients. This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-? (TGF-?), tumor necrosis factor (TNF)-?, interleukin (IL)-1?, and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip (DDH). METHODS:The study included 123 children undergoing surgery for DDH under general anesthesia. The patients were randomly assigned to three groups, using a random number table: the 32, 38, and 43°C groups according to the temperature setting of the forced-air warming blankets. For each patient, body temperature was recorded immediately after anesthesia induction and intubation (T0), at initial incision (T1), at 1 h after incision (T2), at 2 h after incision (T3), at the end of surgery (T4), immediately upon return to the ward after surgery (T5), and then at 12 h (T6), 24 h (T7), 36 h (T8), and 48 h (T9) after the surgery. The serum levels of TGF-?, TNF-?, IL-1?, and IL-10 were measured at T0 and T4 for all groups. RESULTS:The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups (??=?6.630, P?=?0.036). At T0, the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group (F?=?17.992, P?<?0.001). At T2, the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups (F?=?12.776, P?<?0.001). Moreover, at T4, the serum levels of TGF-? (F?=?3286.548, P?<?0.001) and IL-10 (F?=?4628.983, P?<?0.001) were significantly increased in the 38°C group, and the serum levels of TNF-? (F?=?911.415, P?<?0.001) and IL-1? (F?=?322.191, P?<?0.001) were significantly decreased in the 38°C group, compared with the levels in the 32 and 43°C groups. CONCLUSION:Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH. CLINICAL TRIAL REGISTRATION:ChiCTR1800014820; http://www.chictr.org.cn/showproj.aspx?proj=25240.

Project description:BackgroundHemodynamic resuscitation in septic shock requires aggressive fluid replacement and appropriate use of vasopressors to optimize arterial pressure (AP) and cardiac output (CO). Because responses to these drugs vary between patients and within patient over time, strict monitoring of patient condition and repetitive adjustment of drug dose are required. This task is time and labor consuming, and is associated with poor adherence to resuscitation guidelines. To overcome this issue, we developed a computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock, and evaluated the performance of the system in a canine model of endotoxin shock.MethodsOur system monitors AP, CO and central venous pressure, and computes arterial resistance (R), stressed blood volume (V) and Frank-Starling slope of left ventricle (S). The system controls R with noradrenaline (NA), and V with Ringer's acetate solution (RiA), thereby controlling AP and CO. In 4 dogs, AP and CO were measured invasively. In another 4 dogs, AP and CO were measured less invasively using clinically acceptable modalities, aiming to make the system clinically feasible. In all 8 dogs, endotoxin shock was induced by injecting Escherichia coli lipopolysaccharide, which significantly decreased AP from 95 (91-108) to 43 (39-45) mmHg, and CO from 112 (104-142) to 62 (51-73) ml·min-1·kg-1. The system was then connected to the dogs, and activated. System performance was observed over a period of 4 h.ResultsOur system immediately started infusions of NA and RiA. Within 40 min, RiA increased V to target level, and NA maintained R at target level, while S was concomitantly increased. These resulted in restoration of AP to 70 (69-71) mmHg and CO to 130 (125-138) ml·min-1·kg-1. Median of absolute performance error, an index of precision of control, was small in AP [2.5 (2.1-4.5) %] and CO [2.4 (1.4-5.5) %], which were not increased even when the variables were measured less invasively.ConclusionsIn a canine model of endotoxin shock, our system automatically improved and maintained AP and CO at their target values with small performance error. Our system is potentially an attractive clinical tool for rescuing patients with septic shock.

Dataset Information

Automated closed-loop management of body temperature using forced-air blankets: preliminary feasibility study in a porcine model.

Background

Methods

Results

Conclusions

Publications

Automated closed-loop management of body temperature using forced-air blankets: preliminary feasibility study in a porcine model.

Similar Datasets

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