Closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock

Abstract

Hemodynamic resuscitation in septic shock requires aggressive fluid replacements and appropriate use of vasopressors to optimize arterial pressure (AP) and cardiac output (CO). This is time/labor consuming task, because strict hemodynamic monitoring and repetitive adjustment of drug dose are required. To overcome this, we have developed a closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock, and validated performance of the system in 8 dogs with endotoxin shock. Our system computes arterial resistance (R) and stressed blood volume (V) from AP and CO. Our system controls R with noradrenaline, and V with Ringer's solution, thereby controlling AP and CO. Once activated in dogs with shock (AP=42±5 mmHg, CO=60±17 ml/min/kg), our system automatically restored AP to 70±2 mmHg and CO to 130±10 ml/min/kg within 40 min, and maintained them over 4 hours. We conclude that our system could be an attractive clinical tool in rescuing patients with septic shock.