Skip to main content

Fluid resuscitation based on dynamic predictors of fluid responsiveness: closed loop algorithm versus anesthesiologists

Introduction

Closed-loop management of fluid resuscitation has historically been difficult. Given the dynamic predictors of fluid responsiveness, automated management is now feasible. We present simulation data for a novel patient-adaptive closed-loop fluid management algorithm using pulse pressure variation (PPV) as the input variable.

Methods

Using a simulator that includes physiologic PPV output, 20 practicing anesthesiology residents and faculty were asked to manage fluids and pressors for a 1-hour simulated hemorrhage case of 2 l blood loss over 20 minutes (group 1). One week later, they repeated the simulation, but this time fluids were secretly managed by the closed-loop system while practitioner fluid administrations were ignored and only the pressors were entered (group 2). The simulation was also run 20 times with only the closed-loop (group 3) and 20 times with no management (group 4).

Results

Conditions across all groups were similar at baseline for simulated patient weight, height, heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO). Once the hemorrhage began, the closed loop groups (2 and 3) intervened significantly earlier than the practitioners (group 1) and gave more fluid. The mean and final CO was higher in both closed-loop groups than in the practitioner group, and the coefficient of variance was lower. There was no difference in MAP between intervention groups, but all were significantly higher than the unmanaged group. See Figure 1.

Figure 1
figure1

Data are mean ± SD. *P < 0.05 versus groups 2, 3, 4; **P < 0.05 versus groups 1 and 4.

Conclusions

Our data demonstrate that closed-loop management of fluid resuscitation is feasible using our novel dynamic-parameter based algorithm and that this approach can be used to optimize cardiac output.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J Rinehart.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Rinehart, J., Alexander, B., Meng, L. et al. Fluid resuscitation based on dynamic predictors of fluid responsiveness: closed loop algorithm versus anesthesiologists. Crit Care 15, P51 (2011). https://doi.org/10.1186/cc9471

Download citation

Keywords

  • Cardiac Output
  • Mean Arterial Pressure
  • Fluid Resuscitation
  • Fluid Responsiveness
  • Simulated Patient