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Verfasst von:Hundeshagen, Gabriel [VerfasserIn]   i
 Kramer, George [VerfasserIn]   i
 Ribeiro Marques, Nicole [VerfasserIn]   i
 Salter, Michael G. [VerfasserIn]   i
 Koutrouvelis, Aristides K. [VerfasserIn]   i
 Li, Husong [VerfasserIn]   i
 Solanki, Daneshvari R. [VerfasserIn]   i
 Indrikovs, Alexander [VerfasserIn]   i
 Seeton, Roger [VerfasserIn]   i
 Henkel, Sheryl N. [VerfasserIn]   i
 Kinsky, Michael P. [VerfasserIn]   i
Titel:Closed-loop- and decision-assist-guided fluid therapy of human hemorrhagesc
Verf.angabe:Gabriel Hundeshagen, MD; George C. Kramer, PhD; Nicole Ribeiro Marques, MD; Michael G. Salter, MS; Aristides K. Koutrouvelis, MD; Husong Li, MD PhD; Daneshvari R. Solanki, MD; Alexander Indrikovs, MD; Roger Seeton, RN; Sheryl N. Henkel, RN; Michael P. Kinsky, MD
Jahr:2017
Umfang:7 S.
Fussnoten:Gesehen am 05.08.2021
Titel Quelle:Enthalten in: Critical care medicine
Ort Quelle:Hagerstown, Md. : Lippincott Williams & Wilkins, 1973
Jahr Quelle:2017
Band/Heft Quelle:45(2017), 10, Seite e1068-e1074
ISSN Quelle:1530-0293
Abstract:Objectives: - We sought to evaluate the efficacy, efficiency, and physiologic consequences of automated, endpoint-directed resuscitation systems and compare them to formula-based bolus resuscitation. - Design: - Experimental human hemorrhage and resuscitation. - Setting: - Clinical research laboratory. - Subjects: - Healthy volunteers. - Interventions: - Subjects (n = 7) were subjected to hemorrhage and underwent a randomized fluid resuscitation scheme on separate visits 1) formula-based bolus resuscitation; 2) semiautonomous (decision assist) fluid administration; and 3) fully autonomous (closed loop) resuscitation. Hemodynamic variables, volume shifts, fluid balance, and cardiac function were monitored during hemorrhage and resuscitation. Treatment modalities were compared based on resuscitation efficacy and efficiency. - Measurements and Main Results: - All approaches achieved target blood pressure by 60 minutes. Following hemorrhage, the total amount of infused fluid (bolus resuscitation: 30 mL/kg, decision assist: 5.6 ± 3 mL/kg, closed loop: 4.2 ± 2 mL/kg; p < 0.001), plasma volume, extravascular volume (bolus resuscitation: 17 ± 4 mL/kg, decision assist: 3 ± 1 mL/kg, closed loop: -0.3 ± 0.3 mL/kg; p < 0.001), body weight, and urinary output remained stable under decision assist and closed loop and were significantly increased under bolus resuscitation. Mean arterial pressure initially decreased further under bolus resuscitation (-10 mm Hg; p < 0.001) and was lower under bolus resuscitation than closed loop at 20 minutes (bolus resuscitation: 57 ± 2 mm Hg, closed loop: 69 ± 4 mm Hg; p = 0.036). Colloid osmotic pressure (bolus resuscitation: 19.3 ± 2 mm Hg, decision assist, closed loop: 24 ± 0.4 mm Hg; p < 0.05) and hemoglobin concentration were significantly decreased after bolus fluid administration. - Conclusions: - We define efficacy of decision-assist and closed-loop resuscitation in human hemorrhage. In comparison with formula-based bolus resuscitation, both semiautonomous and autonomous approaches were more efficient in goal-directed resuscitation of hemorrhage. They provide favorable conditions for the avoidance of over-resuscitation and its adverse clinical sequelae. Decision-assist and closed-loop resuscitation algorithms are promising technological solutions for constrained environments and areas of limited resources.
DOI:doi:10.1097/CCM.0000000000002593
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext: https://doi.org/10.1097/CCM.0000000000002593
 Volltext: https://journals.lww.com/ccmjournal/Fulltext/2017/10000/Closed_Loop__and_Decision_Assist_Guided_Fluid.48.aspx
 DOI: https://doi.org/10.1097/CCM.0000000000002593
Datenträger:Online-Ressource
Sprache:eng
K10plus-PPN:176565887X
Verknüpfungen:→ Zeitschrift

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