NDLI: Is there opportunity for automated decision-support and closed-loop control in ICU patients receiving vasopressor infusion?

Content Provider	IEEE Xplore Digital Library
Author	Bighamian, R. Rubbo, C. Thorsen, J.E. Jin-Oh Hahn Reisner, A.T.
Copyright Year	2014
Description	Author affiliation: Dept. of Mech. Eng., Univ. of Maryland, College Park, MD, USA (Bighamian, R.; Rubbo, C.; Jin-Oh Hahn) \|\| Dept. of Emergency Med., Massachusetts Gen. Hosp., Boston, MA, USA (Thorsen, J.E.; Reisner, A.T.)
Abstract	Vasopressors are administered to critically ill patients suffering from a body-wide reduction in blood circulation. In theory, if the vasopressor infusion is either too high or too low, it could be harmful to the patient. In a retrospective analysis, we investigated the degree to which today's intensive care unit (ICU) patients receive appropriate vasopressor therapy, in terms of how often the mean arterial pressure (MAP) was kept within a normative range. Using the MIMIC II database, we studied patients with minute-by-minute MAP data, sourced from the bedside monitor, who were receiving vasopressor therapy. For each record, we identified MAP samples that were out-of-range, i.e., MAP <; 60 mmHg or MAP > 100 mmHg, and grouped these into out-of-range episodes. Each out-of-range episode was categorized as either transient (<; 15 min) or sustained (≥ 15 min). Out of the 224 ICU stays, we identified 152 ICU stays (68% of ICU stays) with at least one sustained MAP out-of-range episode. In that subset, MAP was frequently out-of-range (out-of-range 18.4% of the time) due to a combination of sustained episodes of hypotension and hypertension. Compared with all ICU stays, those stays with sustained out-of-range events did not demonstrate an increased MAP variability per hour. It is possible that the out-of-range events resulted from insufficient dose-adjustment. Technologies that might continuously optimize vasopressor dosing throughout the patient's stay and thereby minimize these abnormal cardiovascular states may be worthy of further study.
Sponsorship	IEEE Eng. Med. Biol. Soc.
Starting Page	1949
Ending Page	1952
File Size	768068
Page Count	4
File Format	PDF
ISBN	9781424479290
ISSN	1557170X
DOI	10.1109/EMBC.2014.6943994
Language	English
Publisher	Institute of Electrical and Electronics Engineers, Inc. (IEEE)
Publisher Date	2014-08-26
Publisher Place	USA
Access Restriction	Subscribed
Rights Holder	Institute of Electrical and Electronics Engineers, Inc. (IEEE)
Subject Keyword	Medical treatment Databases Transient analysis Educational institutions Biomedical monitoring Electronic mail Electric shock
Content Type	Text
Resource Type	Article
Subject	Signal Processing Biomedical Engineering Health Informatics Computer Vision and Pattern Recognition

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