Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine.
Journal
Journal of clinical monitoring and computing
ISSN: 1573-2614
Titre abrégé: J Clin Monit Comput
Pays: Netherlands
ID NLM: 9806357
Informations de publication
Date de publication:
06 Jan 2024
06 Jan 2024
Historique:
received:
23
09
2023
accepted:
21
11
2023
medline:
7
1
2024
pubmed:
7
1
2024
entrez:
6
1
2024
Statut:
aheadofprint
Résumé
A closed-loop automatically controls a variable using the principle of feedback. Automation within anesthesia typically aims to improve the stability of a controlled variable and reduce workload associated with simple repetitive tasks. This approach attempts to limit errors due to distractions or fatigue while simultaneously increasing compliance to evidence based perioperative protocols. The ultimate goal is to use these advantages over manual care to improve patient outcome. For more than twenty years, clinical studies in anesthesia have demonstrated the superiority of closed-loop systems compared to manual control for stabilizing a single variable, reducing practitioner workload, and safely administering therapies. This research has focused on various closed-loops that coupled inputs and outputs such as the processed electroencephalogram with propofol, blood pressure with vasopressors, and dynamic predictors of fluid responsiveness with fluid therapy. Recently, multiple simultaneous independent closed-loop systems have been tested in practice and one study has demonstrated a clinical benefit on postoperative cognitive dysfunction. Despite their advantages, these tools still require that a well-trained practitioner maintains situation awareness, understands how closed-loop systems react to each variable, and is ready to retake control if the closed-loop systems fail. In the future, multiple input multiple output closed-loop systems will control anesthetic, fluid and vasopressor titration and may perhaps integrate other key systems, such as the anesthesia machine. Human supervision will nonetheless always be indispensable as situation awareness, communication, and prediction of events remain irreplaceable human factors.
Identifiants
pubmed: 38184504
doi: 10.1007/s10877-023-01111-4
pii: 10.1007/s10877-023-01111-4
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature B.V.
Références
Zaouter C, Joosten A, Rinehart J, Struys M, Hemmerling TM. Autonomous systems in anesthesia: where do we stand in 2020? A narrative review. Anesth Analg. 2020;130(5):1120–32.
pubmed: 32287120
doi: 10.1213/ANE.0000000000004646
Mortier E, Struys M, De Smet T, Versichelen L, Rolly G. Closed-loop controlled administration of propofol using bispectral analysis. Anaesthesia. 1998;53(8):749–54.
pubmed: 9797518
doi: 10.1046/j.1365-2044.1998.00467.x
Absalom AR, Sutcliffe N, Kenny GN. Closed-loop control of anesthesia using Bispectral index: performance assessment in patients undergoing major orthopedic surgery under combined general and regional anesthesia. Anesthesiology. 2002;96(1):67–73.
pubmed: 11753004
doi: 10.1097/00000542-200201000-00017
Liu N, Chazot T, Genty A, Landais A, Restoux A, McGee K, Laloë PA, Trillat B, Barvais L, Fischler M. Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: closed-loop versus manual control: a prospective, randomized, multicenter study. Anesthesiology. 2006;104(4):686–95.
pubmed: 16571963
doi: 10.1097/00000542-200604000-00012
Coeckelenbergh S, Zaouter C, Alexander B, Cannesson M, Rinehart J, Duranteau J, Van der Linden P, Joosten A. Automated systems for perioperative goal-directed hemodynamic therapy. J Anesth. 2020;34(1):104–14.
pubmed: 31555916
doi: 10.1007/s00540-019-02683-9
Coeckelenbergh S, Joosten A, Cannesson M, Rinehart J. Closing the loop: automation in anesthesiology is coming. J Clin Monit Comput. 2023. https://doi.org/10.1007/s10877-023-01077-3 .
doi: 10.1007/s10877-023-01077-3
pubmed: 38108944
Spataru A, Eiben P, Pluddemann A. Performance of closed-loop systems for intravenous drug administration: a systematic review and meta-analysis of randomised controlled trials. J Clin Monit Comput. 2023. https://doi.org/10.1007/s10877-023-01069-3 .
doi: 10.1007/s10877-023-01069-3
pubmed: 37695449
Bodson M. Foundations of Control Engineering. Amazon; 2020.
Mohamed MAE, Jagatheesan K, Anand B. Modern PID/FOPID controllers for frequency regulation of interconnected power system by considering different cost functions. Sci Rep. 2023;13(1):14084.
pubmed: 37640919
pmcid: 10462752
doi: 10.1038/s41598-023-41024-5
Rinehart J, Coeckelenbergh S, Srivastava I, Cannesson M, Joosten A. Physiological modeling of hemodynamic responses to sodium nitroprusside. J Pers Med. 2023;13(7):1101.
pubmed: 37511714
pmcid: 10381667
doi: 10.3390/jpm13071101
Rinehart J, Lee C, Cannesson M, Dumont G. Closed-loop fluid resuscitation: robustness against weight and cardiac contractility variations. Anesth Analg. 2013;117(5):1110–8.
pubmed: 23835454
doi: 10.1213/ANE.0b013e3182930050
Hill BL, Rakocz N, Rudas Á, Chiang JN, Wang S, Hofer I, Cannesson M, Halperin E. Imputation of the continuous arterial line blood pressure waveform from non-invasive measurements using deep learning. Sci Rep. 2021;11(1):15755.
pubmed: 34344934
pmcid: 8333060
doi: 10.1038/s41598-021-94913-y
Alzubaidi L, Zhang J, Humaidi AJ, Al-Dujaili A, Duan Y, Al-Shamma O, Santamaría J, Fadhel MA, Al-Amidie M, Farhan L. Review of deep learning: concepts, CNN architectures, challenges, applications, future directions. J Big Data. 2021;8(1):53.
pubmed: 33816053
pmcid: 8010506
doi: 10.1186/s40537-021-00444-8
Coeckelenbergh S, Sessler DI, Doria S, Patricio D, Jaubert L, Huybrechts I, Stefanidis C, Kapessidou P, Tuna T, Engelman E, et al. Nociception level index-guided antinociception versus routine care during remifentanil-propofol anaesthesia for moderate-to-high risk cardiovascular surgery: a randomized trial. Eur J Anaesthesiol. 2023;40(10):790–3.
pubmed: 37497778
doi: 10.1097/EJA.0000000000001892
Perrin L, Bisdorff M, Saxena S, Tabolcea I, Huybrechts I, Van Obbergh L, Engelman E, Barvais L, Coeckelenbergh S. Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index: a prospective calibration and validation study. Eur J Anaesthesiol. 2022;39(12):918–27.
pubmed: 36125017
doi: 10.1097/EJA.0000000000001751
Coeckelenbergh S, Doria S, Patricio D, Perrin L, Engelman E, Rodriguez A, Di Marco L, Van Obbergh L, Estebe JP, Barvais L, Kapessidou P. Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception: a randomised controlled trial. Eur J Anaesthesiol. 2021;38(5):524–33.
pubmed: 33259449
doi: 10.1097/EJA.0000000000001402
Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311(21):2181–90.
pubmed: 24842135
doi: 10.1001/jama.2014.5305
Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, Kronzer A, McKinnon SL, Park D, Torres BA, et al. Effect of electroencephalography—guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: the ENGAGES randomized clinical trial. JAMA. 2019;321(5):473–83.
pubmed: 30721296
pmcid: 6439616
doi: 10.1001/jama.2018.22005
Puri GD, Mathew PJ, Biswas I, Dutta A, Sood J, Gombar S, Palta S, Tsering M, Gautam PL, Jayant A, et al. A multicenter evaluation of a closed-loop anesthesia delivery system: a randomized controlled trial. Anesth Analg. 2016;122(1):106–14.
pubmed: 25902324
doi: 10.1213/ANE.0000000000000769
Gregory A, Stapelfeldt WH, Khanna AK, Smischney NJ, Boero IJ, Chen Q, Stevens M, Shaw AD. Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery. Anesth Analg. 2021;132(6):1654–65.
pubmed: 33177322
doi: 10.1213/ANE.0000000000005250
Joosten A, Lucidi V, Ickx B, Van Obbergh L, Germanova D, Berna A, Alexander B, Desebbe O, Carrier FM, Cherqui D, et al. Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study. BMC Anesthesiol. 2021;21(1):12.
pubmed: 33430770
pmcid: 7798188
doi: 10.1186/s12871-020-01228-y
Interim Report n°3 On the accident on 1st June 2009 to the Airbus A330-203 registered F-GZCP operated by Air France flight AF 447 Rio de Janeiro—Paris. In: Bureau d’Enquêtes et d’Analyses pour la sécurité de l’aviation civile. June 2009.
Okabayashi T, Hnazaki K, Nishimori I, Sugimoto T, Maeda H, Yatabe T, Dabanaka K, Kobayashi M, Yamashita K. Continuous post-operative blood glucose monitoring and control using a closed-loop system in patients undergoing hepatic resection. Dig Dis Sci. 2008;53(5):1405–10.
pubmed: 17934862
doi: 10.1007/s10620-007-0010-3
Hasegawa A, Iwasaka H, Hagiwara S, Koga H, Hasegawa R, Kudo K, Kusaka J, Noguchi T. Anti-inflammatory effects of perioperative intensive insulin therapy during cardiac surgery with cardiopulmonary bypass. Surg Today. 2011;41(10):1385–90.
pubmed: 21922361
doi: 10.1007/s00595-010-4458-y
Claure N, Bancalari E, D’Ugard C, Nelin L, Stein M, Ramanathan R, Hernandez R, Donn SM, Becker M, Bachman T. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics. 2011;127(1):e76-83.
pubmed: 21187305
doi: 10.1542/peds.2010-0939
Schwilden H, Schüttler J, Stoeckel H. Closed-loop feedback control of methohexital anesthesia by quantitative EEG analysis in humans. Anesthesiology. 1987;67(3):341–7.
pubmed: 3631609
doi: 10.1097/00000542-198709000-00011
Schwilden H, Stoeckel H, Schüttler J. Closed-loop feedback control of propofol anaesthesia by quantitative EEG analysis in humans. Br J Anaesth. 1989;62(3):290–6.
pubmed: 2784685
doi: 10.1093/bja/62.3.290
Puri GD, Kumar B, Aveek J. Closed-loop anaesthesia delivery system (CLADS) using bispectral index: a performance assessment study. Anaesth Intensive Care. 2007;35(3):357–62.
pubmed: 17591128
doi: 10.1177/0310057X0703500306
Liu N, Chazot T, Trillat B, Pirracchio R, Law-Koune JD, Barvais L, Fischler M. Feasibility of closed-loop titration of propofol guided by the Bispectral Index for general anaesthesia induction: a prospective randomized study. Eur J Anaesthesiol. 2006;23(6):465–9.
pubmed: 16672092
doi: 10.1017/S0265021506000196
Struys MM, De Smet T, Versichelen LF, Van De Velde S, Van den Broecke R, Mortier EP. Comparison of closed-loop controlled administration of propofol using Bispectral Index as the controlled variable versus “standard practice” controlled administration. Anesthesiology. 2001;95(1):6–17.
pubmed: 11465585
doi: 10.1097/00000542-200107000-00007
Liu N, Le Guen M, Benabbes-Lambert F, Chazot T, Trillat B, Sessler DI, Fischler M. Feasibility of closed-loop titration of propofol and remifentanil guided by the spectral M-Entropy monitor. Anesthesiology. 2012;116(2):286–95.
pubmed: 22222478
doi: 10.1097/ALN.0b013e318242ad4f
West N, Dumont GA, van Heusden K, Petersen CL, Khosravi S, Soltesz K, Umedaly A, Reimer E, Ansermino JM. Robust closed-loop control of induction and maintenance of propofol anesthesia in children. Paediatr Anaesth. 2013;23(8):712–9.
pubmed: 23668370
doi: 10.1111/pan.12183
Castellanos Peñaranda C, Casas Arroyave FD, Gómez FJ, Pinzón Corredor PA, Fernández JM, Velez Botero M, Bohórquez Bedoya JD, Marulanda Toro C. Technical and clinical evaluation of a closed loop TIVA system with SEDLine(TM) spectral density monitoring: multicentric prospective cohort study. Perioper Med. 2020;9:1.
doi: 10.1186/s13741-019-0130-2
Pasin L, Nardelli P, Pintaudi M, Greco M, Zambon M, Cabrini L, Zangrillo A. Closed-loop delivery systems versus manually controlled administration of total IV anesthesia: a meta-analysis of randomized clinical trials. Anesth Analg. 2017;124(2):456–64.
pubmed: 28099320
doi: 10.1213/ANE.0000000000001394
Brogi E, Cyr S, Kazan R, Giunta F, Hemmerling TM. Clinical performance and safety of closed-loop systems: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2017;124(2):446–55.
pubmed: 27482773
doi: 10.1213/ANE.0000000000001372
Dussaussoy C, Peres M, Jaoul V, Liu N, Chazot T, Picquet J, Fischler M, Beydon L. Automated titration of propofol and remifentanil decreases the anesthesiologist’s workload during vascular or thoracic surgery: a randomized prospective study. J Clin Monit Comput. 2014;28(1):35–40.
pubmed: 23494090
doi: 10.1007/s10877-013-9453-6
Bonhomme V, Deflandre E, Hans P. Correlation and agreement between bispectral index and state entropy of the electroencephalogram during propofol anaesthesia. Br J Anaesth. 2006;97(3):340–6.
pubmed: 16829672
doi: 10.1093/bja/ael171
Hans P, Dewandre PY, Brichant JF, Bonhomme V. Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth. 2005;94(3):336–40.
pubmed: 15591328
doi: 10.1093/bja/aei047
Pandin P, Van Cutsem N, Tuna T, D’Hollander A. Bispectral index is a topographically dependent variable in patients receiving propofol anaesthesia. Br J Anaesth. 2006;97(5):676–80.
pubmed: 16928697
doi: 10.1093/bja/ael235
Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassonyi E. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Br J Anaesth. 2001;86(4):523–7.
pubmed: 11573626
doi: 10.1093/bja/86.4.523
Hans P, Giwer J, Brichant JF, Dewandre PY, Bonhomme V. Effect of an intubation dose of rocuronium on Spectral Entropy and Bispectral Index responses to laryngoscopy during propofol anaesthesia. Br J Anaesth. 2006;97(6):842–7.
pubmed: 16997837
doi: 10.1093/bja/ael253
Lobo FA, Schraag S. Limitations of anaesthesia depth monitoring. Curr Opin Anaesthesiol. 2011;24(6):657–64.
pubmed: 21971394
doi: 10.1097/ACO.0b013e32834c7aba
Dahaba AA. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg. 2005;101(3):765–73.
pubmed: 16115989
doi: 10.1213/01.ane.0000167269.62966.af
Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical electroencephalography for anesthesiologists: part I: background and basic signatures. Anesthesiology. 2015;123(4):937–60.
pubmed: 26275092
doi: 10.1097/ALN.0000000000000841
Faraoni D, Salengros JC, Engelman E, Ickx B, Barvais L. Ketamine has no effect on bispectral index during stable propofol-remifentanil anaesthesia. Br J Anaesth. 2009;102(3):336–9.
pubmed: 19189986
doi: 10.1093/bja/aen403
Schnetz MP, Reon BJ, Ibinson JW, Kaynar M, Mahajan A, Vogt KM. Bispectral index changes following boluses of commonly used intravenous medications during volatile anesthesia identified from retrospective data. Anesth Analg. 2023. https://doi.org/10.1213/ANE.0000000000006633 .
doi: 10.1213/ANE.0000000000006633
pubmed: 37712482
Shao YR, Kahali P, Houle TT, Deng H, Colvin C, Dickerson BC, Brown EN, Purdon PL. Low frontal alpha power is associated with the propensity for burst suppression: an electroencephalogram phenotype for a “vulnerable brain.” Anesth Analg. 2020;131(5):1529–39.
pubmed: 33079876
pmcid: 7553194
doi: 10.1213/ANE.0000000000004781
Khalifa C, Lenoir C, Robert A, Watremez C, Kahn D, Mastrobuoni S, Aphram G, Ivanoiu A, Bonhomme V, Mouraux A, Momeni M. Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: a prospective cohort study. Eur J Anaesthesiol. 2023;40(10):777–87.
pubmed: 37551153
doi: 10.1097/EJA.0000000000001895
Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth. 2019;123(2):e312–21.
pubmed: 31047645
pmcid: 6676047
doi: 10.1016/j.bja.2019.03.024
Coeckelenbergh S, Richebé P, Longrois D, Joosten A, De Hert S. Current trends in anesthetic depth and antinociception monitoring: an international survey. J Clin Monit Comput. 2022;36(5):1407–22.
pubmed: 34826017
doi: 10.1007/s10877-021-00781-2
Luginbühl M, Bieniok C, Leibundgut D, Wymann R, Gentilini A, Schnider TW. Closed-loop control of mean arterial blood pressure during surgery with Alfentanil: clinical evaluation of a novel model-based predictive controller. Anesthesiology. 2006;105(3):462–70.
pubmed: 16931977
doi: 10.1097/00000542-200609000-00008
Liu N, Chazot T, Hamada S, Landais A, Boichut N, Dussaussoy C, Trillat B, Beydon L, Samain E, Sessler DI, Fischler M. Closed-loop coadministration of propofol and remifentanil guided by bispectral index: a randomized multicenter study. Anesth Analg. 2011;112(3):546–57.
pubmed: 21233500
doi: 10.1213/ANE.0b013e318205680b
Le Guen M, Liu N, Bourgeois E, Chazot T, Sessler DI, Rouby JJ, Fischler M. Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial. Intensive Care Med. 2013;39(3):454–62.
pubmed: 23223772
doi: 10.1007/s00134-012-2762-2
Hemmerling TM, Arbeid E, Wehbe M, Cyr S, Taddei R, Zaouter C. Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: a randomized controlled trial. Br J Anaesth. 2013;110(6):1031–9.
pubmed: 23427212
doi: 10.1093/bja/aet001
De jonckheere J, Jeanne M, Keribedj A, Couturier N, Logier R. Automated analgesic drugs delivery guided by vagal tone evaluation: interest of the Analgesia Nociception Index (ANI). In: 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp. 1952–5.
Pohl B, Hofmockel R, Simanski O, Wende K, Lampe BP. Feedback control of muscle relaxation with a varying on-off controller using cisatracurium. Anaesthesist. 2004;53(1):66–72.
pubmed: 14749879
doi: 10.1007/s00101-003-0605-9
Eleveld DJ, Proost JH, Wierda J. Evaluation of a closed-loop muscle relaxation control system. Anesth Analg. 2005;101(3):758–64.
pubmed: 16115988
doi: 10.1213/01.ane.0000167069.54613.50
Michard F, Chemla D, Teboul JL. Applicability of pulse pressure variation: how many shades of grey? Crit Care. 2015;19(1):144.
pubmed: 25887325
pmcid: 4372274
doi: 10.1186/s13054-015-0869-x
Cannesson M, Ramsingh D, Rinehart J, Demirjian A, Vu T, Vakharia S, Imagawa D, Yu Z, Greenfield S, Kain Z. Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study. Crit Care. 2015;19(1):261.
pubmed: 26088649
pmcid: 4512146
doi: 10.1186/s13054-015-0945-2
Joosten A, Coeckelenbergh S, Delaporte A, Ickx B, Closset J, Roumeguere T, Barvais L, Van Obbergh L, Cannesson M, Rinehart J, Van der Linden P. Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery: a case-control study with propensity matching. Eur J Anaesthesiol. 2018;35(9):650–8.
pubmed: 29750699
doi: 10.1097/EJA.0000000000000827
Chong MA, Wang Y, Berbenetz NM, McConachie I. Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes? A systematic review and meta-analysis. Eur J Anaesthesiol. 2018;35(7):469–83.
pubmed: 29369117
doi: 10.1097/EJA.0000000000000778
Hammond JJ, Kirkendall WM, Calfee RV. Hypertensive crisis managed by computer controlled infusion of sodium nitroprusside: a model for the closed loop administration of short acting vasoactive agents. Comput Biomed Res. 1979;12(2):97–108.
pubmed: 428218
doi: 10.1016/0010-4809(79)90008-9
Futier E, Lefrant JY, Guinot PG, Godet T, Lorne E, Cuvillon P, Bertran S, Leone M, Pastene B, Piriou V, et al. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA. 2017;318(14):1346–57.
pubmed: 28973220
pmcid: 5710560
doi: 10.1001/jama.2017.14172
Ngan Kee WD, Khaw KS, Ng FF, Tam YH. Randomized comparison of closed-loop feedback computer-controlled with manual-controlled infusion of phenylephrine for maintaining arterial pressure during spinal anaesthesia for caesarean delivery. Br J Anaesth. 2013;110(1):59–65.
pubmed: 23015618
doi: 10.1093/bja/aes339
Ngan Kee WD, Tam YH, Khaw KS, Ng FF, Lee SWY. Closed-loop feedback computer-controlled phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery: a randomized trial comparing automated boluses versus infusion. Anesth Analg. 2017;125(1):117–23.
pubmed: 28368936
doi: 10.1213/ANE.0000000000001974
Joosten A, Chirnoaga D, Van der Linden P, Barvais L, Alexander B, Duranteau J, Vincent JL, Cannesson M, Rinehart J. Automated closed-loop versus manually controlled norepinephrine infusion in patients undergoing intermediate- to high-risk abdominal surgery: a randomised controlled trial. Br J Anaesth. 2021;126(1):210–8.
pubmed: 33041014
doi: 10.1016/j.bja.2020.08.051
Desebbe O, Rinehart J, Van der Linden P, Cannesson M, Delannoy B, Vigneron M, Curtil A, Hautin E, Vincent JL, Duranteau J, Joosten A. Control of postoperative hypotension using a closed-loop system for norepinephrine infusion in patients after cardiac surgery: a randomized trial. Anesth Analg. 2022;134(5):964–73.
pubmed: 35061635
pmcid: 9808983
doi: 10.1213/ANE.0000000000005888
Joosten A, Delaporte A, Cannesson M, Rinehart J, Dewilde JP, Van Obbergh L, Barvais L. Fully automated anesthesia and fluid management using multiple physiologic closed-loop systems in a patient undergoing high-risk surgery. A A Case Rep. 2016;7(12):260–5.
pubmed: 27669030
doi: 10.1213/XAA.0000000000000405
Joosten A, Jame V, Alexander B, Chazot T, Liu N, Cannesson M, Rinehart J, Barvais L. Feasibility of fully automated hypnosis, analgesia, and fluid management using 2 independent closed-loop systems during major vascular surgery: a pilot study. Anesth Analg. 2019;128(6):e88–92.
pubmed: 31094779
doi: 10.1213/ANE.0000000000003433
Joosten A, Rinehart J, Bardaji A, Van der Linden P, Jame V, Van Obbergh L, Alexander B, Cannesson M, Vacas S, Liu N, et al. Anesthetic management using multiple closed-loop systems and delayed neurocognitive recovery: a randomized controlled trial. Anesthesiology. 2020;132(2):253–66.
pubmed: 31939839
doi: 10.1097/ALN.0000000000003014
Libert N, Chenegros G, Harrois A, Baudry N, Decante B, Cordurie G, Benosman R, Mercier O, Vicaut E, Duranteau J. Performance of closed-loop resuscitation in a pig model of haemorrhagic shock with fluid alone or in combination with norepinephrine, a pilot study. J Clin Monit Comput. 2021;35(4):835–47.
pubmed: 32533529
doi: 10.1007/s10877-020-00542-7
Libert N, Chenegros G, Harrois A, Baudry N, Cordurie G, Benosman R, Vicaut E, Duranteau J. Performance of closed-loop resuscitation of haemorrhagic shock with fluid alone or in combination with norepinephrine: an experimental study. Ann Intensive Care. 2018;8(1):89.
pubmed: 30225814
pmcid: 6141407
doi: 10.1186/s13613-018-0436-0
Kouz K, Monge García MI, Cerutti E, Lisanti I, Draisci G, Frassanito L, Sander M, Ali Akbari A, Frey UH, Grundmann CD, et al. Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT). BJA Open. 2023;6:100140.
pubmed: 37588176
pmcid: 10430826
doi: 10.1016/j.bjao.2023.100140
Parvinian B, Scully C, Wiyor H, Kumar A, Weininger S. Regulatory considerations for physiological closed-loop controlled medical devices used for automated critical care: food and drug administration workshop discussion topics. Anesth Analg. 2018;126(6):1916–25.
pubmed: 28763355
pmcid: 6233305
doi: 10.1213/ANE.0000000000002329
Nielsen AH, Karbing DS, Sølling CG, Winding RR, Rees SE, Dey N. Efficacy of an automated secretion removal technology at different inspiratory pressures. Respir Care. 2023;68(11):1502–9.
pubmed: 37117014
doi: 10.4187/respcare.10850
Neuschwander A, Chhor V, Yavchitz A, Resche-Rigon M, Pirracchio R. Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis. J Crit Care. 2021;61:191–8.
pubmed: 33181416
doi: 10.1016/j.jcrc.2020.10.025
Grieco DL, Bitondo MM, Aguirre-Bermeo H, Italiano S, Idone FA, Moccaldo A, Santantonio MT, Eleuteri D, Antonelli M, Mancebo J, Maggiore SM. Patient-ventilator interaction with conventional and automated management of pressure support during difficult weaning from mechanical ventilation. J Crit Care. 2018;48:203–10.
pubmed: 30240991
doi: 10.1016/j.jcrc.2018.08.043
Rose L, Presneill JJ, Johnston L, Cade JF. A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS. Intensive Care Med. 2008;34(10):1788–95.
pubmed: 18575843
doi: 10.1007/s00134-008-1179-4
Kantrowitz A, Freed PS, Cardona RR, Gage K, Marinescu GN, Westveld AH, Litch B, Suzuki A, Hayakawa H, Takano T, et al. Initial clinical trial of a closed loop, fully automatic intra-aortic balloon pump. ASAIO J. 1992;38(3):M617-621.
pubmed: 1457934
doi: 10.1097/00002480-199207000-00110
Zelano JA, Li JK, Welkowitz W. A closed-loop control scheme for intraaortic balloon pumping. IEEE Trans Biomed Eng. 1990;37(2):182–92.
pubmed: 2312143
doi: 10.1109/10.46258
Goudra B, Singh PM. Failure of Sedasys: destiny or poor design? Anesth Analg. 2017;124(2):686–8.
pubmed: 27861440
doi: 10.1213/ANE.0000000000001643
De Smet T, Struys MM, Neckebroek MM, Van den Hauwe K, Bonte S, Mortier EP. The accuracy and clinical feasibility of a new Bayesian-based closed-loop control system for propofol administration using the bispectral index as a controlled variable. Anesth Analg. 2008;107(4):1200–10.
pubmed: 18806028
doi: 10.1213/ane.0b013e31817bd1a6
Agarwal J, Puri GD, Mathew PJ. Comparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgery. Acta Anaesthesiol Scand. 2009;53(3):390–7.
pubmed: 19243324
doi: 10.1111/j.1399-6576.2008.01884.x
Hemmerling TM, Charabati S, Zaouter C, Minardi C, Mathieu PA. A randomized controlled trial demonstrates that a novel closed-loop propofol system performs better hypnosis control than manual administration. Can J Anaesth. 2010;57(8):725–35.
pubmed: 20533013
doi: 10.1007/s12630-010-9335-z
Biswas I, Mathew PJ, Singh RS, Puri GD. Evaluation of closed-loop anesthesia delivery for propofol anesthesia in pediatric cardiac surgery. Paediatr Anaesth. 2013;23(12):1145–52.
pubmed: 24118468
doi: 10.1111/pan.12265
Orliaguet GA, Benabbes Lambert F, Chazot T, Glasman P, Fischler M, Liu N. Feasibility of closed-loop titration of propofol and remifentanil guided by the bispectral monitor in pediatric and adolescent patients: a prospective randomized study. Anesthesiology. 2015;122(4):759–67.
pubmed: 25545655
doi: 10.1097/ALN.0000000000000577
Kenny GN, Mantzaridis H. Closed-loop control of propofol anaesthesia. Br J Anaesth. 1999;83(2):223–8.
pubmed: 10618933
doi: 10.1093/bja/83.2.223
Rinehart J, Alexander B, Le Manach Y, Hofer C, Tavernier B, Kain ZN, Cannesson M. Evaluation of a novel closed-loop fluid-administration system based on dynamic predictors of fluid responsiveness: an in silico simulation study. Crit Care. 2011;15(6):R278.
pubmed: 22112587
pmcid: 3388660
doi: 10.1186/cc10562
Rinehart J, Lee C, Canales C, Kong A, Kain Z, Cannesson M. Closed-loop fluid administration compared to anesthesiologist management for hemodynamic optimization and resuscitation during surgery: an in vivo study. Anesth Analg. 2013;117(5):1119–29.
pubmed: 23835453
doi: 10.1213/ANE.0b013e3182937d61
Rinehart J, Chung E, Canales C, Cannesson M. Intraoperative stroke volume optimization using stroke volume, arterial pressure, and heart rate: closed-loop (learning intravenous resuscitator) versus anesthesiologists. J Cardiothorac Vasc Anesth. 2012;26(5):933–9.
pubmed: 22795172
doi: 10.1053/j.jvca.2012.05.015
Rinehart J, Lilot M, Lee C, Joosten A, Huynh T, Canales C, Imagawa D, Demirjian A, Cannesson M. Closed-loop assisted versus manual goal-directed fluid therapy during high-risk abdominal surgery: a case-control study with propensity matching. Crit Care. 2015;19(1):94.
pubmed: 25888403
pmcid: 4372998
doi: 10.1186/s13054-015-0827-7
Joosten A, Huynh T, Suehiro K, Canales C, Cannesson M, Rinehart J. Goal-Directed fluid therapy with closed-loop assistance during moderate risk surgery using noninvasive cardiac output monitoring: a pilot study. Br J Anaesth. 2015;114(6):886–92.
pubmed: 25690834
doi: 10.1093/bja/aev002
Lilot M, Bellon A, Gueugnon M, Laplace MC, Baffeleuf B, Hacquard P, Barthomeuf F, Parent C, Tran T, Soubirou JL, et al. Comparison of cardiac output optimization with an automated closed-loop goal-directed fluid therapy versus non standardized manual fluid administration during elective abdominal surgery: first prospective randomized controlled trial. J Clin Monit Comput. 2018;32(6):993–1003.
pubmed: 29380190
doi: 10.1007/s10877-018-0106-7
Gricourt Y, Prin Derre C, Demattei C, Bertran S, Louart B, Muller L, Simon N, Lefrant JY, Cuvillon P, Jaber S, Roger C. A pilot study assessing a closed-loop system for goal-directed fluid therapy in abdominal surgery patients. J Pers Med. 2022;12(9):1409.
pubmed: 36143194
pmcid: 9505637
doi: 10.3390/jpm12091409
Ngan Kee WD, Tam YH, Khaw KS, Ng FF, Critchley LA, Karmakar MK. Closed-loop feedback computer-controlled infusion of phenylephrine for maintaining blood pressure during spinal anaesthesia for caesarean section: a preliminary descriptive study. Anaesthesia. 2007;62(12):1251–6.
pubmed: 17991262
doi: 10.1111/j.1365-2044.2007.05257.x
Ngan Kee WD, Khaw KS, Tam YH, Ng FF, Lee SW. Performance of a closed-loop feedback computer-controlled infusion system for maintaining blood pressure during spinal anaesthesia for caesarean section: a randomized controlled comparison of norepinephrine versus phenylephrine. J Clin Monit Comput. 2017;31(3):617–23.
pubmed: 27139726
doi: 10.1007/s10877-016-9883-z
Joosten A, Delaporte A, Alexander B, Su F, Creteur J, Vincent JL, Cannesson M, Rinehart J. Automated titration of vasopressor infusion using a closed-loop controller: in vivo feasibility study using a swine model. Anesthesiology. 2019;130(3):394–403.
pubmed: 30608239
doi: 10.1097/ALN.0000000000002581
Joosten A, Alexander B, Duranteau J, Taccone FS, Creteur J, Vincent JL, Cannesson M, Rinehart J. Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery. Br J Anaesth. 2019;123(4):430–8.
pubmed: 31255290
pmcid: 6972231
doi: 10.1016/j.bja.2019.04.064
Rinehart J, Cannesson M, Weeraman S, Barvais L, Obbergh LV, Joosten A. Closed-loop control of vasopressor administration in patients undergoing cardiac revascularization surgery. J Cardiothorac Vasc Anesth. 2020;34(11):3081–5.
pubmed: 32434724
pmcid: 7541612
doi: 10.1053/j.jvca.2020.03.038
Joosten A, Coeckelenbergh S, Alexander B, Cannesson M, Rinehart J. Feasibility of computer-assisted vasopressor infusion using continuous non-invasive blood pressure monitoring in high-risk patients undergoing renal transplant surgery. Anaesth Crit Care Pain Med. 2020;39(5):623–4.
pubmed: 32268211
pmcid: 8104119
doi: 10.1016/j.accpm.2019.12.011
Joosten A, Rinehart J, Van der Linden P, Alexander B, Penna C, De Montblanc J, Cannesson M, Vincent JL, Vicaut E, Duranteau J. Computer-assisted individualized hemodynamic management reduces intraoperative hypotension in intermediate- and high-risk surgery: a randomized controlled trial. Anesthesiology. 2021;135(2):258–72.
pubmed: 33951140
doi: 10.1097/ALN.0000000000003807