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Closed-loop regulation of arterial pressure after acute brain death

Soltesz, Kristian LU ; Sjöberg, Trygve LU ; Jansson, Tomas LU ; Johansson, Rolf LU ; Robertsson, Anders LU ; Paskevicius, Audrius LU ; Liao, Qiuming LU ; Qin, Guangqi LU and Steen, Stig LU (2017) In Journal of Clinical Monitoring and Computing
Abstract
Purpose: The purpose of this concept study was to investigate the possibility of automatic mean arterial pressure (MAP) regulation in a porcine heart-beating brain death (BD) model. Hemodynamic stability of BD donors is necessary for maintaining acceptable quality of donated organs for transplantation. Manual stabilization is challenging, due to the lack of vasomotor function in BD donors. Closed-loop stabilization therefore has the potential of increasing availability of acceptable donor organs, and serves to indicate feasibility within less demanding patient groups.

Method: A dynamic model of nitroglycerine pharmacology, suitable for controller synthesis, was identified from an experiment involving an anesthetized pig, using a... (More)
Purpose: The purpose of this concept study was to investigate the possibility of automatic mean arterial pressure (MAP) regulation in a porcine heart-beating brain death (BD) model. Hemodynamic stability of BD donors is necessary for maintaining acceptable quality of donated organs for transplantation. Manual stabilization is challenging, due to the lack of vasomotor function in BD donors. Closed-loop stabilization therefore has the potential of increasing availability of acceptable donor organs, and serves to indicate feasibility within less demanding patient groups.

Method: A dynamic model of nitroglycerine pharmacology, suitable for controller synthesis, was identified from an experiment involving an anesthetized pig, using a gradient-based output error method. The model was used to synthesize a robust PID controller for hypertension prevention, evaluated in a second experiment, on a second, brain dead, pig. Hypotension was simultaneously prevented using closed-loop controlled infusion of noradrenaline, by means of a previously published controller.

Results: A linear model of low order, with variable (uncertain) gain, was sufficient to describe the dynamics to be controlled. The robustly tuned PID controller utilized in the second experiment kept the MAP within a user-defined range. The system was able to prevent hypertension, exceeding a reference of 100 mmHg by more than 10 %, during 98 % of a 12 h experiment.

Conclusion: This early work demonstrates feasibility of the investigated modelling and control synthesis approach, for the purpose of maintaining normotension in a porcine BD model. There remains a need to characterize individual variability, in order to ensure robust performance over the expected population. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
hemodynamics, blood pressure, closed-loop control, brain death
in
Journal of Clinical Monitoring and Computing
publisher
Springer
external identifiers
  • scopus:85020649703
ISSN
1573-2614
DOI
10.1007/s10877-017-0033-z
language
English
LU publication?
yes
id
d2c0e77c-0650-44e1-82ef-0d93635ee291
date added to LUP
2017-05-30 11:38:43
date last changed
2017-09-17 09:47:40
@article{d2c0e77c-0650-44e1-82ef-0d93635ee291,
  abstract     = {Purpose: The purpose of this concept study was to investigate the possibility of automatic mean arterial pressure (MAP) regulation in a porcine heart-beating brain death (BD) model. Hemodynamic stability of BD donors is necessary for maintaining acceptable quality of donated organs for transplantation. Manual stabilization is challenging, due to the lack of vasomotor function in BD donors. Closed-loop stabilization therefore has the potential of  increasing availability of acceptable donor organs, and serves to indicate feasibility within less demanding patient groups.<br/><br/>Method: A dynamic model of nitroglycerine pharmacology, suitable for controller synthesis, was identified from an experiment involving an anesthetized pig, using a gradient-based output error method. The model was used to synthesize a robust PID controller for hypertension prevention, evaluated in a second experiment, on a second, brain dead, pig. Hypotension was simultaneously prevented using closed-loop controlled infusion of noradrenaline, by means of a previously published controller.<br/><br/>Results: A linear model of low order, with variable (uncertain) gain, was sufficient to describe the dynamics to be controlled. The robustly tuned PID controller utilized in the second experiment kept the MAP within a user-defined range. The system was    able to prevent hypertension, exceeding a reference of 100 mmHg by more than 10 %, during 98 % of a 12 h experiment.<br/><br/>Conclusion: This early work demonstrates feasibility of the investigated modelling and control synthesis approach, for the purpose of maintaining normotension in a porcine BD model. There remains a need to characterize individual variability, in order to ensure robust performance over the expected population.},
  author       = {Soltesz, Kristian and Sjöberg, Trygve and Jansson, Tomas and Johansson, Rolf and Robertsson, Anders and Paskevicius, Audrius and Liao, Qiuming and Qin, Guangqi and Steen, Stig},
  issn         = {1573-2614},
  keyword      = {hemodynamics,blood pressure,closed-loop control,brain death},
  language     = {eng},
  publisher    = {Springer},
  series       = {Journal of Clinical Monitoring and Computing},
  title        = {Closed-loop regulation of arterial pressure after acute brain death},
  url          = {http://dx.doi.org/10.1007/s10877-017-0033-z},
  year         = {2017},
}