Performance of closed-loop resuscitation in a pig model of haemorrhagic shock with fluid alone or in combination with norepinephrine, a pilot study

Abstract

We evaluated the performance of a new device to control the administration of fluid alone or co-administration of fluid and norepinephrine in a pig model of haemorrhagic shock in two sets of experiments. In the first one, resuscitation was guided using continuous arterial pressure measurements (three groups: resuscitation with fluid by a physician, CL resuscitation with fluid, and CL resuscitation with fluid and norepinephrine). In the second one, resuscitation was guided using discontinuous arterial pressure measurements (three groups: CL resuscitation with fluid alone, CL resuscitation with fluid and moderate dose norepinephrine, and CL resuscitation with fluid and a high dose of norepinephrine). Pigs were resuscitated for 1 h. In the first set of experiments, proportion of time spent in the target area of 78–88 mmHg of systolic arterial pressure was not statistically different between the three groups: manual, 71.2% (39.1–80.1); CL with fluid, 87.8% (68.3–97.4); and CL with fluid and norepinephrine, 78.1% (59.2–83.6), p = 0.151. In the second set of experiments, performance of CL resuscitation with fluid or with combination of fluid and high or moderate dose of norepinephrine was not significantly different (p = 0.543 for time in target). Pigs resuscitated with norepinephrine required less fluid and had less haemodilution than pigs resuscitated with fluid alone. Performance of CL resuscitation using continuous arterial pressure measurement was not significantly different than optimised manual treatment by a dedicated physician. Performance of CL resuscitation was reduced with discontinuous arterial pressure measurements in comparison with continuous arterial pressure measurements.

Full text

Vol.:(0123456789)
1 3
Journal of Clinical Monitoring and Computing (2021) 35:835–847
https://doi.org/10.1007/s10877-020-00542-7
ORIGINAL RESEARCH
Performance ofclosed‑loop resuscitation inapig model
ofhaemorrhagic shock withfluid alone orincombination
withnorepinephrine, apilot study
NicolasLibert1,2 · GuillaumeChenegros3· AnatoleHarrois1,4· NathalieBaudry1· BenoitDecante5·
GillesCordurie3· RyadBenosman3· OlafMercier6,7· EricVicaut1,8· JacquesDuranteau1,4
Received: 12 December 2019 / Accepted: 28 May 2020 / Published online: 12 June 2020
© Springer Nature B.V. 2020
Abstract
We evaluated the performance of a new device to control the administration of fluid alone or co-administration of fluid and
norepinephrine in a pig model of haemorrhagic shock in two sets of experiments. In the first one, resuscitation was guided
using continuous arterial pressure measurements (three groups: resuscitation with fluid by a physician, CL resuscitation with
fluid, and CL resuscitation with fluid and norepinephrine). In the second one, resuscitation was guided using discontinuous
arterial pressure measurements (three groups: CL resuscitation with fluid alone, CL resuscitation with fluid and moderate
dose norepinephrine, and CL resuscitation with fluid and a high dose of norepinephrine). Pigs were resuscitated for 1h. In
the first set of experiments, proportion of time spent in the target area of 78–88mmHg of systolic arterial pressure was not
statistically different between the three groups: manual, 71.2% (39.1–80.1); CL with fluid, 87.8% (68.3–97.4); and CL with
fluid and norepinephrine, 78.1% (59.2–83.6), p = 0.151. In the second set of experiments, performance of CL resuscitation
with fluid or with combination of fluid and high or moderate dose of norepinephrine was not significantly different (p = 0.543
for time in target). Pigs resuscitated with norepinephrine required less fluid and had less haemodilution than pigs resuscitated
with fluid alone. Performance of CL resuscitation using continuous arterial pressure measurement was not significantly
different than optimised manual treatment by a dedicated physician. Performance of CL resuscitation was reduced with
discontinuous arterial pressure measurements in comparison with continuous arterial pressure measurements.
Keywords Closed-loop· Resuscitation· Haemorrhagic shock· Fluid· Norepinephrine
1 Introduction
Trauma remains an important cause of morbidity and mor-
tality worldwide, particularly among young people. Haem-
orrhagic shock is the major mechanism leading to death
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s1087 7-020-00542 -7) contains
supplementary material, which is available to authorized users.
* Jacques Duranteau
jacques.duranteau@aphp.fr
1 Laboratoire d’Étude de la Microcirculation, UMR 942,
Université Paris, 7-11-13, Paris, France
2 Service d’Anesthésie-Réanimation, Hôpital d’instruction des
armées Percy, Clamart, France
3 Institut de la Vision UMR-S 968, Sorbonne Université,
Université Pierre et Marie Curie UPMC, Paris, France
4 Service d’Anesthésie-Réanimation Chirurgicale, Hôpital
de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires
Paris-Sud, Assistance Publique-Hôpitaux de Paris,
LeKremlinBicêtre, France
5 Unité de Recherche et d’innovation, Hôpital Marie
Lannelongue, LePlessisRobinson, France
6 École de médecine, Université Paris-Sud et Paris-Saclay,
Kremlin-Bicêtre, France
7 Département de Chirurgie Thoracique et Vasculaire et
Transplantation cœur-Poumon, DHU Thorax Innovation,
INSERM UMR-S 999, LabEx LERMIT, Hôpital Marie
Lannelongue, LePlessisRobinson, France
8 Unité de Recherche Clinique, Université Paris 7, Hôpitaux
Saint Louis Lariboisière, Assistance Publique-Hôpitaux de
Paris, Paris, France
Content courtesy of Springer Nature, terms of use apply. Rights reserved.