Intraoperative stroke volume optimization using stroke volume, arterial pressure, and heart rate: closed-loop (learning intravenous resuscitator) versus anesthesiologists.

摘要: Objective The authors compared the performance of a group anesthesia providers to closed-loop (Learning Intravenous Resuscitator [LIR]) management in simulated hemorrhage scenario using cardiac output monitoring. Design A prospective cohort study. Setting In silico simulation. Participants University hospital anesthesiologists and LIR fluid administration system. Interventions Using patient simulator, 90-minute protocol was run, which included 1,200-mL blood loss over 30 minutes. Twenty practicing anesthesiology were asked manage this by providing fluids vasopressor medication at their discretion. simulation program also run 20 times with algorithm managing an additional no intervention. Measurements Main Results Simulated weight, height, heart rate, mean arterial pressure, (CO) similar baseline. stroke volume, CO, final CO higher than practitioners group, coefficient variance lower. received slightly more (2.1 v 1.9 L, p Conclusions Despite roughly volumes given, maintained stable hemodynamics primarily because given earlier optimized before began, whereas tended resuscitate well but only after significant hemodynamic change indicated need. Overall, these data support potential usefulness clinical settings dynamic predictors are not available or applicable.