Closed-loop and decision-assist resuscitation of burn patients

Jose Salinas, Guy Drew, James Gallagher, Leopoldo C. Cancio, Steven E. Wolf, Charles E. Wade, John B. Holcomb, David N. Herndon, George C. Kramer

Research output: Contribution to journalReview article

54 Scopus citations

Abstract

Effective resuscitation is critical in reducing mortality and morbidity rates of patients with acute burns. To this end, guidelines and formulas have been developed to define infusion rates and volume requirements during the first 48 hours postburn. Even with these standardized resuscitation guidelines, however, over- and under-resuscitation are not uncommon. Two approaches to adjust infusion rate are decision-assist and closed-loop algorithms based on levels of urinary output. Specific decision assist guidelines or a closed-loop system using computer-controlled feedback technology that supplies automatic control of infusion rates can potentially achieve better control of urinary output. In a properly designed system, closed-loop control has the potential to provide more accurate titration rates, while lowering the incidence of over- and under-resuscitation. Because the system can self-adjust based on monitoring inputs, the technology can be pushed to environments such as combat zones where burn resuscitation expertise is limited. A closed-loop system can also assist in the management of mass casualties, another scenario in which medical expertise is often in short supply. This article reviews the record of fluid balance of contemporary burn resuscitation and approaches, as well as the engineering efforts, animal studies, and algorithm development of our most recent autonomous systems for burn resuscitation.

Original languageEnglish (US)
Pages (from-to)S321-S332
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume64
Issue numberSUPPL. 4
DOIs
StatePublished - Apr 1 2008

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Keywords

  • Burns
  • Closed-loop
  • Critical care
  • Decision-assist
  • Resuscitation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Salinas, J., Drew, G., Gallagher, J., Cancio, L. C., Wolf, S. E., Wade, C. E., Holcomb, J. B., Herndon, D. N., & Kramer, G. C. (2008). Closed-loop and decision-assist resuscitation of burn patients. Journal of Trauma - Injury, Infection and Critical Care, 64(SUPPL. 4), S321-S332. https://doi.org/10.1097/TA.0b013e31816bf4f7