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Yan Y, Zhao C, Bi X, Or CK, Ye X. The mental workload of ICU nurses performing human-machine tasks and associated factors: A cross-sectional questionnaire survey. J Adv Nurs 2024. [PMID: 38687803 DOI: 10.1111/jan.16199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/11/2024] [Accepted: 04/06/2024] [Indexed: 05/02/2024]
Abstract
AIMS To assess the level of mental workload (MWL) of intensive care unit (ICU) nurses in performing different human-machine tasks and examine the predictors of the MWL. DESIGN A cross-sectional questionnaire study. METHODS Between January and February 2021, data were collected from ICU nurses (n = 427) at nine tertiary hospitals selected from five (east, west, south, north, central) regions in China through an electronic questionnaire, including sociodemographic questions, the National Aeronautics and Space Administration Task Load Index, General Self-Efficacy Scale, Difficulty-assessing Index System of Nursing Operation Technique, and System Usability Scale. Descriptive statistics, t-tests, one-way ANOVA and multiple linear regression models were used. RESULTS ICU nurses experienced a medium level of MWL (score 52.04 on a scale of 0-100) while performing human-machine tasks. ICU nurses' MWL was notably higher in conducting first aid and life support tasks (using defibrillators or ventilators). Predictors of MWL were task difficulty, system usability, professional title, age, self-efficacy, ICU category, and willingness to study emerging technology actively. Task difficulty and system usability were the strongest predictors of nearly all typical tasks. CONCLUSION ICU nurses experience a medium MWL while performing human-machine tasks, but higher mental, temporal, and effort are perceived compared to physical demands. The MWL varied significantly across different human-machine tasks, among which are significantly higher: first aid and life support and information-based human-machine tasks. Task difficulty and system availability are decisive predictors of MWL. IMPACT This is the first study to investigate the level of MWL of ICU nurses performing different representative human-machine tasks and to explore its predictors, which provides a reference for future research. These findings suggest that healthcare organizations should pay attention to the MWL of ICU nurses and develop customized management strategies based on task characteristics to maintain a moderate level of MWL, thus enabling ICU nurses to perform human-machine tasks better. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yan Yan
- School of Nursing, Naval Medical University, Shanghai, China
| | - Chenglei Zhao
- Department of Anesthesia SICU, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xuanyi Bi
- School of Nursing, Naval Medical University, Shanghai, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Xuchun Ye
- School of Nursing, Naval Medical University, Shanghai, China
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Coeckelenbergh S, Boelefahr S, Alexander B, Perrin L, Rinehart J, Joosten A, Barvais L. Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine. J Clin Monit Comput 2024; 38:487-504. [PMID: 38184504 DOI: 10.1007/s10877-023-01111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/21/2023] [Indexed: 01/08/2024]
Abstract
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.
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Affiliation(s)
- Sean Coeckelenbergh
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Sebastian Boelefahr
- Department of Anesthesiology and Intensive Care, Klinikum Aschaffenburg-Alzenau, Frankfurt University and Wuerzburg University Affiliated Academic Training Hospital, Aschaffenburg, Germany
| | - Brenton Alexander
- Department of Anesthesiology & Perioperative Care, University of California San Diego, San Diego, CA, USA
| | - Laurent Perrin
- Department of Anaesthesia and Resuscitation, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Rinehart
- Outcomes Research Consortium, Cleveland, OH, USA
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Irvine, CA, USA
| | - Alexandre Joosten
- Department of Anesthesiology & Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Luc Barvais
- Department of Anaesthesia and Resuscitation, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Lopes S, Rocha G, Guimarães-Pereira L. Artificial intelligence and its clinical application in Anesthesiology: a systematic review. J Clin Monit Comput 2024; 38:247-259. [PMID: 37864754 PMCID: PMC10995017 DOI: 10.1007/s10877-023-01088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE Application of artificial intelligence (AI) in medicine is quickly expanding. Despite the amount of evidence and promising results, a thorough overview of the current state of AI in clinical practice of anesthesiology is needed. Therefore, our study aims to systematically review the application of AI in this context. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Medline and Web of Science for articles published up to November 2022 using terms related with AI and clinical practice of anesthesiology. Articles that involved animals, editorials, reviews and sample size lower than 10 patients were excluded. Characteristics and accuracy measures from each study were extracted. RESULTS A total of 46 articles were included in this review. We have grouped them into 4 categories with regard to their clinical applicability: (1) Depth of Anesthesia Monitoring; (2) Image-guided techniques related to Anesthesia; (3) Prediction of events/risks related to Anesthesia; (4) Drug administration control. Each group was analyzed, and the main findings were summarized. Across all fields, the majority of AI methods tested showed superior performance results compared to traditional methods. CONCLUSION AI systems are being integrated into anesthesiology clinical practice, enhancing medical professionals' skills of decision-making, diagnostic accuracy, and therapeutic response.
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Affiliation(s)
- Sara Lopes
- Department of Anesthesiology, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - Gonçalo Rocha
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Guimarães-Pereira
- Department of Anesthesiology, Centro Hospitalar Universitário São João, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Coeckelenbergh S, Vincent JL, Duranteau J, Joosten A, Rinehart J. Perioperative Fluid and Vasopressor Therapy in 2050: From Experimental Medicine to Personalization Through Automation. Anesth Analg 2024; 138:284-294. [PMID: 38215708 DOI: 10.1213/ane.0000000000006672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid therapy was first described in Scotland during the 1832 cholera epidemic, when pioneers in medicine saved critically ill patients dying from hypovolemic shock. However, widespread use of IV fluids only began in the 20th century. Epinephrine was discovered and purified in the United States at the end of the 19th century, but its short half-life limited its implementation into patient care. Advances in venous access, including the introduction of the central venous catheter, and the ability to administer continuous infusions of fluids and vasopressors rather than just boluses, facilitated the use of fluids and adrenergic agents. With the advent of advanced hemodynamic monitoring, most notably the pulmonary artery catheter, the role of fluids and vasopressors in the maintenance of tissue oxygenation through adequate cardiac output and perfusion pressure became more clearly established, and hemodynamic goals could be established to better titrate fluid and vasopressor therapy. Less invasive hemodynamic monitoring techniques, using echography, pulse contour analysis, and heart-lung interactions, have facilitated hemodynamic monitoring at the bedside. Most recently, advances have been made in closed-loop fluid and vasopressor therapy, which apply computer assistance to interpret hemodynamic variables and therapy. Development and increased use of artificial intelligence will likely represent a major step toward fully automated hemodynamic management in the perioperative environment in the near future. In this narrative review, we discuss the key events in experimental medicine that have led to the current status of fluid and vasopressor therapies and describe the potential benefits that future automation has to offer.
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Affiliation(s)
- Sean Coeckelenbergh
- From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France
- Outcomes Research Consortium, Cleveland, Ohio
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Duranteau
- From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital De Bicêtre, Paris, France
| | - Alexandre Joosten
- From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital De Bicêtre, Paris, France
| | - Joseph Rinehart
- Outcomes Research Consortium, Cleveland, Ohio
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, California
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Coeckelenbergh S, Joosten A, Cannesson M, Rinehart J. Closing the loop: automation in anesthesiology is coming. J Clin Monit Comput 2024; 38:1-4. [PMID: 37707703 DOI: 10.1007/s10877-023-01077-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Anesthesiology and intensive care medicine provide fertile ground for innovation in automation, but to date we have only achieved preliminary studies in closed-loop intravenous drug administration. Anesthesiologists have yet to implement these tools on a large scale despite clear evidence that they outperform manual titration. Closed-loops continuously assess a predefined variable as input into a controller and then attempt to establish equilibrium by administering a treatment as output. The aim is to decrease the error between the closed-loop controller's input and output. In this editorial we consider the available intravenous anesthesia closed-loop systems, try to clarify why they have not yet been implemented on a large scale, see what they offer, and propose the future steps towards automation in anesthesia.
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Affiliation(s)
- Sean Coeckelenbergh
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique - Hôpitaux de Paris, 12 avenue Paul Vaillant-Couturier, Villejuif, 94800, France.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Alexandre Joosten
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique - Hôpitaux de Paris, 12 avenue Paul Vaillant-Couturier, Villejuif, 94800, France
- Department of Anesthesiology & Perioperative Medicine, University of California, Los Angeles, CA, USA
| | - Maxime Cannesson
- Department of Anesthesiology & Perioperative Medicine, University of California, Los Angeles, CA, USA
| | - Joseph Rinehart
- Outcomes Research Consortium, Cleveland, OH, USA
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Irvine, CA, USA
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Duran HT, Kingeter M, Reale C, Weinger MB, Salwei ME. Decision-making in anesthesiology: will artificial intelligence make intraoperative care safer? Curr Opin Anaesthesiol 2023; 36:691-697. [PMID: 37865848 PMCID: PMC11100504 DOI: 10.1097/aco.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making. RECENT FINDINGS Naturalistic decision-making, a rich research field that aims to understand how cognitive work is accomplished in complex environments, provides insight into anesthesiologists' decision processes. Due to the complexity of clinical work and limits of human decision-making (e.g. fatigue, distraction, and cognitive biases), attention on the role of artificial intelligence to support anesthesiologists' decision-making has grown. Artificial intelligence, a computer's ability to perform human-like cognitive functions, is increasingly used in anesthesiology. Examples include aiding in the prediction of intraoperative hypotension and postoperative complications, as well as enhancing structure localization for regional and neuraxial anesthesia through artificial intelligence integration with ultrasound. SUMMARY To fully realize the benefits of artificial intelligence in anesthesiology, several important considerations must be addressed, including its usability and workflow integration, appropriate level of trust placed on artificial intelligence, its impact on decision-making, the potential de-skilling of practitioners, and issues of accountability. Further research is needed to enhance anesthesiologists' clinical decision-making in collaboration with artificial intelligence.
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Affiliation(s)
- Huong-Tram Duran
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Carrie Reale
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Megan E. Salwei
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Carvalho H, Verdonck M, Eleveld DJ, Ramirez D, D'Haese J, Flamée P, Geerts L, Wylleman J, Cools W, Barbe K, Struys MMRF, Poelaert J. Neuromuscular end-point predictive capability of published rocuronium pharmacokinetic/pharmacodynamic models: An observational trial. J Clin Anesth 2023; 90:111225. [PMID: 37542918 DOI: 10.1016/j.jclinane.2023.111225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/16/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Objective neuromuscular monitoring remains the single most reliable method to ensure optimal perioperative neuromuscular management. Nevertheless, the prediction of clinical neuromuscular endpoints by means of Pharmacokinetic (PK) and Pharmacodynamic (PD) modelling has the potential to complement monitoring and improve perioperative neuromuscular management.s STUDY OBJECTIVE: The present study aims to assess the performance of published Rocuronium PK/PD models in predicting intraoperative Train-of-four (TOF) ratios when benchmarked against electromyographic TOF measurements. DESIGN Observational trial. SETTING Tertiary Belgian hospital, from August 2020 up to September 2021. PATIENTS AND INTERVENTIONS Seventy-four patients undergoing general anaesthesia for elective surgery requiring the administration of rocuronium and subject to continuous EMG neuromuscular monitoring were included. PK/PD-simulated TOF ratios were plotted and synchronised with their measured electromyographic counterparts and their differences analysed by means of Predictive Error derivatives (Varvel criteria). MAIN RESULTS Published rocuronium PK/PD models overestimated clinically registered TOF ratios. The models of Wierda, Szenohradszky, Cooper, Alvarez-Gomez and McCoy showed significant predictive consistency between themselves, displaying Median Absolute Performance Errors between 38% and 41%, and intra-individual differences (Wobble) between 14 and 15%. The Kleijn model outperformed the former with a lower Median Absolute Performance Error (16%, 95%CI [0.01; 57]) and Wobble (11%, 95%CI [0.01; 34]). All models displayed considerably wide 95% confidence intervals for all performance metrics, suggesting a significantly variable performance. CONCLUSIONS Simulated TOF ratios based on published PK/PD models do not accurately predict real intraoperative TOF ratio dynamics. TRIAL REGISTRATION NCT04518761 (clinicaltrials.gov), registered on 19 August 2020.
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Affiliation(s)
- Hugo Carvalho
- Department of Anesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium; Department of Anesthesiology and Reanimation, AZ Sint Jan Brugge-Oostende, Belgium.
| | - Michaël Verdonck
- Department of Anesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Douglas J Eleveld
- Head of Department, Professor, Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - David Ramirez
- Servicio Anestesiología y Reanimación, Fundación Valle de Lili, Cali, Colombia
| | - Jan D'Haese
- Department of Anesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Panagiotis Flamée
- Department of Anesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Lieselot Geerts
- Department of Anaesthesia, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jasper Wylleman
- Department of Anesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kurt Barbe
- Interfaculty Center Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Michel M R F Struys
- Head of Department, Professor, Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Basic and Applied Medical Sciences, Ghent University, Gent, Belgium
| | - Jan Poelaert
- Department of Anesthesia, AZ Maria Middelares Gent, Ghent, Belgium
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Singhal M, Gupta L, Hirani K. A Comprehensive Analysis and Review of Artificial Intelligence in Anaesthesia. Cureus 2023; 15:e45038. [PMID: 37829964 PMCID: PMC10566398 DOI: 10.7759/cureus.45038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
In the field of anaesthesia, artificial intelligence (AI) has become a game-changing technology. Applications of AI include keeping records, monitoring patients, calculating and administering drugs, and carrying out mechanical procedures. This article explores the current uses, challenges, and prospective applications of AI in anaesthesia practices. This review discusses AI-supported systems like anaesthesia information management systems (AIMS), mechanical robots for carrying out procedures, and pharmacological models for drug delivery. AIMS has helped in automated record-keeping, predicting bad events, and monitoring the vital signs of the patient. Their application has a vital role in improving the efficacy of anaesthesia management and patient safety. The application of AI in anaesthesia comes with its own unique difficulties. Noteworthy obstacles include issues with data quantity and quality, technical limitations, and moral and legal dilemmas. The key to overcoming these barriers is to set guidelines for the ethical use of AI in healthcare, improve the reliability and comprehension of AI systems, and certify the health data precision and security. AI has very bright potential. Exciting future directions include developments in AI and machine learning thus development of new applications, and the possible enhancement in training and education. Potential research areas include the application of AI to chronic disease management, pain management, and the reinforcement of anaesthesiologists' education. AI could be used to design authentic lifelike training simulations and individualized student feedback systems, hence transforming anaesthesia education and training methodology. For this review, we conducted a PubMed, Google Scholar, and Cochrane Database search in 2022-2023 and retrieved articles on AI and its uses in anaesthesia. Recommendations for future research and development include strengthening the safety and reliability of health data, building a better understanding of AI systems, and looking into new areas of use. The power of AI can be used to innovate anaesthesia practices by concentrating on these areas.
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Affiliation(s)
- Meghna Singhal
- Department of Anesthesiology and Critical Care, Maulana Azad Medical College, Delhi, IND
| | - Lalit Gupta
- Department of Anesthesiology and Critical Care, Maulana Azad Medical College, Delhi, IND
| | - Kshitiz Hirani
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, IND
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Rinehart J, Coeckelenbergh S, Srivastava I, Cannesson M, Joosten A. Physiological Modeling of Hemodynamic Responses to Sodium Nitroprusside. J Pers Med 2023; 13:1101. [PMID: 37511714 PMCID: PMC10381667 DOI: 10.3390/jpm13071101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Computational modeling of physiology has become a routine element in the development, evaluation, and safety testing of many types of medical devices. Members of the Food and Drug Administration have recently published a manuscript detailing the development, validation, and sensitivity testing of a computational model for blood volume, cardiac stroke volume, and blood pressure, noting that such a model might be useful in the development of closed-loop fluid administration systems. In the present study, we have expanded on this model to include the pharmacologic effect of sodium nitroprusside and calibrated the model against our previous experimental animal model data. METHODS Beginning with the model elements in the original publication, we added six new parameters to control the effect of sodium nitroprusside: two for the onset time and clearance rates, two for the stroke volume effect (which includes venodilation as a "hidden" element), and two for the direct effect on arterial blood pressure. Using this new model, we then calibrated the predictive performance against previously collected animal study data using nitroprusside infusions to simulate shock with the primary emphasis on MAP. Root-mean-squared error (RMSE) was calculated, and the performance was compared to the performance of the model in the original study. RESULTS RMSE of model-predicted MAP to actual MAP was lower than that reported in the original model, but higher for SV and CO. The individually fit models showed lower RMSE than using the population average values for parameters, suggesting the fitting process was effective in identifying improved parameters. Use of partially fit models after removal of the lowest variance population parameters showed a very minor decrement in improvement over the fully fit models. CONCLUSION The new model added the clinical effects of SNP and was successfully calibrated against experimental data with an RMSE of <10% for mean arterial pressure. Model-predicted MAP showed an error similar to that seen in the original base model when using fluid shifts, heart rate, and drug dose as model inputs.
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Affiliation(s)
- Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Orange, CA 92868, USA
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Sean Coeckelenbergh
- Outcomes Research Consortium, Cleveland, OH 44195, USA
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, 1050 Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Hôpitaux Universitaires Paris-Sud, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, 44195 Paris, France
| | - Ishita Srivastava
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Orange, CA 92868, USA
| | - Maxime Cannesson
- Departments of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, 1050 Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Hôpitaux Universitaires Paris-Sud, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, 44195 Paris, France
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Khan MJ, Karmakar A. Emerging Robotic Innovations and Artificial Intelligence in Endotracheal Intubation and Airway Management: Current State of the Art. Cureus 2023; 15:e42625. [PMID: 37641747 PMCID: PMC10460626 DOI: 10.7759/cureus.42625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Robotic sciences have rapidly advanced and revolutionized various aspects of medicine, including the field of airway management. Robotic endotracheal intubation is an innovative method that utilizes robotic systems to aid in the accurate placement of an endotracheal tube within the trachea. This cutting-edge technique shows great promise in improving procedural precision and ensuring patient safety. In this comprehensive overview, we delve into the present status of robotic-assisted endotracheal intubation, examining its advantages, obstacles, and the potential implications it holds for the future. In addition, this review encompasses a comprehensive analysis of the existing literature and references on recent advances in robotic technology and artificial intelligence related to airway management.
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Affiliation(s)
| | - Arunabha Karmakar
- Anesthesiology and Perioperative Medicine, Hamad Medical Corporation, Doha, QAT
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11
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Maheshwari K, Cywinski JB, Papay F, Khanna AK, Mathur P. Artificial Intelligence for Perioperative Medicine: Perioperative Intelligence. Anesth Analg 2023; 136:637-645. [PMID: 35203086 DOI: 10.1213/ane.0000000000005952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The anesthesiologist's role has expanded beyond the operating room, and anesthesiologist-led care teams can deliver coordinated care that spans the entire surgical experience, from preoperative optimization to long-term recovery of surgical patients. This expanded role can help reduce postoperative morbidity and mortality, which are regrettably common, unlike rare intraoperative mortality. Postoperative mortality, if considered a disease category, will be the third leading cause of death just after heart disease and cancer. Rapid advances in technologies like artificial intelligence provide an opportunity to build safe perioperative practices. Artificial intelligence helps by analyzing complex data across disparate systems and producing actionable information. Using artificial intelligence technologies, we can critically examine every aspect of perioperative medicine and devise innovative value-based solutions that can potentially improve patient safety and care delivery, while optimizing cost of care. In this narrative review, we discuss specific applications of artificial intelligence that may help advance all aspects of perioperative medicine, including clinical care, education, quality improvement, and research. We also discuss potential limitations of technology and provide our recommendations for successful adoption.
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Affiliation(s)
| | | | | | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
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12
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Hughes SP, Macintyre I. Robotic techniques benefit anaesthesia too. J R Soc Med 2023; 116:88. [PMID: 36892208 PMCID: PMC10041618 DOI: 10.1177/01410768231160278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Sean P Hughes
- Sean P Hughes: Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, SW7 2AZ, UK
| | - Iain Macintyre
- Iain Macintyre: Royal College of Surgeons of Edinburgh, Edinburgh EH8 9DW, UK
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Karer G, Škrjanc I. Improved Individualized Patient-Oriented Depth-of-Hypnosis Measurement Based on Bispectral Index. SENSORS (BASEL, SWITZERLAND) 2022; 23:293. [PMID: 36616891 PMCID: PMC9824030 DOI: 10.3390/s23010293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Total intravenous anesthesia is an anesthesiologic technique where all substances are injected intravenously. The main task of the anesthesiologist is to assess the depth of anesthesia, or, more specifically, the depth of hypnosis (DoH), and accordingly adjust the dose of intravenous anesthetic agents. However, it is not possible to directly measure the anesthetic agent concentrations or the DoH, so the anesthesiologist must rely on various vital signs and EEG-based measurements, such as the bispectral (BIS) index. The ability to better measure DoH is directly applicable in clinical practice-it improves the anesthesiologist's assessment of the patient state regarding anesthetic agent concentrations and, consequently, the effects, as well as provides the basis for closed-loop control algorithms. This article introduces a novel structure for modeling DoH, which employs a residual dynamic model. The improved model can take into account the patient's individual sensitivity to the anesthetic agent, which is not the case when using the available population-data-based models. The improved model was tested using real clinical data. The results show that the predictions of the BIS-index trajectory were improved considerably. The proposed model thus seems to provide a good basis for a more patient-oriented individualized assessment of DoH, which should lead to better administration methods that will relieve the anesthesiologist's workload and will benefit the patient by providing improved safety, individualized treatment, and, thus, alleviation of possible adverse effects during and after surgery.
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14
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Vanhonacker D, Verdonck M, Nogueira Carvalho H. Impact of Closed-Loop Technology, Machine Learning, and Artificial Intelligence on Patient Safety and the Future of Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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15
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Moon JS, Cannesson M. A Century of Technology in Anesthesia & Analgesia. Anesth Analg 2022; 135:S48-S61. [PMID: 35839833 PMCID: PMC9298489 DOI: 10.1213/ane.0000000000006027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Technological innovation has been closely intertwined with the growth of modern anesthesiology as a medical and scientific discipline. Anesthesia & Analgesia, the longest-running physician anesthesiology journal in the world, has documented key technological developments in the specialty over the past 100 years. What began as a focus on the fundamental tools needed for effective anesthetic delivery has evolved over the century into an increasing emphasis on automation, portability, and machine intelligence to improve the quality, safety, and efficiency of patient care.
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Affiliation(s)
- Jane S Moon
- From the Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
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16
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Schiavo M, Padula F, Latronico N, Paltenghi M, Visioli A. A modified PID-based control scheme for depth-of-hypnosis control: Design and experimental results. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106763. [PMID: 35349908 DOI: 10.1016/j.cmpb.2022.106763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Many methodologies have been proposed for the control of total intravenous anesthesia in general surgery, as this yields a reduced stress for the anesthesiologist and an increased safety for the patient. The objective of this work is to design a PID-based control system for the regulation of the depth of hypnosis by propofol and remifentanil coadministration that takes into account the clinical practice. METHODS With respect to a standard PID control system, additional functionalities have been implemented in order to consider specific requirements related to the clinical practice. In particular, suitable boluses are determined and used in the induction phase and a nonzero baseline infusion is used in the maintenance phase when the predicted effect-site concentration drops below a safety threshold. RESULTS The modified controller has been experimentally assessed on a group of 10 patients receiving general anesthesia for elective plastic surgery. The control system has been able to induce and maintain adequate anesthesia without any manual intervention from the anesthesiologist. CONCLUSIONS Results confirm the effectiveness of the overall design approach and, in particular, highlight that the new version of the control system, with respect to a standard PID controller, provides significant advantages from a clinical standpoint.
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Affiliation(s)
- Michele Schiavo
- Dipartimento di Ingegneria dell'Informazione, University of Brescia, Brescia, Italy.
| | - Fabrizio Padula
- Curtin Centre for Optimisation and Decision Science, Curtin University, Perth, Australia.
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesiology, Critical Care and Emergency Spedali Civili di Brescia, Brescia, Italy.
| | - Massimiliano Paltenghi
- Department of Anesthesiology, Critical Care and Emergency Spedali Civili di Brescia, Brescia, Italy.
| | - Antonio Visioli
- Dipartimento di Ingegneria Meccanica e Industriale University of Brescia, Brescia, Italy.
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17
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Hu Y, Lim A. MAP 65-is it enough? Curr Opin Anaesthesiol 2022; 35:242-247. [PMID: 35125394 DOI: 10.1097/aco.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to look at the current evidence on the consequences of intraoperative hypotension and discuss improvements that can be implemented for its prevention. RECENT FINDINGS Literature continues to supply convincing evidence that even brief periods of intraoperative hypotension are associated with increased perioperative morbidity and mortality. Recent randomized controlled trial showed intraoperative early use of vasopressor and maintaining blood pressure within tight ranges improves outcomes. SUMMARY There should be a shift in paradigm in focusing on the prevention of intraoperative hypotension instead treatment. The suggested goals to help maintaining hemodynamic stability during anesthesia include ensure adequate blood pressure and flow; hypotension prevention; and ensure adequate anesthetic depth without overdose.
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Affiliation(s)
- Yaqi Hu
- Virginia Commonwealth University, Department of Anesthesiology, 1250 East Marshall St, Richmond, Virginia, USA
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18
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Introna M, van den Berg JP, Eleveld DJ, Struys MMRF. Bayesian statistics in anesthesia practice: a tutorial for anesthesiologists. J Anesth 2022; 36:294-302. [PMID: 35147768 PMCID: PMC8967750 DOI: 10.1007/s00540-022-03044-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
This narrative review intends to provide the anesthesiologist with the basic knowledge of the Bayesian concepts and should be considered as a tutorial for anesthesiologists in the concept of Bayesian statistics. The Bayesian approach represents the mathematical formulation of the idea that we can update our initial belief about data with the evidence obtained from any kind of acquired data. It provides a theoretical framework and a statistical method to use pre-existing information within the context of new evidence. Several authors have described the Bayesian approach as capable of dealing with uncertainty in medical decision-making. This review describes the Bayes theorem and how it is used in clinical studies in anesthesia and critical care. It starts with a general introduction to the theorem and its related concepts of prior and posterior probabilities. Second, there is an explanation of the basic concepts of the Bayesian statistical inference. Last, a summary of the applicability of some of the Bayesian statistics in current literature is provided, such as Bayesian analysis of clinical trials and PKPD modeling.
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Affiliation(s)
- Michele Introna
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Anesthesiology and Intensive Care Medicine, Cremona Hospital, Cremona, Italy
| | - Johannes P van den Berg
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Douglas J Eleveld
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Michel M R F Struys
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
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19
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Michard F, Futier E, Joosten A. Goal-directed haemodynamic therapy: what else? Comment on Br J Anaesth 2022. Br J Anaesth 2022; 128:e286-e288. [DOI: 10.1016/j.bja.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 11/02/2022] Open
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20
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Singh M, Nath G. Artificial intelligence and anesthesia: A narrative review. Saudi J Anaesth 2022; 16:86-93. [PMID: 35261595 PMCID: PMC8846233 DOI: 10.4103/sja.sja_669_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/04/2022] Open
Abstract
Rapid advances in Artificial Intelligence (AI) have led to diagnostic, therapeutic, and intervention-based applications in the field of medicine. Today, there is a deep chasm between AI-based research articles and their translation to clinical anesthesia, which needs to be addressed. Machine learning (ML), the most widely applied arm of AI in medicine, confers the ability to analyze large volumes of data, find associations, and predict outcomes with ongoing learning by the computer. It involves algorithm creation, testing and analyses with the ability to perform cognitive functions including association between variables, pattern recognition, and prediction of outcomes. AI-supported closed loops have been designed for pharmacological maintenance of anesthesia and hemodynamic management. Mechanical robots can perform dexterity and skill-based tasks such as intubation and regional blocks with precision, whereas clinical-decision support systems in crisis situations may augment the role of the clinician. The possibilities are boundless, yet widespread adoption of AI is still far from the ground reality. Patient-related “Big Data” collection, validation, transfer, and testing are under ethical scrutiny. For this narrative review, we conducted a PubMed search in 2020-21 and retrieved articles related to AI and anesthesia. After careful consideration of the content, we prepared the review to highlight the growing importance of AI in anesthesia. Awareness and understanding of the basics of AI are the first steps to be undertaken by clinicians. In this narrative review, we have discussed salient features of ongoing AI research related to anesthesia and perioperative care.
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21
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AnesthesiaGUIDE: a MATLAB tool to control the anesthesia. SN APPLIED SCIENCES 2022. [DOI: 10.1007/s42452-021-04885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractThe goals of this paper are: (a) to investigate adaptive and fractional-order adaptive control algorithms for an automatic anesthesia process, using a closed-loop system, and (b) to develop an easy-to-use tool for MATLAB/Simulink to facilitate simulations for users with less knowledge about anesthesia and adaptive control. A model reference adaptive control structure was chosen for the entire system. First of all, to control the patient’s state during the surgery process, the patient mathematical model is useful, or even required for simulation studies. The pharmacokinetic/pharmacodynamics (PK/PD) model was determined using MATLAB’s SimBiology tool, starting from a previously available block diagram, and validated through simulation. Then, to achieve the desired control performances, two controllers are designed: a PI adaptive controller and a PIλ (PI-fractional) adaptive controller, using the MIT algorithm. The time response during anesthetic drug infusion for each patient can be plotted with the AnesthesiaGUIDE tool, which is also designed in MATLAB/Simulink. The tool was tested on data from 12 patients, subjected to general anesthesia, with successful results. Through this tool, the article provides a good opportunity for any user to experience with adaptive control for the anesthesia process.
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22
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Ma X, Pan B, Song T, Sun Y, Fu Y. Development of a Novel Anesthesia Airway Management Robot. SENSORS 2021; 21:s21238144. [PMID: 34884149 PMCID: PMC8662423 DOI: 10.3390/s21238144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/21/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
Non-invasive positive pressure ventilation has attracted increasing attention for air management in general anesthesia. This work proposes a novel robot equipped with two snake arms and a mask-fastening mechanism to facilitate trachea airway management for anesthesia as well as deep sedation and to improve surgical outcomes. The two snake arms with supporting terminals have been designed to lift a patient's jaw with design optimization, and the mask-fastening mechanism has been utilized to fasten the mask onto a patient's face. The control unit has been developed to implement lifting and fastening force control with safety and robustness. Loading experiments on the snake arm and tension experiments on the mask-fastening mechanism have been performed to investigate and validate the performances of the proposed anesthesia airway management robot. Experiments on a mock person have also been employed to further verify the effectiveness and reliability of the developed robot system. As an early study of an anesthesia airway management robot, it was verified as a valid attempt to perform mask non-invasive positive pressure ventilation technology by taking advantage of a robotic system.
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Affiliation(s)
- Xuesong Ma
- School of Life Science and Technology, Harbin Institute of Technology, Harbin 150001, China;
- The Fourth Clinical Medical School, Harbin Medical University, Harbin 150001, China
| | - Bo Pan
- State Key Laboratory of Robotics and Systems, Harbin Institute of Technology, Harbin 150001, China; (B.P.); (T.S.); (Y.S.)
| | - Tao Song
- State Key Laboratory of Robotics and Systems, Harbin Institute of Technology, Harbin 150001, China; (B.P.); (T.S.); (Y.S.)
| | - Yanwen Sun
- State Key Laboratory of Robotics and Systems, Harbin Institute of Technology, Harbin 150001, China; (B.P.); (T.S.); (Y.S.)
| | - Yili Fu
- School of Life Science and Technology, Harbin Institute of Technology, Harbin 150001, China;
- State Key Laboratory of Robotics and Systems, Harbin Institute of Technology, Harbin 150001, China; (B.P.); (T.S.); (Y.S.)
- Correspondence:
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23
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Tivay A, Kramer GC, Hahn JO. Collective Variational Inference for Personalized and Generative Physiological Modeling: A Case Study on Hemorrhage Resuscitation. IEEE Trans Biomed Eng 2021; 69:666-677. [PMID: 34375275 DOI: 10.1109/tbme.2021.3103141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Individual physiological experiments typically provide useful but incomplete information about a studied physiological process. As a result, inferring the unknown parameters of a physiological model from experimental data is often challenging. The objective of this paper is to propose and illustrate the efficacy of a collective variational inference (C-VI) method, intended to reconcile low-information and heterogeneous data from a collection of experiments to produce robust personalized and generative physiological models. METHODS To derive the C-VI method, we utilize a probabilistic graphical model to impose structure on the available physiological data, and algorithmically characterize the graphical model using variational Bayesian inference techniques. To illustrate the efficacy of the C-VI method, we apply it to a case study on the mathematical modeling of hemorrhage resuscitation. RESULTS In the context of hemorrhage resuscitation modeling, the C-VI method could reconcile heterogeneous combinations of hematocrit, cardiac output, and blood pressure data across multiple experiments to obtain (i) robust personalized models along with associated measures of uncertainty and signal quality, and (ii) a generative model capable of reproducing the physiological behavior of the population. CONCLUSION The C-VI method facilitates the personalized and generative modeling of physiological processes in the presence of low-information and heterogeneous data. SIGNIFICANCE The resulting models provide a solid basis for the development and testing of interpretable physiological monitoring, decision-support, and closed-loop control algorithms.
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24
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The electronic health record: marching anesthesiology toward value-added processes and digital patient experiences. Int Anesthesiol Clin 2021; 59:12-21. [PMID: 34369398 DOI: 10.1097/aia.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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25
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Vatansever S, Schlessinger A, Wacker D, Kaniskan HÜ, Jin J, Zhou M, Zhang B. Artificial intelligence and machine learning-aided drug discovery in central nervous system diseases: State-of-the-arts and future directions. Med Res Rev 2021; 41:1427-1473. [PMID: 33295676 PMCID: PMC8043990 DOI: 10.1002/med.21764] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 01/11/2023]
Abstract
Neurological disorders significantly outnumber diseases in other therapeutic areas. However, developing drugs for central nervous system (CNS) disorders remains the most challenging area in drug discovery, accompanied with the long timelines and high attrition rates. With the rapid growth of biomedical data enabled by advanced experimental technologies, artificial intelligence (AI) and machine learning (ML) have emerged as an indispensable tool to draw meaningful insights and improve decision making in drug discovery. Thanks to the advancements in AI and ML algorithms, now the AI/ML-driven solutions have an unprecedented potential to accelerate the process of CNS drug discovery with better success rate. In this review, we comprehensively summarize AI/ML-powered pharmaceutical discovery efforts and their implementations in the CNS area. After introducing the AI/ML models as well as the conceptualization and data preparation, we outline the applications of AI/ML technologies to several key procedures in drug discovery, including target identification, compound screening, hit/lead generation and optimization, drug response and synergy prediction, de novo drug design, and drug repurposing. We review the current state-of-the-art of AI/ML-guided CNS drug discovery, focusing on blood-brain barrier permeability prediction and implementation into therapeutic discovery for neurological diseases. Finally, we discuss the major challenges and limitations of current approaches and possible future directions that may provide resolutions to these difficulties.
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Affiliation(s)
- Sezen Vatansever
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Center for Transformative Disease ModelingIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Icahn Institute for Data Science and Genomic TechnologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Avner Schlessinger
- Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Center for Therapeutics DiscoveryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Daniel Wacker
- Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Center for Therapeutics DiscoveryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - H. Ümit Kaniskan
- Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Center for Therapeutics DiscoveryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Oncological Sciences, Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jian Jin
- Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Center for Therapeutics DiscoveryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Oncological Sciences, Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Ming‐Ming Zhou
- Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Oncological Sciences, Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Bin Zhang
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Center for Transformative Disease ModelingIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Icahn Institute for Data Science and Genomic TechnologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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26
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McKendrick M, Yang S, McLeod GA. The use of artificial intelligence and robotics in regional anaesthesia. Anaesthesia 2021; 76 Suppl 1:171-181. [PMID: 33426667 DOI: 10.1111/anae.15274] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
The current fourth industrial revolution is a distinct technological era characterised by the blurring of physics, computing and biology. The driver of change is data, powered by artificial intelligence. The UK National Health Service Topol Report embraced this digital revolution and emphasised the importance of artificial intelligence to the health service. Application of artificial intelligence within regional anaesthesia, however, remains limited. An example of the use of a convoluted neural network applied to visual detection of nerves on ultrasound images is described. New technologies that may impact on regional anaesthesia include robotics and artificial sensing. Robotics in anaesthesia falls into three categories. The first, used commonly, is pharmaceutical, typified by target-controlled anaesthesia using electroencephalography within a feedback loop. Other types include mechanical robots that provide precision and dexterity better than humans, and cognitive robots that act as decision support systems. It is likely that the latter technology will expand considerably over the next decades and provide an autopilot for anaesthesia. Technical robotics will focus on the development of accurate sensors for training that incorporate visual and motion metrics. These will be incorporated into augmented reality and visual reality environments that will provide training at home or the office on life-like simulators. Real-time feedback will be offered that stimulates and rewards performance. In discussing the scope, applications, limitations and barriers to adoption of these technologies, we aimed to stimulate discussion towards a framework for the optimal application of current and emerging technologies in regional anaesthesia.
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Affiliation(s)
- M McKendrick
- Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh, UK.,Optomize Ltd, Glasgow, UK
| | - S Yang
- James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - G A McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,University of Dundee, UK
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27
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Intelligent automated drug administration and therapy: future of healthcare. Drug Deliv Transl Res 2021; 11:1878-1902. [PMID: 33447941 DOI: 10.1007/s13346-020-00876-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
In the twenty-first century, the collaboration of control engineering and the healthcare sector has matured to some extent; however, the future will have promising opportunities, vast applications, and some challenges. Due to advancements in processing speed, the closed-loop administration of drugs has gained popularity for critically ill patients in intensive care units and routine life such as personalized drug delivery or implantable therapeutic devices. For developing a closed-loop drug delivery system, the control system works with a group of technologies like sensors, micromachining, wireless technologies, and pharmaceuticals. Recently, the integration of artificial intelligence techniques such as fuzzy logic, neural network, and reinforcement learning with the closed-loop drug delivery systems has brought their applications closer to fully intelligent automatic healthcare systems. This review's main objectives are to discuss the current developments, possibilities, and future visions in closed-loop drug delivery systems, for providing treatment to patients suffering from chronic diseases. It summarizes the present insight of closed-loop drug delivery/therapy for diabetes, gastrointestinal tract disease, cancer, anesthesia administration, cardiac ailments, and neurological disorders, from a perspective to show the research in the area of control theory.
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28
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Joosten A, Lucidi V, Ickx B, Van Obbergh L, Germanova D, Berna A, Alexander B, Desebbe O, Carrier FM, Cherqui D, Adam R, Duranteau J, Saugel B, Vincent JL, Rinehart J, Van der Linden P. Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study. BMC Anesthesiol 2021; 21:12. [PMID: 33430770 PMCID: PMC7798188 DOI: 10.1186/s12871-020-01228-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background Acute kidney injury (AKI) occurs frequently after liver transplant surgery and is associated with significant morbidity and mortality. While the impact of intraoperative hypotension (IOH) on postoperative AKI has been well demonstrated in patients undergoing a wide variety of non-cardiac surgeries, it remains poorly studied in liver transplant surgery. We tested the hypothesis that IOH is associated with AKI following liver transplant surgery. Methods This historical cohort study included all patients who underwent liver transplant surgery between 2014 and 2019 except those with a preoperative creatinine > 1.5 mg/dl and/or who had combined transplantation surgery. IOH was defined as any mean arterial pressure (MAP) < 65 mmHg and was classified according to the percentage of case time during which the MAP was < 65 mmHg into three groups, based on the interquartile range of the study cohort: “short” (Quartile 1, < 8.6% of case time), “intermediate” (Quartiles 2–3, 8.6–39.5%) and “long” (Quartile 4, > 39.5%) duration. AKI stages were classified according to a “modified” “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Logistic regression modelling was conducted to assess the association between IOH and postoperative AKI. The model was run both as a univariate and with multiple perioperative covariates to test for robustness to confounders. Results Of the 205 patients who met our inclusion criteria, 117 (57.1%) developed AKI. Fifty-two (25%), 102 (50%) and 51 (25%) patients had short, intermediate and long duration of IOH respectively. In multivariate analysis, IOH was independently associated with an increased risk of AKI (adjusted odds ratio [OR] 1.05; 95%CI 1.02–1.09; P < 0.001). Compared to “short duration” of IOH, “intermediate duration” was associated with a 10-fold increased risk of developing AKI (OR 9.7; 95%CI 4.1–22.7; P < 0.001). “Long duration” was associated with an even greater risk of AKI compared to “short duration” (OR 34.6; 95%CI 11.5-108.6; P < 0.001). Conclusions Intraoperative hypotension is independently associated with the development of AKI after liver transplant surgery. The longer the MAP is < 65 mmHg, the higher the risk the patient will develop AKI in the immediate postoperative period, and the greater the likely severity. Anesthesiologists and surgeons must therefore make every effort to avoid IOH during surgery.
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Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. .,Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
| | - Valerio Lucidi
- Department of Digestive Surgery, Unit of Hepatobiliary Surgery and Liver Transplantation, Erasme hospital, Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Ickx
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luc Van Obbergh
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Desislava Germanova
- Department of Digestive Surgery, Unit of Hepatobiliary Surgery and Liver Transplantation, Erasme hospital, Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Berna
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brenton Alexander
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Olivier Desebbe
- Department of Anesthesiology and Perioperative Medicine, Sauvegarde Clinic, Ramsay Santé, Lyon, France
| | - Francois-Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Paul Brousse Hospital, Villejuif, France
| | - Rene Adam
- Department of Hepatobiliary Surgery, Paul Brousse Hospital, Villejuif, France
| | - Jacques Duranteau
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Rinehart
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | - Philippe Van der Linden
- Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
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Goldstein HV, Goldstein JC. Perioperative automation: Time to become artificial intelligence literate? Response to Br J Anaesth 2020; 125: 843-6. Br J Anaesth 2020; 126:e59-e61. [PMID: 33250182 DOI: 10.1016/j.bja.2020.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Heidi V Goldstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joseph C Goldstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
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30
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Nathan N. Rise of the Machines. Anesth Analg 2020; 130:1119. [DOI: 10.1213/ane.0000000000004737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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