Mathematical Modeling of Hemodynamics in Trauma-Induced Shock and Closed- Loop Trauma Resuscitation
Abstract
Our long-term goal is to deliver automated closed-loop fluid and drug resuscitation systems for combat casualty and trauma care. An analogy to closed-loop control in medicine is an airplane’s autopilot. Skilled experienced pilots use intuitive instrument displays and autopilots to maintain the plane’s speed, altitude, and direction during normal flight. When a plane hits a region of severe turbulence, the pilot “takes the stick,” which disengages the autopilot. Similarly, medical closed-loop systems would maintain a patient’s physiological condition (e.g., keep blood pressure near a certain value) by automatically adjusting the amount of drug being delivered. If the patient has, for example, a sudden drop in blood pressure or there is failure of the patient’s monitor or intravenous pump delivering therapy, the physician can use an override button, which disengages the closed-loop control and return to the standard manual methods of controlling infusion rate. We have prototyped and performed extensive animal studies of such systems for hemorrhagic shock and burn shock. However, animal studies alone may not be sufficient to demonstrate the safety of these systems across the wide range of patient and clinical conditions they may need to be used in during critical care. A key component to demonstrating the safety of these systems is to use mathematical models that describe the physiology of shock and its response to a full range of injuries and therapies. The focus of this grant is to establish such mathematical models as the foundation for the development and evaluation of closed-loop trauma resuscitation algorithms and systems, and demonstrate the utility of these models in the development and optimization of closed-loop resuscitation algorithms. We will achieve our research objectives with three specific aims. We will: (1) Develop mathematical models of trauma-induced shock and resuscitation specifically for developing and evaluating closed-loop resuscitation control algorithms. We will perform animal studies to provide the key data to develop models. (2) Perform quantitative evaluation of mathematical models of trauma-induced shock and resuscitation. (3) Establish utility of the mathematical models by comparing in silico versus animal testing of closed-loop resuscitation algorithms. Future autonomous closed-loop resuscitation systems well validated with extensive in silico testing based on mathematical models will allow Medics, Corpsmen, Forward Surgical Teams, and Combat Support Hospitals to apply resuscitation therapies equivalent to that of the best civilian trauma centers. Such systems will provide emergency, perioperative, and critical care therapy of multiple casualties, when military caregivers are overwhelmed. Closed-loop technologies can be miniaturized and applied in a far-forward combat environment and then continued through the potential 48 hours of evacuation phases.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jul 16, 2019
- Source ID
- W81XWH1910322
Entities
People
- George C. Kramer
Organizations
- United States Army
- University of Texas Medical Branch