The future of intraoperative blood pressure management

Excerpt

In this issue of the Journal, Rinehart et al. [1] described a new closed loop system designed to maintain blood pressure (BP) within a predetermined target zone by triggering the automatic administration of a vasopressor. This was a computer or “in silico” study where the goal was to maintain the virtual mean arterial pressure of virtual patients between 65 and 75 mmHg. In this well controlled experimental setting, the controller performance was excellent. This study was a first development step, or engineering requirement. Animal and human studies are now needed to investigate the safety and reliability of the system in real physiologic or pathophysiologic conditions, and in an environment where artifacts and measurement errors may occur. Other groups have already conducted in vivo evaluations of closed loop systems for BP control either with fluids or vasopressors [2, 3 ]. In 222 women having spinal anesthesia for caesarean delivery, Ngan Kee et al. [3] reported a better BP control, with fewer interventions and less wobble, with computer-controlled than with manual-controlled phenylephrine infusion. Given the exponential development of computer capabilities and digital health solutions, closed loop hemodynamic systems may become available soon in operating rooms and intensive care units [4, 5]. …