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, 33 (4), 675-686

A Comparison of propofol-to-BIS Post-Operative Intensive Care Sedation by Means of Target Controlled Infusion, Bayesian-based and Predictive Control Methods: An Observational, Open-Label Pilot Study

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A Comparison of propofol-to-BIS Post-Operative Intensive Care Sedation by Means of Target Controlled Infusion, Bayesian-based and Predictive Control Methods: An Observational, Open-Label Pilot Study

M Neckebroek et al. J Clin Monit Comput.

Abstract

Purpose: We evaluated the feasibility and robustness of three methods for propofol-to-bispectral index (BIS) post-operative intensive care sedation, a manually-adapted target controlled infusion protocol (HUMAN), a computer-controlled predictive control strategy (EPSAC) and a computer-controlled Bayesian rule-based optimized control strategy (BAYES).

Methods: Thirty-six patients undergoing short lasting sedation following cardiac surgery were included to receive propofol to maintain a BIS between 40 and 60. Robustness of control for all groups was analysed using prediction error and spectrographic analysis.

Results: Although similar time courses of measured BIS were obtained in all groups, a higher median propofol effect-site concentration (CePROP) was required in the HUMAN group compared to the BAYES and EPSAC groups. The time course analysis of the remifentanil effect-site concentration (CeREMI) revealed a significant increase in CeREMI in the EPSAC group compared to BAYES and HUMAN during the case. Although similar bias and divergence in control was found in all groups, larger control inaccuracy was observed in HUMAN versus EPSAC and BAYES. Spectrographic analysis of the system behavior shows that BAYES covers the largest spectrum of frequencies, followed by EPSAC and HUMAN.

Conclusions: Both computer-based control systems are feasible to be used during ICU sedation with overall tighter control than HUMAN and even with lower required CePROP. EPSAC control required higher CeREMI than BAYES or HUMAN to maintain stable control. Clinical trial number: NCT00735631.

Keywords: Bispectral index; Closed-loop; Intensive care sedation; Propofol.

Conflict of interest statement

K. van Amsterdam declare that he have no conflict of interest, for department conflicts of interest, see MMRFS. T. De Smet: is an employee of Demed Medical, Temse, Belgium. M. Neckebroek, C. M. Ionescu, P. De Baets, J. Decruyenaere and R. De Keyser declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
MPC-EPSAC strategy as a block scheme (MPC model predictive control, EPSAC extended prediction self adaptive control)
Fig. 2
Fig. 2
Time course for measured BIS, targeted BIS, predicted propofol effect-site concentration (CePROP), and predicted remifentanil effect-site concentration (CeREMI) for the three groups. Blue line represents population mean value at every time point; grey lines are the data for each individual
Fig. 3
Fig. 3
Time-synchronized analysis of the differences between groups for measured BIS, targeted BIS, predicted propofol effect-site concentration (CePROP), and predicted remifentanil effect-site concentration (CeREMI). Blue line represents the absolute difference of the means of both populations at every time point; dotted red lines represent upper and lower 95% confidence interval at every time point
Fig. 4
Fig. 4
Time course of non-invasive mean arterial blood pressure (MAP) and heart rate (HR) for the three groups. Blue line represents population mean value at every time point; grey lines are the data for each individual
Fig. 5
Fig. 5
Time-synchronized analysis of the differences between groups for heart rate (HR) and non-invasive mean arterial blood pressure (NIBP). Blue line represents the absolute difference of the means of both populations at every time point; dotted red lines represent upper and lower 95% confidence interval at every time point
Fig. 6
Fig. 6
Spectrogram and time signal for measured BIS values in open loop (left) versus closed loop. a: BAYES, b: EPSAC and c: HUMAN

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