Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 1 , Pages 95-114 , March 2009

Closed-loop control for intensive care unit sedation

  • Wassim M. Haddad, PhD (Professor of Aerospace Engineering)

      Affiliations

    • School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0150, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 404 894 1078; Fax: +1 404 894 2760.
    • ,
  • James M. Bailey, MD, PhD (Director of Cardiac Anesthesia)

      Affiliations

    • Department of Anesthesiology, Northeast Georgia Medical Center, Gainesville, GA 30503, USA

References 

  1. In:  Murray RM editors. Control in an information rich World. Philadelphia, PA: SIAM; 2003;
  2. Keener J, Sneyd J. Mathematical physiology. New York: Springer-Verlag; 1998;
  3. Jacquez JA. Compartmental analysis in biology and medicine. Ann Arbor, MI: University of Michigan Press; 1985;
  4. Cherruault Y. Mathematical modelling in biomedicine. Dordrecht, Holland: Reidel; 1986;
  5. Grodins FS. Control theory and biological systems. New York: Columbia University Press; 1963;
  6. Riggs DS. Control theory and physiological feedback mechanisms. Baltimore, MD: Williams and Wilkins; 1970;
  7. Bailey JM, Haddad WM. Drug dosing control in clinical pharamacology: Paradigms, benefits, and challenges. Control Systems Magazine. 2005;25:35–51
  8. Absalom R, Sutcliffe N, Kenny GN. Closed-loop control of anesthesia using bispectral index: Performance assessment in patients undergoing major orthopedic surgery under combined general and regional anesthesia. Anesthesiology. 2002;96(1):67–73
  9. Schwilden H, Schuttler J, Stoeckel H. Closed-loop feedback control of methohexital anesthesia by quantitative EEG analysis in humans. Anesthesiology. 1987;67(3):341–347
  10. Linkens DA, Abbod MF, Peacock JE. Clinical implementation of advanced control in anaesthesia. Transactions of the Institute of Measurement and Control. 2000;22(4):303–330
  11. Tung A, Rosenthal M. Patients requiring sedation. Critical Care Clinics. 1995;vol. 11:791–802
  12. Mazzeo J. Sedation for the mechanically ventilated patient. Critical Care Clinics. 1995;11:937–955
  13. Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ. Sedation in the intensive care unit: A systematic review. JAMA: The Journal of the American Medical Association. 2000;283:1451–1459
  14. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing. The New England Journal of Medicine. 2000;342:1471–1477
  15. Strain J. Psychological reactions to acute medical illness and critical care. Critical Care Clinics. 1978;6:39–45
  16. The Acute Respiratory Distress Syndrome Network . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The New England Journal of Medicine. 2000;342:1301–1308
  17. Bidani A, Tzouanakis AE, Cardenas JVJ, Zwischenberger JB. Permissive hypercapnia in acute respiratory failure. JAMA: The Journal of the American Medical Association. 1994;272:957–962
  18. Hawes DW, Ross JA, White DC, Wloch RT. Servocontrol of closed circuit anesthesia. British Journal of Anaesthesia. 1982;54:229–230
  19. Hayes JK, Westenkow DR, East TD, Jordan WS. Computer controlled anesthesia delivery system. Medical Instrumentation. 1984;18:224–231
  20. Westenkow DR, Jordan WS. The Utah system: Computer controlled anesthesia delivery. Future Anesthesia Delivery Systems. 1984;8:221–233
  21. Ritchie RG, Ernst EA, Late BL, et al. Closed-loop control of an anesthesia delivery system: Development and animal testing. IEEE Transactions on Bio-medical Engineering. 1987;34:437–443
  22. Spain JA, Janett TC, Ernst EA. The Alabama automated closed-circuit anesthesia project. Future Anesthesia Delivery Systems. 1984;vol. 8:177–183
  23. Vishnoi R, Roy RJ. Adaptive control of closed-circuit anesthesia. IEEE Transactions on Bio-medical Engineering. 1991;38(1):39–47
  24. Jee GI, Roy RJ. Adaptive control of multiplexed closed-circuit anesthesia. IEEE Transactions on Bio-medical Engineering. 1992;39(10):1071–1080
  25. Bickford RG. Automatic electroencephalographic control of anesthesia (servo-anesthesia). Electroencephalography and Clinical Neurophysiology. 1951;3:83–86
  26. Hill AV. The possible effects of the aggregation of the molecules of haemoglobin on its dissociation curves. Journal of Physics. 1910;40:4–7
  27. Schwilden H, Stoeckel H, Schuttler J. Closed-loop feedback control of propofol anesthesia by quantitative EEG analysis in humans. British Journal of Anaesthesia. 1989;62(3):290–296
  28. Sebel PS, Lang E, Rampil IJ, et al. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesthesia and Analgesia. 1997;84(4):891–899
  29. Glass PS, Bloom M, Kearse L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in normal volunteers. Anesthesiology. 1997;86(4):836–847
  30. Struys MMRF, Smet TD, Versichelen LFM, et al. Comparison of closed-loop controlled administration of propofol using bispectral index as the controlled variable versus “standard practice” controlled administration. Anesthesiology. 2001;95:6–17
  31. Glass PSA, Rampil IJ. Automated anesthesia: Fact or fantasy?. Anesthesiology. 2001;95(1):1–2
  32. Kenny GN, Mantzardis H. Closed-loop control of propofol anaesthesia. British Journal of Anaesthesia. 1999;83(2):223–228
  33. Gentilini A, Rossoni-Gerosa M, Frei CW, et al. Modeling and closed-loop control of hypnosis by means of bispectral index (BIS) with isoflurane. IEEE Transactions on Bio-medical Engineering. 2001;48(8):874–889
  34. Simmons LE, Riker RR, Prato S, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the bispectral index and the sedation-agitation scale. Critical Care Medicine. 1999;27:1499–1504
  35. Shapiro BA. Bispectral index: Better information for sedation in the intensive care unit?. Critical Care Medicine. 1999;27(6):1663–1664
  36. Riess ML, Graefe UA, Aken HV, Bone HG. Usefulness of bispectral index to assess the level of sedation in critically ill patients. Critical Care Medicine. 1999;27(12):A132
  37. Nasraway SA, Wu EC, Kelleher RM, et al. How reliable in the bispectral index in critically ill patients? A prospective, comparative, single-blinded observer study. Critical Care Medicine. 2002;30(7):1483–1487
  38. Nasraway SA. The bispectral index: Expanded performance for everyday use in the intensive care unit. Critical Care Medicine. 2002;33(3):685–687
  39. Hijazi MN, Chaudhary A. The correlation between the bispectral index (bis) and motor activity assessment scale (maas) in sedated and mechanically ventilated patients, CHEST Meeting Abstracts; 2004. p. 897.
  40. Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology. 2000;93:1336–1340
  41. Kallet RH, Campbell AR, Dicker RA, et al. Effects of tidal volume on work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome. Critical Care Medicine. 2006;34(1):8–14
  42. Hess DR, Thompson BT. Patient-ventilator dyssynchrony during lung protective ventilation: What's a clinician to do?. Critical Care Medicine. 2006;34(1):231–233
  43. Nilsestuen JO, Hargett KD. Using ventilator graphics to identify patient-ventilator asynchrony. Respiratory Care. 2005;50(2):202–234
  44. Anderson BDO, Moore JB. Optimal control: Linear quadratic methods. Englewood Cliffs, New Jersey: Prentice-Hall; 1990;
  45. Weinert CR, Chlan L, Gross C. Sedating critically ill patients: Factors affecting nurses' delivery of sedative therapy. American Journal of Critical Care. 2001;10(3):156–167
  46. Gelinas C, Fortier M, Viens C, et al. Pain assessment and management in critically ill intubated patients: A retroscpective study. American Journal of Critical Care. 2004;13(2):126–135
  47. Sessler CN. Sedation scales in the ICU. Chest. 2004;126:1727–1730
  48. Jong MMJD, Burnes SM, Campbell ML, et al. Development of the American Association of Critical-Care Nurses' sedation assessment scale for critically ill patients. American Journal of Critical Care. 2005;14(6):531–544
  49. Devlin JW, Boleski G, Mlynarek M, et al. Motor activity assessment scale: A valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Critical Care Medicine. 1999;27:1271–1275
  50. Åström KJ, Wittenmark B. Adaptive control. Reading, MA: Addison-Wesley; 1989;
  51. Narendra KS, Annaswamy AM. Stable adaptive systems. Englewood Cliffs, NJ: Prentice-Hall; 1989;
  52. Ioannou PA, Sun J. Robust adaptive control. Upper Saddle River, NJ: Prentice-Hall; 1996;
  53. Rescigno A, Beck JS. Compartments. In:  Rosen R editors. New York. Foundation of mathematical biology, ser. 5. vol. 2:NY: Academic Press; 1972;p. 255–322
  54. Mohler RR. Biological modeling with variable compartmental structure. IEEE Transactions on Automatic Control. 1974;19:922–926
  55. Sandberg W. On the mathematical foundations of compartmental analysis in biology, medicine and ecology. IEEE Transactions on Circuits and Systems. 1978;25:273–279
  56. Brown RF. Compartmental system analysis: State of the art. IEEE Transactions on Bio-medical Engineering. 1980;27:1–11
  57. Anderson DH. Compartmental modeling and tracer kinetics. Berlin, New York: Springer-Verlag; 1983;
  58. Godfrey K. Compartmental models and their applications. New York: Academic Press; 1983;
  59. Jacquez J. Compartmental modeling. In: IFAC Proceedings Series; 1989. p. 31–37.
  60. Hull CJ. How far can we go with compartmental models?. Anesthesiology. 1990;72:399–402
  61. Jacquez JA, Simon CP. Qualitative theory of compartmental systems. SIAM Review. 1993;35:43–79
  62. Jacquez JA. Modeling with compartments. Ann Aarbor, MI: BioMedWare; 1999;
  63. Haddad WM, Chellaboina V. Nonlinear dynamical systems and control: A Lyapunov-based approach. Princeton, NJ: Princeton University Press; 2008;
  64. Haddad WM, Chellaboina V. Stability and dissipativity theory for nonnegative dynamical systems: A unified analysis framework for biological and physiological systems. Nonlinear Analysis: Real World Applications. 2005;6:35–65
  65. Haddad WM, Hayakawa T, Bailey JM. Adaptive control for nonnegative and compartmental dynamical systems with applications to general anesthesia. International Journal of Adaptive Control and Signal Processing. 2003;17:209–235
  66. Haddad WM, Hayakawa T, Bailey JM. Adaptive control for nonlinear compartmental dynamical systems with applications to clinical pharmacology. Systems & Control Letters. 2006;62–70
  67. Volyanskyy K, Haddad WM, Bailey JM. Adaptive disturbance rejection control for compartmental systems with applications to intraoperative anesthesia influenced by hemorrhage and hemodilution effects. International Journal of Adaptive Control and Signal Processing, in press.
  68. Haddad WM, Bailey JM, Hayakawa T, Hovakimyan N. Neural network adaptive output feedback control for intensive care uint sedation and intraoperative anesthesia. IEEE Transactions on Neural Networks. 2007;18(4):1049–1066
  69. Bailey JM, Haddad WM., Im JJ, et al. Adaptive and neural network adaptive control of depth of anesthesia during surgery. In: Proceedings of American Control Conference. Minneapolis, MN; 2006. p. 3409–3414.
  70. Kazama T, Kurita T, Morita K, et al. Influence of hemorrhage on propofol pseudo-steady state concentration. Anesthesiology. 2002;97:1156–1161
  71. Haddad WM, Hayakawa T, Bailey JM. Nonlinear adaptive control for intensive care unit sedation and operating room hypnosis. In: Proceedings of American Control Conference. Denver, CO; June 2003. p. 1808–1813.
  72. Volyansky K, Htaddad WM. Adaptive control for compartmental dynamical systems with disturbance rejection guarantees. In: Proceedings of American Control Conference. New York, NY; July 2007. p. 1215–1220.
  73. Leonessa A, Haddad WM, Hayakawa T, Morel Y. Adaptive control for nonlinear uncertain systems with actuator amplitude and rate saturation constraints. International Journal of Adaptive Control and Signal Processing, in press.
  74. Hui Q, Haddad WM, Chellaboina V, Hayakawa T. Adaptive control of mammillary drug delivery systems with actuator amplitude constraints and system time delays. European Journal of Control. 2005;11:586–600
  75. Haddad WM, Volyanskyy KY, Bailey JM. Neuroadaptive output feedback control for automated anesthesia with noisy EEG measurements. In: Proceedings of American Control Conference. Seattle, WA; June 2008. p. 813--818.
  76. Henthorn TK, Krejcie TC, Niemann CU, et al. Ketamine distribution described by a recirculatory pharmacokinetic model is not stereo-selective. Anesthesiology. 1999;91(6):1733–1743
  77. Gyori . Delay differential and integro-differential equations in biological compartment models. Systems Science. 1982;8(2–3):167–187
  78. Maeda H, Kodama S, Konishi T. Stability theory and existence of periodic solutions of time delayed compartmental systems. Electronics and Communications in Japan. 1982;65(1):1–8
  79. Haddad WM, Chellaboina V. Stability and dissipativity theory for nonnegative and compartmental dynamical systems with time delay. In:  Niculescu S-I,  Gu K editor. Advances in time-delay systems. Springer; 2004;p. 421–435
  80. Hale K, Verduyn lunel SM. Introduction to functional differential equations. New York, NY: Springer-Verlag; 1993;
  81. Niculescu S-I. Delay effects on stability: a robust control approach. New York, NY: Springer; 2001;
  82. Chellaboina V, Haddad WM, Ramakrishnan J, Hayakawa T. Direct adaptive control of nonnegative and compartmental dynamical systems with time delay. In: Proceedings of American Control Conference. Boston, MA; July 2004. p. 1235–1240.
  83. Chellaboina V, Haddad W, Ramakrishnan J, Hui Q. Direct adaptive control of nonnegative and compartmental systems with time delay. In:  Queinnec I,  Tarbouriech S,  Garcia G,  Niculescu S-I editor. Biology and control theory: current challenges. Springer; 2007;p. 291–316
  84. Narendra S, Parthasarathy K. Identification and control of dynamical systems using neural networks. IEEE Transactions on Neural Networks. 1990;1:4–27
  85. Chen FC, Khalil HK. Adaptive control of nonlinear systems using neural networks. International Journal of Control. 1992;55(6):1299–1317
  86. Hunt J, Sbarbaro D, Zbikowski R, Gawthrop PJ. Neural networks for control: A survey. Automatica. 1992;28:1083–1112
  87. Lewis FL, Yesildirek A, Liu K. Multilayer neural-net robot controller with guaranteed tracking performance. IEEE Transactions on Neural Networks. 1996;7(2):388–399
  88. Lewis FL, Jagannathan S, Yesildirak A. Neural network control of robot manipulators and nonlinear systems. London, UK: Taylor & Francis; 1999;
  89. Spooner J, Maggiore M, Ordonez R, Passino K. Stable adaptive control and estimation for nonlinear systems: Neural and fuzzy approximator techniques. New York, NY: John Wiley & Sons; 2002;
  90. Buell J, Jelliffe R, Kalaba R, Sridhar R. Modern control theory and optimal drug regiments, I: The plateau effect. Mathematical Biosciences. 1969;5:285–296
  91. Buell J, Jelliffe R, Kalaba R, Sridhar R. Modern control theory and optimal drug regiments, II: Combination therapy. Mathematical Biosciences. 1970;6:67–74
  92. Soong TT. Pharmacokinetics with uncertainties in rate constants–II: Sensitivity analysis and optimal dosage control. Mathematical Biosciences. 1972;13:391–396
  93. Pierce JG, Schumitzky A. Optimal impulsive control of compartment models, I: Qualitative aspects. Journal of Optimization Theory and Application. 1976;18:537–554
  94. Kusuoka H, Kodama S, Hori M, et al. Optimal control of drug administration. Proceeding of International Conference Cybern Society. 1978;1:63–68
  95. Pierce JG, Schumitzky A. Optimal control of compartment models, II: Algorithm. Journal of Optimization Theory and Application. 1978;26(1):581–599
  96. Kusuoka H, Kodama S, Maeda H, et al. Optimal control in compartmental systems and its application to drug administration. Mathematical Biosciences. 1981;53(1–2):59–77
  97. Martin P, Ahuja AA. Optimal pharmacokinetic delivery of infused drugs: Application to the treatment of cardiac arrhythmias. Journal of Biomedical Engineering. 1988;10(4):360–364
  98. Nersesov SG, Haddad WM, Chellaboina V. Optimal fixed-structure control for linear nonnegative dynamical systems. International Journal of Robust and Nonlinear Control. 2004;14:487–511
  99. Bernstein DS, Hyland DC. Optimal projection approach to robust, fixed-structure control design. In:  Junkins J editors. Mechanics and control of space structures. Washington, D.C.: AIAA; 1993;
  100. Bernstein DS, Haddad WM, Nett CN. Minimal complexity control law synthesis, Part 2: Problem solution via H2/H⧜ optimal static output feedback. In: Proceedings of American Control Conference. Pittsburgh, PA; 1989. p. 2506–2511.
  101. Levine WS, Athans M. On the determination of the optimal output feedback gains for linear multivariable systems. IEEE Transactions on Automatic Control. 1970;15:44–48
  102. Haddad WM, Chellaboina V, Nersesov SG. Impulsive and hybrid dynamical systems: Stability, dissipativity, and control. Princeton, NJ: Princeton University Press; 2006;
  103. Campbell D, Brown J. The electrical analog of the lung. British Journal of Anaesthesia. 1963;35:684–693
  104. Wald AA, Murphy TW, Mazzia VD. A theoretical study of controlled ventilation. IEEE Transactions on Bio-medical Engineering. 1968;15:237–248
  105. Epstein A, Epstein RA. Airway flow patterns during mechanical ventilation of infants: A mathematical model. IEEE Transactions on Bio-medical Engineering. 1979;26:299–306
  106. Barbini P. Nonlinear models of the mechanics of breathing applied to the use and design of ventilators. Journal of Biomedical Engineering. 1982;4:294–304
  107. Marini JJ, Crooke PS. A general mathematical model for respiratory dynamics relevant to the clinical setting. American Review of Respiratory Disease. 1993;147:14–24
  108. Hotchkiss JR, Crooke PS, Adams AB, Marini JJ. Implications of a biphasic two-compartment model of constant flow ventilation for the clinical setting. Journal of Critical Care. 1994;9:114–123
  109. Similowski T, Bates JH. Two-compartment modeling of respiratory system mechanics at low frequencies: Gas redistribution or tissue rheology. European Respiratory Journal. 1991;4:353–358
  110. Crooke PS, Head JD, Marini JJ. A general two-compartment model for mechanical ventilation. Mathematical and Computer Modeling. 1996;24:1–18
  111. Chellaboina V, Haddad WM, Bailey JM, Li H, Limit cycle stability analysis of a multi-compartment model for a pressure-limited respirator and lung mechanics system. In Proceedings of American Control Conference. New York, NY; 2007. p. 2411–2416.
  112. Chellaboina V, Haddad WM, Li H, & Bailey JM. Direct adaptive control for a multi-compartment model of a pressure-limited respirator and lung mechanics systems. In: Proceedings of IEEE Conference on Decision and Control. Cancun, Mexico; 2008.
  113. Grap J, Borchers T, Munro CL, et al. Actigraphy in the critically ill: Correlation with acitivity, agition, and sedation. American Journal of Critical Care. 2005;14(1):52–60
  114. Weinbroum A, Abraham RB, Ezri T, Zomer J. Wrist actigraphy in anesthesia. Journal of Clinical Anesthesia. 2001;13:455–460
  115. Chase JG, Agogue F, Starfinger C, et al. Quantifying agitation in sedated ICU patients using digital imaging. Computer Methods and Programs in Biomedicine. 2004;76(2):131–141
  116. Becouze CE, Hann JG, Chase , Shaw GM. Measuring facial grimacing for quantifying patient agitation in critical care. Computer Methods and Programs in Biomedicine. 2007;87(2):134–147
  117. Ashraf AB, Lucey S, Cohn JF et al. The painful face: Pain expression recognition using active appearance models. In: Proceedings of the 9th International Conference on Multimodal Interface. Nagoya, Japan; 2007.
  118. Brahnam S, Chuang C-F, Sexton RS, Shih FY. Machine assessment of neonatal facial expressions of acute pain. Decision Support Systems. 2007;43:1242–1254
  119. Monwar MM, Rezaei S, Prkachin K. Eigenimage based pain expression recongintion. International Journal of Applied Mathematics. 2007;36(2):

☆ This reseach was supported in part by the National Science Foundation under Grant ECS-0601311.

PII: S1521-6896(08)00063-3

doi: 10.1016/j.bpa.2008.07.007

Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 1 , Pages 95-114 , March 2009

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