ArticleBritish journal of anaesthesia2019
Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery.
Article in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03515161 (Computer-assisted Vasopressor Infusion for Hemodynamic Optimization in Patients Undergoing High Risk Surgery), which is not on this map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Computer-assisted Vasopressor Infusion for Hemodynamic Optimization in Patients Undergoing High Risk Surgery
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management.British journal of anaesthesia · 2024Guideline
- Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial.Anesthesiology · 2021Trial
- Automated closed-loop versus manually controlled norepinephrine infusion in patients undergoing intermediate- to high-risk abdominal surgery: a randomised controlled trial.British journal of anaesthesia · 2021Trial
- Monitoring Inputs, Control Architectures, and Failure Modes in Closed-Loop Vasopressor Systems: A Comprehensive Review.Sensors (Basel, Switzerland) · 2026Review
- Automated hemodynamic management system for the prevention of hypotension and cardiac output reduction during general anesthesia: preclinical experimental validation.Journal of anesthesia · 2026Article
- Evaluation of Automated Vasopressor Administration Algorithms Using Lower-Limit Control for Intraoperative Hypotension: A Simulation Study.Journal of clinical medicine · 2025Article
- Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine.Journal of clinical monitoring and computing · 2024Review
- Knowing the ropes of vasopressor dosing: a focus on norepinephrine.Intensive care medicine · 2024Article
- Computer-controlled closed-loop norepinephrine infusion system for automated control of mean arterial pressure in dogs under isoflurane-induced hypotension: a feasibility study.Frontiers in veterinary science · 2024Article
- Review
- Bibliometric and visual analysis of intraoperative hypotension from 2004 to 2022.Frontiers in cardiovascular medicine · 2023Article
- Model enhanced reinforcement learning to enable precision dosing: A theoretical case study with dosing of propofol.CPT: pharmacometrics & systems pharmacology · 2022Article
- Systolic Arterial Pressure Control Using an Automated Closed-Loop System for Vasopressor Infusion during Intermediate-to-High-Risk Surgery: A Feasibility Study.Journal of personalized medicine · 2022Article
- Vasopressors in Septic Shock: The Quest for Refinement.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2022Article
- Detection of arterial pressure waveform error using machine learning trained algorithms.Journal of clinical monitoring and computing · 2022Article
- Machine Learning, Deep Learning, and Closed Loop Devices-Anesthesia Delivery.Anesthesiology clinics · 2021Review
- Performance of closed-loop resuscitation in a pig model of haemorrhagic shock with fluid alone or in combination with norepinephrine, a pilot study.Journal of clinical monitoring and computing · 2021Article
- Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study.BMC anesthesiology · 2021Article
- Feasibility of computer-assisted vasopressor infusion using continuous non-invasive blood pressure monitoring in high-risk patients undergoing renal transplant surgery.Anaesthesia, critical care & pain medicine · 2020Article
- Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review.BMC anesthesiology · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundVasopressor agents are used to prevent intraoperative hypotension and ensure adequate perfusion. Vasopressors are usually administered as intermittent boluses or manually adjusted infusions, but this practice requires considerable time and attention. We have developed a closed-loop vasopressor (CLV) controller to correct hypotension more efficiently. Here, we conducted a proof-of-concept study to assess the feasibility and performance of CLV control in surgical patients.
methodsTwenty patients scheduled for elective surgical procedures were included in this study. The goal of the CLV system was to maintain MAP within 5 mm Hg of the target MAP by automatically adjusting the rate of a norepinephrine infusion using MAP values recorded continuously from an arterial catheter. The primary outcome was the percentage of time that patients were hypotensive, as defined by a MAP of 5 mm Hg below the chosen target. Secondary outcomes included the total dose of norepinephrine, percentage of time with hypertension (MAP>5 mm Hg of the chosen target), raw percentage "time in target" and Varvel performance criteria.
resultsThe 20 subjects (median age: 64 years [52-71]; male (35%)) underwent elective surgery lasting 154 min [124-233]. CLV control maintained MAP within ±5 mm Hg of the target for 91.6% (85.6-93.3) of the intraoperative period. Subjects were hypotensive for 2.6% of the intraoperative period (range, 0-8.4%). Additional performance criteria for the controller included mean absolute performance error of 2.9 (0.8) and mean predictive error of 0.5 (1.0). No subjects experienced major complications.
conclusionsIn this proof of concept study, CLV control minimised perioperative hypotension in subjects undergoing moderate- or high-risk surgery. Further studies to demonstrate efficacy are warranted. TRIAL REGISTRY NUMBER: NCT03515161 (ClinicalTrials.gov).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.