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Performance of closed-loop resuscitation in a pig model of haemorrhagic shock with fluid alone or in combination with norepinephrine, a pilot study

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Abstract

We evaluated the performance of a new device to control the administration of fluid alone or co-administration of fluid and norepinephrine in a pig model of haemorrhagic shock in two sets of experiments. In the first one, resuscitation was guided using continuous arterial pressure measurements (three groups: resuscitation with fluid by a physician, CL resuscitation with fluid, and CL resuscitation with fluid and norepinephrine). In the second one, resuscitation was guided using discontinuous arterial pressure measurements (three groups: CL resuscitation with fluid alone, CL resuscitation with fluid and moderate dose norepinephrine, and CL resuscitation with fluid and a high dose of norepinephrine). Pigs were resuscitated for 1 h. In the first set of experiments, proportion of time spent in the target area of 78–88 mmHg of systolic arterial pressure was not statistically different between the three groups: manual, 71.2% (39.1–80.1); CL with fluid, 87.8% (68.3–97.4); and CL with fluid and norepinephrine, 78.1% (59.2–83.6), p = 0.151. In the second set of experiments, performance of CL resuscitation with fluid or with combination of fluid and high or moderate dose of norepinephrine was not significantly different (p = 0.543 for time in target). Pigs resuscitated with norepinephrine required less fluid and had less haemodilution than pigs resuscitated with fluid alone. Performance of CL resuscitation using continuous arterial pressure measurement was not significantly different than optimised manual treatment by a dedicated physician. Performance of CL resuscitation was reduced with discontinuous arterial pressure measurements in comparison with continuous arterial pressure measurements.

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Funding

This work was supported by a grant from Mission innovation participative, Direction Générale de l’Armement, Ministère de la défense, France. https://www.defense.gouv.fr/dga/liens/mission-innovation-participative. A grant from BIOMEDEF, Direction Générale de l’Armement, Ministère de la défense, France. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Authors and Affiliations

  1. Laboratoire d’Étude de la Microcirculation, UMR 942, Université Paris, 7-11-13, Paris, France

    Nicolas Libert, Anatole Harrois, Nathalie Baudry, Eric Vicaut & Jacques Duranteau

  2. Service d’Anesthésie-Réanimation, Hôpital d’instruction des armées Percy, Clamart, France

    Nicolas Libert

  3. Institut de la Vision UMR-S 968, Sorbonne Université, Université Pierre et Marie Curie UPMC, Paris, France

    Guillaume Chenegros, Gilles Cordurie & Ryad Benosman

  4. Service d’Anesthésie-Réanimation Chirurgicale, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France

    Anatole Harrois & Jacques Duranteau

  5. Unité de Recherche et d’innovation, Hôpital Marie Lannelongue, Le Plessis Robinson, France

    Benoit Decante

  6. École de médecine, Université Paris-Sud et Paris-Saclay, Kremlin-Bicêtre, France

    Olaf Mercier

  7. Département de Chirurgie Thoracique et Vasculaire et Transplantation cœur-Poumon, DHU Thorax Innovation, INSERM UMR-S 999, LabEx LERMIT, Hôpital Marie Lannelongue, Le Plessis Robinson, France

    Olaf Mercier

  8. Unité de Recherche Clinique, Université Paris 7, Hôpitaux Saint Louis Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France

    Eric Vicaut

Authors
  1. Nicolas Libert
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  2. Guillaume Chenegros
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  3. Anatole Harrois
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  4. Nathalie Baudry
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  5. Benoit Decante
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  6. Gilles Cordurie
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  7. Ryad Benosman
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  8. Olaf Mercier
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  9. Eric Vicaut
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  10. Jacques Duranteau
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Contributions

NL, AH, EV and JD designed the study. NL, GC, GC and RB designed the closed-loop device. NL, NB, BD, OM and GC conducted the study and collected the data. NL, AH, EV and JD analyzed the data. NL, GC, AH, EV and JD prepared the manuscript. All authors critically reviewed and approved the final manuscript.

Corresponding author

Correspondence to Jacques Duranteau.

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Conflict of interest

NL has received research grants from Mission innovation participative, Direction Générale de l’Armement, Ministère de la défense, France and BIOMEDEF, Direction Générale de l’Armement, Ministère de la défense, France.

Research involving Animals

All the procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted (Institutional animal committee:Comité d'Ethique en Expérimentation Animale Capsud n°26). All procedures were reviewed and approved by the institutional animal committee and by the French national ethical committee (APAFIS authorisation number: #3918-2016020213092528). This manuscript adheres to the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines for reporting animal research.

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Libert, N., Chenegros, G., Harrois, A. et al. Performance of closed-loop resuscitation in a pig model of haemorrhagic shock with fluid alone or in combination with norepinephrine, a pilot study. J Clin Monit Comput 35, 835–847 (2021). https://doi.org/10.1007/s10877-020-00542-7

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  • DOI: https://doi.org/10.1007/s10877-020-00542-7

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