Abstract: Background: Management of a patient’s body temperature is an important aspect of care that should be addressed by targeted temperature management (TTM). Often, non-invasive methods like forced-air blankets are used. Especially in the operating room this management may be a subsidiary and repetitive task requiring constant observation of the patient’s body temperature and adaption using the limited set of available settings. Thus, automation of TTM is a feasible target to improve patient outcome and reduce caregiver workload. Methods: A Philips IntelliVue MP 50 patient monitor with an arterial PiCCO catheter system was used to measure patient blood temperature. Thermal management was performed with a 3M Bair Hugger 755 warming unit with forced air blankets. The warming unit was extended by a computer interface to allow for remote and automated control. A proposed closed-loop algorithm reads the measured temperature and performs automated control of the 3M Bair Hugger. Evaluation was performed in an experimental intensive care setting for animal studies. Two fully automated trials are compared with two manual and two uncontrolled trials in the same study setting using six female pigs for prolonged observation times of up to 90 hours in each trial. Results: The developed system and proposed algorithm allow more precise temperature management by keeping a set target temperature within a range of ± 0.5 °C in 88% of the observation time and within a range of ± 1.0 °C at all times. The proposed algorithm yielded better performance than did manual control or uncontrolled trials. It was able to adapt to individual patient needs as it is more dynamic than look-up table approaches with fixed settings for various temperatures. Conclusions: Closed-loop TTM using non-invasive forced-air warming blankets was successfully tested in a porcine study with the proposed hardware interface and control algorithm. This automation can be beneficial for patient outcome and can reduce caregiver workload and patient risk in clinical settings. As temperature readings are most often available, existing devices like the 3M Bair Hugger can easily be expanded. However, even if clinical application is feasible, open questions regarding approval and certification of such automated systems within the current legal situation still need to be answered.

@article{JKWKACWM072018, author = {Peter, Jörg and Klingert, Kathrin and Klingert, Wilfried and Thiel, Karolin and Königsrainer, Alfred and Grasshoff, Christian and Rosenstiel, Wolfgang and Schenk, Martin}, title = {Automated closed-loop management of body temperature using forced-air blankets: preliminary feasibility study in a porcine model}, journal = {BMC Anesthesiology}, year = {2018}, month = {jul}, volume = {18}, number = {80}, doi = {10.1186/s12871-018-0542-4}, month_numeric = {7} }

Abstract: Background: Automated systems are available in various application areas all over the world for the purpose of reducing workload and increasing safety. However, such support systems that would aid caregivers are still lacking in the medical sector. With respect to workload and safety, especially, the intensive care unit appears to be an important and challenging application field. Whereas many closed-loop subsystems for single applications already exist, no comprehensive system covering multiple therapeutic aspects and interactions is available yet. This paper describes a fully closed-loop intensive care therapy and presents a feasibility analysis performed in three healthy pigs over a period of 72 h each to demonstrate the technical and practical implementation of automated intensive care therapy. Methods: The study was performed in three healthy, female German Landrace pigs under general anesthesia with endotracheal intubation. An arterial and a central venous line were implemented, and a suprapubic urinary catheter was inserted. Electrolytes, glucose levels, acid-base balance, and respiratory management were completely controlled by an automated fuzzy logic system based on individual targets. Fluid management by adaption of the respective infusion rates for the individual parameters was included. Results: During the study, no manual modification of the device settings was allowed or required. Homoeostasis in all animals was kept stable during the entire observation period. All remote-controlled parameters were maintained within physiological ranges for most of the time (free arterial calcium 73%, glucose 98%, arterial base excess 89%, and etCO2 98%). Subsystem interaction was analyzed. Conclusions: In the presented study, we demonstrate the feasibility of a fully closed-loop system, for which we collected high-resolution data on the interaction and response of the different subsystems. Further studies should use big data approaches to analyze and investigate the interactions between the subsystems in more detail.

@article{WJCKWKCAM012018, author = {Klingert, Wilfried and Peter, Jörg and Thiel, C. and Thiel, Karolin and Rosenstiel, Wolfgang and Klingert, Kathrin and Grasshoff, Christian and Königsrainer, Alfred and Schenk, Martin}, title = {Fully automated life support: an implementation and feasibility pilot study in healthy pigs}, journal = {Intensive Care Medicine Experimental}, year = {2018}, month = {jan}, volume = {6}, number = {2}, doi = {10.1186/s40635-018-0168-3}, month_numeric = {1} }

@article{JWKKDAWM082017, author = {Peter, Jörg and Klingert, Wilfried and Klingert, Kathrin and Thiel, Karolin and Wulff, D. and Königsrainer, Alfred and Rosenstiel, Wolfgang and Schenk, Martin}, title = {Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics}, journal = {World Journal of Critical Care Medicine}, year = {2017}, month = {aug}, volume = {6}, number = {3}, pages = {172-178}, month_numeric = {8} }

@inproceedings{JWMAWM022017, author = {Peter, Jörg and Klingert, Wilfried and Spüler, Martin and Königsrainer, Alfred and Rosenstiel, Wolfgang and Schenk, Martin}, title = {Automated Therapeutic Anticoagulation: A Closed-Loop Approach Using a Modified Measurement Device}, booktitle = {Proceeding of the International Conference on Biomedical Engineering (BIOMED) }, publisher = {ACTA Press}, year = {2017}, month = {feb}, organization = {IASTED}, month_numeric = {2} }

@inproceedings{JWAWMM052014, author = {Peter, Jörg and Klingert, Wilfried and Königsrainer, Alfred and Rosenstiel, Wolfgang and Bogdan, Martin and Schenk, Martin}, title = {TICoMS - A modular and message-based framework for monitoring and control of medical devices}, booktitle = {IEEE 27th International Symposium on Computer-Based Medical Systems (CBMS), New York City, USA}, year = {2014}, month = {may}, month_numeric = {5} }

@inproceedings{ETCJUMW062011, author = {Tafaj, Enkelejda and Kübler, Thomas C. and Peter, Jörg and Schiefer, Ulrich and Bogdan, Martin and Rosenstiel, Wolfgang}, title = {Vishnoo - An Open-Source Software for Vision Research}, booktitle = {24th IEEE International Symposium on Computer-Based Medical Systems (CBMS 2011), Bristol, UK}, year = {2011}, month = {jun}, month_numeric = {6} }