Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic.
BACKGROUND
The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.


METHODS
Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.


RESULTS
Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01).


CONCLUSIONS
Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.


BACKGROUND
Trial registration: Clinicaltrials.gov NCT00763906.
Merouani
Mehdi
M
Samu 93 - EA 3409, Université Paris 13, Hôpital Avicenne, Rue de Stalingrad, 93000 Bobigny, France. mehdi.merouani@wanadoo.fr
Guignard
Bruno
B
Vincent
François
F
Borron
Stephen W
SW
Karoubi
Philippe
P
Fosse
Jean-Philippe
JP
Cohen
Yves
Y
Clec'h
Christophe
C
Vicaut
Eric
E
Marbeuf-Gueye
Carole
C
Lapostolle
Frederic
F
Adnet
Frederic
F
D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D017143:Fuzzy Logic; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D012772:Shock, Septic / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D028761:Withholding Treatment
D014662:Vasoconstrictor Agents; D009638:Norepinephrine