title: Adaptive control of bivalirudin in the cardiac intensive care unit.
abstract: Bivalirudin is a direct thrombin inhibitor used in the cardiac intensive care unit when heparin is contraindicated due to heparin-induced thrombocytopenia. Since it is not a commonly used drug, clinical experience with its dosing is sparse. In earlier work [1], we developed a dynamic system model that accurately predicts the effect of bivalirudin given dosage over time and patient physiological characteristics. This paper develops adaptive dosage controllers that regulate its effect to desired levels. To that end, and in the case that bivalirudin model parameters are available, we develop a Model Reference Control law. In the case that model parameters are unknown, an indirect Model Reference Adaptive Control scheme is applied to estimate model parameters first and then adapt the controller. Alternatively, direct Model Reference Adaptive Control is applied to adapt the controller directly without estimating model parameters first. Our algorithms are validated using actual patient data from a large hospital in the Boston area.
authors.affiliation: Division of Systems Engineering, Boston University, Boston, MA, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology, Perioperative Medicine, and General Intensive Care Medicine, Salzburg General Hospital, Salzburg, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Edrich
authors.affiliation: Department of Electrical & Computer EngineeringDivision of Systems Engineering.
authors.forename: Ioannis Ch
authors.initials: IC
authors.lastname: Paschalidis
mesh_terms: D000991:Antithrombins / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003198:Computer Simulation; D016903:Drug Monitoring / Q000379:methods; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D025461:Feedback, Physiological; D006629:Hirudins / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008955:Models, Cardiovascular; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000493:pharmacokinetics; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000493:pharmacokinetics; D013927:Thrombosis / Q000097:blood* / Q000517:prevention & control*
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin