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Article ; Online: Intraoperative hypotension and postoperative outcomes. Comment on Br J Anaesth 2023; 131: 823-831.

Patricio, Daniel / Boelefahr, Sebastian / Coeckelenbergh, Sean

2024 Volume 132, Issue 3, Page(s) 616–618

MeSH term(s)	Humans ; Hypotension/etiology ; Postoperative Period
Language	English
Publishing date	2024-01-04
Publishing country	England
Document type	Letter
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.11.048
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Article ; Online: Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial. Comment on Br J Anaesth 2023; 131: 253-65.

Coeckelenbergh, Sean / Soucy-Proulx, Maxime / Radtke, Finn M

British journal of anaesthesia

2023 Volume 131, Issue 4, Page(s) e142–e143

MeSH term(s)	Humans ; Aged ; Propofol ; Sevoflurane ; Anesthesia ; Anesthetics, Intravenous/adverse effects ; Delirium/etiology ; Neoplasms ; Anesthetics, Inhalation/adverse effects ; Methyl Ethers
Chemical Substances	Propofol (YI7VU623SF) ; Sevoflurane (38LVP0K73A) ; Anesthetics, Intravenous ; Anesthetics, Inhalation ; Methyl Ethers
Language	English
Publishing date	2023-08-03
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Letter ; Comment
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.07.020
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Article ; Online: Closing the loop: automation in anesthesiology is coming.

Coeckelenbergh, Sean / Joosten, Alexandre / Cannesson, Maxime / Rinehart, Joseph

Journal of clinical monitoring and computing

2023 Volume 38, Issue 1, Page(s) 1–4

Abstract: Anesthesiology and intensive care medicine provide fertile ground for innovation in automation, but to date we have only achieved preliminary studies in closed-loop intravenous drug administration. Anesthesiologists have yet to implement these tools on a ...

Abstract	Anesthesiology and intensive care medicine provide fertile ground for innovation in automation, but to date we have only achieved preliminary studies in closed-loop intravenous drug administration. Anesthesiologists have yet to implement these tools on a large scale despite clear evidence that they outperform manual titration. Closed-loops continuously assess a predefined variable as input into a controller and then attempt to establish equilibrium by administering a treatment as output. The aim is to decrease the error between the closed-loop controller's input and output. In this editorial we consider the available intravenous anesthesia closed-loop systems, try to clarify why they have not yet been implemented on a large scale, see what they offer, and propose the future steps towards automation in anesthesia.
MeSH term(s)	Humans ; Anesthesiology ; Anesthesia ; Automation ; Anesthesia, Intravenous ; Infusions, Intravenous
Language	English
Publishing date	2023-09-14
Publishing country	Netherlands
Document type	Editorial ; Comment
ZDB-ID	1418733-4
ISSN	1573-2614 ; 1387-1307 ; 0748-1977
ISSN (online)	1573-2614
ISSN	1387-1307 ; 0748-1977
DOI	10.1007/s10877-023-01077-3
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Article ; Online: Perioperative Fluid and Vasopressor Therapy in 2050: From Experimental Medicine to Personalization Through Automation.

Coeckelenbergh, Sean / Vincent, Jean-Louis / Duranteau, Jacques / Joosten, Alexandre / Rinehart, Joseph

Anesthesia and analgesia

2024 Volume 138, Issue 2, Page(s) 284–294

Abstract: Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid ... ...

Abstract	Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid therapy was first described in Scotland during the 1832 cholera epidemic, when pioneers in medicine saved critically ill patients dying from hypovolemic shock. However, widespread use of IV fluids only began in the 20th century. Epinephrine was discovered and purified in the United States at the end of the 19th century, but its short half-life limited its implementation into patient care. Advances in venous access, including the introduction of the central venous catheter, and the ability to administer continuous infusions of fluids and vasopressors rather than just boluses, facilitated the use of fluids and adrenergic agents. With the advent of advanced hemodynamic monitoring, most notably the pulmonary artery catheter, the role of fluids and vasopressors in the maintenance of tissue oxygenation through adequate cardiac output and perfusion pressure became more clearly established, and hemodynamic goals could be established to better titrate fluid and vasopressor therapy. Less invasive hemodynamic monitoring techniques, using echography, pulse contour analysis, and heart-lung interactions, have facilitated hemodynamic monitoring at the bedside. Most recently, advances have been made in closed-loop fluid and vasopressor therapy, which apply computer assistance to interpret hemodynamic variables and therapy. Development and increased use of artificial intelligence will likely represent a major step toward fully automated hemodynamic management in the perioperative environment in the near future. In this narrative review, we discuss the key events in experimental medicine that have led to the current status of fluid and vasopressor therapies and describe the potential benefits that future automation has to offer.
MeSH term(s)	Humans ; Artificial Intelligence ; Hemodynamics ; Vasoconstrictor Agents/therapeutic use ; Vasoconstrictor Agents/pharmacology ; Fluid Therapy/methods ; Automation ; Biomedical Research
Chemical Substances	Vasoconstrictor Agents
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006672
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Article ; Online: Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine.

Coeckelenbergh, Sean / Boelefahr, Sebastian / Alexander, Brenton / Perrin, Laurent / Rinehart, Joseph / Joosten, Alexandre / Barvais, Luc

Journal of clinical monitoring and computing

2024 Volume 38, Issue 2, Page(s) 487–504

Abstract: A closed-loop automatically controls a variable using the principle of feedback. Automation within anesthesia typically aims to improve the stability of a controlled variable and reduce workload associated with simple repetitive tasks. This approach ... ...

Abstract	A closed-loop automatically controls a variable using the principle of feedback. Automation within anesthesia typically aims to improve the stability of a controlled variable and reduce workload associated with simple repetitive tasks. This approach attempts to limit errors due to distractions or fatigue while simultaneously increasing compliance to evidence based perioperative protocols. The ultimate goal is to use these advantages over manual care to improve patient outcome. For more than twenty years, clinical studies in anesthesia have demonstrated the superiority of closed-loop systems compared to manual control for stabilizing a single variable, reducing practitioner workload, and safely administering therapies. This research has focused on various closed-loops that coupled inputs and outputs such as the processed electroencephalogram with propofol, blood pressure with vasopressors, and dynamic predictors of fluid responsiveness with fluid therapy. Recently, multiple simultaneous independent closed-loop systems have been tested in practice and one study has demonstrated a clinical benefit on postoperative cognitive dysfunction. Despite their advantages, these tools still require that a well-trained practitioner maintains situation awareness, understands how closed-loop systems react to each variable, and is ready to retake control if the closed-loop systems fail. In the future, multiple input multiple output closed-loop systems will control anesthetic, fluid and vasopressor titration and may perhaps integrate other key systems, such as the anesthesia machine. Human supervision will nonetheless always be indispensable as situation awareness, communication, and prediction of events remain irreplaceable human factors.
MeSH term(s)	Humans ; Perioperative Medicine ; Anesthesia/methods ; Propofol ; Anesthesiology ; Blood Pressure
Chemical Substances	Propofol (YI7VU623SF)
Language	English
Publishing date	2024-01-06
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1418733-4
ISSN	1573-2614 ; 1387-1307 ; 0748-1977
ISSN (online)	1573-2614
ISSN	1387-1307 ; 0748-1977
DOI	10.1007/s10877-023-01111-4
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Article ; Online: Control of mean arterial pressure using a closed-loop system for norepinephrine infusion in severe brain injury patients: the COMAT randomized controlled trial.

Joosten, Alexandre / Rinehart, Joseph / Cannesson, Maxime / Coeckelenbergh, Sean / Pochard, Jonas / Vicaut, Eric / Duranteau, Jacques

Journal of clinical monitoring and computing

2024 Volume 38, Issue 1, Page(s) 25–30

Abstract: Brain injury patients require precise blood pressure (BP) management to maintain cerebral perfusion pressure (CPP) and avoid intracranial hypertension. Nurses have many tasks and norepinephrine titration has been shown to be suboptimal. This can lead to ... ...

Abstract	Brain injury patients require precise blood pressure (BP) management to maintain cerebral perfusion pressure (CPP) and avoid intracranial hypertension. Nurses have many tasks and norepinephrine titration has been shown to be suboptimal. This can lead to limited BP control in patients that are in critical need of cerebral perfusion optimization. We have designed a closed-loop vasopressor (CLV) system capable of maintaining mean arterial pressure (MAP) in a narrow range and we aimed to assess its performance when treating severe brain injury patients. Within the first 48 h of intensive care unit (ICU) admission, 18 patients with a severe brain injury underwent either CLV or manual norepinephrine titration. In both groups, the objective was to maintain MAP in target (within ± 5 mmHg of a predefined target MAP) to achieve optimal CPP. Fluid administration was standardized in the two groups. The primary objective was the percentage of time patients were in target. Secondary outcomes included time spent over and under target. Over the four-hour study period, the mean percentage of time with MAP in target was greater in the CLV group than in the control group (95.8 ± 2.2% vs. 42.5 ± 27.0%, p < 0.001). Severe undershooting, defined as MAP < 10 mmHg of target value was lower in the CLV group (0.2 ± 0.3% vs. 7.4 ± 14.2%, p < 0.001) as was severe overshooting defined as MAP > 10 mmHg of target (0.0 ± 0.0% vs. 22.0 ± 29.0%, p < 0.001). The CLV system can maintain MAP in target better than nurses caring for severe brain injury patients.
MeSH term(s)	Humans ; Norepinephrine ; Arterial Pressure ; Vasoconstrictor Agents/therapeutic use ; Brain Injuries/drug therapy ; Intensive Care Units ; Intracranial Pressure
Chemical Substances	Norepinephrine (X4W3ENH1CV) ; Vasoconstrictor Agents
Language	English
Publishing date	2024-02-04
Publishing country	Netherlands
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1418733-4
ISSN	1573-2614 ; 1387-1307 ; 0748-1977
ISSN (online)	1573-2614
ISSN	1387-1307 ; 0748-1977
DOI	10.1007/s10877-023-01119-w
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Article: Physiological Modeling of Hemodynamic Responses to Sodium Nitroprusside.

Rinehart, Joseph / Coeckelenbergh, Sean / Srivastava, Ishita / Cannesson, Maxime / Joosten, Alexandre

Journal of personalized medicine

2023 Volume 13, Issue 7

Abstract: Background: Computational modeling of physiology has become a routine element in the development, evaluation, and safety testing of many types of medical devices. Members of the Food and Drug Administration have recently published a manuscript detailing ...

Abstract	Background: Computational modeling of physiology has become a routine element in the development, evaluation, and safety testing of many types of medical devices. Members of the Food and Drug Administration have recently published a manuscript detailing the development, validation, and sensitivity testing of a computational model for blood volume, cardiac stroke volume, and blood pressure, noting that such a model might be useful in the development of closed-loop fluid administration systems. In the present study, we have expanded on this model to include the pharmacologic effect of sodium nitroprusside and calibrated the model against our previous experimental animal model data. Methods: Beginning with the model elements in the original publication, we added six new parameters to control the effect of sodium nitroprusside: two for the onset time and clearance rates, two for the stroke volume effect (which includes venodilation as a "hidden" element), and two for the direct effect on arterial blood pressure. Using this new model, we then calibrated the predictive performance against previously collected animal study data using nitroprusside infusions to simulate shock with the primary emphasis on MAP. Root-mean-squared error (RMSE) was calculated, and the performance was compared to the performance of the model in the original study. Results: RMSE of model-predicted MAP to actual MAP was lower than that reported in the original model, but higher for SV and CO. The individually fit models showed lower RMSE than using the population average values for parameters, suggesting the fitting process was effective in identifying improved parameters. Use of partially fit models after removal of the lowest variance population parameters showed a very minor decrement in improvement over the fully fit models. Conclusion: The new model added the clinical effects of SNP and was successfully calibrated against experimental data with an RMSE of <10% for mean arterial pressure. Model-predicted MAP showed an error similar to that seen in the original base model when using fluid shifts, heart rate, and drug dose as model inputs.
Language	English
Publishing date	2023-07-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm13071101
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Article ; Online: Response to: Should we infuse more fluids in liver resection?

Coeckelenbergh, Sean / Van der Linden, Philippe / Joosten, Alexandre

European journal of anaesthesiology

2022 Volume 39, Issue 9, Page(s) 790–791

MeSH term(s)	Hepatectomy/adverse effects ; Humans ; Liver ; Spinal Fusion
Language	English
Publishing date	2022-07-20
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0000000000001724
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Article ; Online: Antinocicepção intravenosa sem opioides orientada pelo Índice de Analgesia/Nocicepção: relato de caso.

Coeckelenbergh, Sean / Estebe, Jean-Pierre

Brazilian journal of anesthesiology (Elsevier)

2020 Volume 70, Issue 6, Page(s) 678–681

Abstract: Background: Opioid-free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid-free infusions with a nociception monitor may be the solution.!## ...

Title translation	Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report.
Abstract	Background: Opioid-free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid-free infusions with a nociception monitor may be the solution. Case report: We describe the feasibility and potential limitations of titrating opioid-free antinociception during major abdominal surgery using the Analgesia Nociception Index (Mdoloris, Lille, France) in an obese patient. After stabilizing the patient's nociception-antinociception balance intraoperatively we quickly reversed anesthesia and the patient did not require postoperative opioids. Conclusion: Personalizing opioid-free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort.
MeSH term(s)	Analgesia/instrumentation ; Analgesia/methods ; Analgesics, Opioid/adverse effects ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Electroencephalography ; Female ; Humans ; Middle Aged ; Nociception ; Obesity, Morbid/complications ; Precision Medicine/methods ; Urinary Incontinence/etiology ; Urinary Incontinence/surgery ; Vesicovaginal Fistula/complications ; Vesicovaginal Fistula/surgery
Chemical Substances	Analgesics, Opioid
Language	Portuguese
Publishing date	2020-11-07
Publishing country	Brazil
Document type	Case Reports
ISSN	2352-2291
ISSN (online)	2352-2291
DOI	10.1016/j.bjan.2020.07.005
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Article ; Online: Nociception level-guided fentanyl titration: potential impact of multimodal anaesthesia and false positives. Comment on Br J Anaesth 2020; 125: 1070-8.

Coeckelenbergh, Sean / Vereecke, Hugo E M / Richebé, Philippe

British journal of anaesthesia

2020 Volume 126, Issue 2, Page(s) e64–e65

MeSH term(s)	Anesthesia ; Fentanyl ; Humans ; Nociception ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Sevoflurane
Chemical Substances	Sevoflurane (38LVP0K73A) ; Fentanyl (UF599785JZ)
Language	English
Publishing date	2020-11-26
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2020.10.030
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