%0 Journal Article
%T Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic
%A Mehdi Merouani
%A Bruno Guignard
%A Fran£¿ois Vincent
%A Stephen W Borron
%A Philippe Karoubi
%A Jean-Philippe Fosse
%A Yves Cohen
%A Christophe Clec'h
%A Eric Vicaut
%A Carole Marbeuf-Gueye
%A Frederic Lapostolle
%A Frederic Adnet
%J Critical Care
%D 2008
%I BioMed Central
%R 10.1186/cc7149
%X 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.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] ¦Ìg/kg versus 1.4 [0.6 to 2.7] ¦Ìg/kg; P < 0.01).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.Trial registration: Clinicaltrials.gov NCT00763906.Despite advances in critical care, the death rate from severe sepsis remains approximately 30% to 50%. In 1995, severe sepsis accounted for 9.3% of all deaths in the USA [1]. It is generally agreed that fluid resuscitation and vasopressors should be initiated promptly to treat shock and organ failure, and rapidly restore the mean arterial pressure (MAP) to 60 to 90 mmHg [2,3].The vasopressor in most common use is norepinephrine (noradrenaline) but, because of its weak inotropic effect and concerns about regional blood flow, dobutamine is often administered concomit
%U http://ccforum.com/content/12/6/R155