Clinical Decision Support for Multivariable Circulatory Control with Multiple Cardiovascular Infusions

We are investigating the development of a novel clinical decision support system which advises intensive care staff on the co-ordinated adjustment of multiple cardiovascular infusions. Here three novel derived haemodynamic variables which directly relate to the three main types of cardiovascular infusions are proposed to simplify this complex multivariable control task in intensive care. To develop this system a simulator was constructed using a steady flow model of the human circulatory system. This permits the safe evaluation of expert control performance with alternative system configurations which utilise these novel derived haemodynamic variables under identical patient conditions. This includes an enhanced system which advises on the size and timing of manual and computerised changes in cardiovascular infusions based on algorithms which track infusion sensitivities. Such systems will require computer-interfacing of infusion devices and the clinical authorization or override of any infusion adjustments to ensure their safe operation and achievement of safe trajectories in approaching target ranges in mean arterial pressure (MAP) and cardiac output (CO).