Technology is advancing at a staggering rate, and medical technology is no exception. In the perioperative environment, this advance takes many forms, but the most obvious is the increasing sophistication of physiologic sensors, the computer systems we use to interpret them, and the devices we use to deliver therapy based on our interpretations. Drs. Maxime Cannesson and Joe Rinehart are focused on improving each of these aspects of the technologies used in operating rooms and intensive care units.
In order to improve monitoring technologies, the first requirement is a deep understanding of the underlying physiology and its significance. Our research in this area is focused on hemodynamic physiology and fluid management strategies, including goal-directed fluid therapies based on dynamic predictors of fluid responsiveness and stroke volume optimization. Ultimately, we hope to help answer some of the decades old questions like “how much fluid is the right amount?” using new monitoring technologies, including those we are helping to refine.
The questions for anesthesiologists are what impact is automation likely to have on clinical practice and how will the field position itself to take advantage of those changes that are likely to come? 2
One of our recent efforts in this area is the extraction of novel data from the EKG waveform. Several research groups (including our own) have shown that EKG lead II R-wave amplitude can predict patient responses to fluid boluses under the right conditions. Using this information, we have developed a novel computer algorithm to extract this data in real-time so that clinicians can use it at the bedside. The utility and impact of this data is a subject of ongoing research.
The other area of heavy interest in our lab is in advanced synthesis and analysis of physiologic data. In some cases, this may involve novel graphical presentations of data to clinicians to enhance interpretation. At the other end of the spectrum, this may mean building automated therapy delivery devices that can independently interpret physiologic data and take appropriate actions with minimal provider supervision. These types of technologies can provide a level of stability and standardization that is otherwise impossible to achieve and thereby improve the safety of surgical patients.
...the future of anesthesia will rely on two separate but interdependent technologies: the sensors and monitors on one side, and the controllers on the other.3
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