Description du projet
Anesthésie commandée par ordinateur
L’administration de médicaments au cours d’une anesthésie chirurgicale est effectuée manuellement par l’anesthésiste, qui tient compte de paramètres physiologiques très spécifiques et de la réponse attendue du patient aux stimuli chirurgicaux. Dans des situations complexes, impliquant des comorbidités ou des antagonismes des médicaments, l’optimisation de la vitesse de perfusion des médicaments semble toutefois impossible. L’objectif principal du projet AMICAS, financé par le Conseil européen de la recherche, est d’ouvrir la voie à l’optimisation des médicaments assistée par ordinateur à l’aide de modèles multivariables. L’idée est de combiner ces modèles avec l’expertise humaine pour réduire autant que possible les grandes incertitudes dans la réponse du patient sous anesthésie et améliorer les résultats de la chirurgie.
Objectif
A major challenge in anesthesia is to adapt the drug infusion rates from observed patient response to surgical stimuli. The patient models are based on nominal population characteristic response and lack specific surgical effects. In major surgery (e.g. cardiac, transplant, obese patients) modelling uncertainty stems from significant blood losses, anomalous drug diffusion, drug effect synergy/antagonism, anesthetic-hemodynamic interactions, etc. This complex optimisation problem requires superhuman abilities of the anesthesiologist.
Computer controlled anesthesia holds the answer to be the game changer for best surgery outcomes. Although few, clinical studies report that computer based anesthesia for one or two drugs outperforms manual management. In reality, clinical practice mitigates a multi-drug optimization problem while accommodating large patient model uncertainty. The anesthesiologist makes decisions based on future surgeon actions and expected patient response. This is a predictive control strategy, a mature methodology in systems and control engineering with potential to faster recovery times and lower risk of complications.
The goal of this proposal is to advance the scope and clinical use of computer based constrained optimization of multi-drug infusion rates for anesthesia with strong effects on hemodynamics. I plan to identify multivariable models and minimize the large uncertainties in patient response. With adaptation mechanisms from nominal to individual patient models, we design multivariable optimal predictive control methodologies to manage strongly coupled dynamics. To maximize performance of the closed loop, we model the surgical stimulus as a known disturbance signal and additional bolus infusions from anesthesiologist as known inputs.
I am convinced that integration of human expertise with computer optimization is a successful solution for breakthrough into clinical practice.
Champ scientifique
- engineering and technologyelectrical engineering, electronic engineering, information engineeringelectronic engineeringcontrol systems
- medical and health sciencesclinical medicinesurgery
- engineering and technologyelectrical engineering, electronic engineering, information engineeringelectronic engineeringcontrol engineering
Mots‑clés
Programme(s)
- HORIZON.1.1 - European Research Council (ERC) Main Programme
Régime de financement
HORIZON-ERC - HORIZON ERC GrantsInstitution d’accueil
9000 Gent
Belgique