Title:
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Hybrid physiological modelling and intelligent decision support for treatment of septic shock patients in cardiac intensive care unit
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In this information dominated era, computers have proved invaluable In the
monitoring and the processing of signals, especially in sensitive environments such
as Intensive Care Units and operating theatres. Despite the widespread use of
systems engineering and control techniques in various industries, the benefits have
usually extended to biomedical processes last, possibly due to concerns over safety.
Where this can be established, applications tend to proliferate, as can be seen over
the past few decades with the control of depth of anaesthesia, diabetes, respiration
etc. However, only a few applications have been reported dealing with Septic
Shock/Sepsis. Sepsis, the inflammatory state caused by infection, is a leading cause
of death in Intensive Care Units worldwide. Patients in the United Kingdom are
quoted a 2% through 20% risk of serious injury, stroke or death for each individual
cardiac operation carried:out. The aim of the research work included in this thesis is
to first describe the physiological behaviour of septic human patients via a hybrid
model, by hybrid is meant a combination of different architectures, and second to
exploit such a model by designing and implementing a decision support and control
system to deliver the 'optimal' drug therapy which will reduce morbidity as well as
mortality. The components of this research study will include the following
overarching'themes:
1. A hybridphysiologically-based model is proposed/or the simulation ofaspects 0/
the cardiovascular system and its response to drugs and the onset 0/sepsis.
The hybrid modelling strategy incorporates techniques from' cardiovascular
modelling, microvascular exchange and pharmacokineticll?harmacodynamic
(PKlPD) modelling to model cardiovascular blood flow, movement of fluid between
the circulation and the interstitium and the response of the system to drugs
respectively. Model suitability for describing real-life situations is tested by fitting
model parameters to clinical data trends using a least-square technique. It is designed
to be simple, yet physiologically relevant as this usually provides a greater insight into how a real life system works, as well as giving realistic results where real data
are difficult to obtain. The completed model leads to a comprehensive platform for
testing various control strategies in response to sepsis.
2. A multivariable self-organising fuzzy-logic controller (SOFLe) is developed to
control drug infusionsfor post-CPB patients during sepsis.
The SOFLC control scheme performance is improved with the addition of noise
filtering and the functional range increased with the use of drug sensitivity
estimation. The control scheme is extended to the multivariable case with the use of
Relative Gain Array (RGA) decoupling technique.
3. The development of a comprehensive decision support and control structure for
the management ofsimulated sepsis.
Key to the development of this system is the acquisition of clinical expert
knowledge, via a series of interviews and discussions. This gives rise to a decision
tree structure which was represented as a hierarchical structure of fuzzy linguistic
rules and implemented in a novel, comprehensive decision support and control
structure. This is tested in simulation with closed-loop control of various states and
evaluation of the decisions made.
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