A Glimpse into the Future ICU: The Closed Loop System
The impact of these changes will be evident in every discipline of medicine but will perhaps completely revolutionize the field of critical care which might become “dependent” on these gadgets. The basis for these changes will rest on sophisticated computerized programs and algorithms to not only detect a potentially deleterious alteration in the physiological parameter but also to intervene and perhaps most importantly to alert the health care personnel. Such systems are termed as “closed loop” systems and are already being investigated in the research settings.
When we see the functioning of “routine” clinical systems, the significance of such closed loop systems becomes crystal clear. For instance lets consider a critically ill patient suffering from diabetes admitted due to sepsis. It is logical that the glycemic levels have to be maintained but how will the paramedical staff know about the increased blood sugar levels?
Even in the most robust centers, the nurse will monitor an hourly blood glucose level. Now lets suppose, that the patient (for any reason) develops hyperglycemia at 2:05 am. The nurse will check the glucose level at 3:00 am and then notify the clinician. Now lets assume that the nurse does that without wasting any time and the physician immediately orders the patient to be placed on sliding scale insulin and the nurse injects insulin at 3:30 am.
This rather simplified example demonstrates that even in the most rigorous setting, there will be a considerable time lapse between a clinical alteration and the intervention. This is where the concept of closed loop system comes into place. In such a system, there will be automated sensors to detect the glucose levels. Not only will they sense the levels, but they will inject an estimated insulin dose based on the algorithms!
If all of this sounds a tad unrealistic, it might be prudent to mention here that the Journal of critical care recently published a study of a new closed loop computerized protocol which demonstrated the safety of closed loop ventilation in weaning children. Whether or not these systems actually benefit the patients in terms of clinical outcomes remains to be seen. Also, technology is never “flawless” and human supervision of these systems supplemented with clinical acumen will be warranted.
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