Original ArticlesClosed-Loop Strategies for Patient Care SystemsPauldine, Ronald MD; Beck, George BS, RRT; Salinas, Jose PhD; Kaczka, David W. MD, PhDAuthor Information From the Department of Anesthesiology and Critical Care Medicine (R.P.), Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Impact Instrumentation Inc. (G.B.), West Caldwell, New Jersey; Trauma Information Systems Development (J.S.), US Army Institute of Surgical Research, Fort Sam Houston, Texas; and Department of Anesthesiology and Critical Care Medicine, Department of Biomedical Engineering (D.W.K.), The Johns Hopkins University, Baltimore, Maryland. Submitted for publication January 30, 2008. Accepted for publication February 4, 2008. Address for reprints: Ronald Pauldine, MD, Department of Anesthesiology and Critical Care Medicine, A3W-387, Johns Hopkins Bayview Medical Center, Baltimore, MD; email: [email protected]. The Journal of Trauma: Injury, Infection, and Critical Care: April 2008 - Volume 64 - Issue 4 - p S289-S294 doi: 10.1097/TA.0b013e31816bce43 Buy Metrics Abstract Military operations, mass casualty events, and remote work sites present unique challenges to providers of immediate medical care, who may lack the necessary skills for optimal clinical management. Moreover, the number of patients in these scenarios may overwhelm available health care resources. Recent applications of closed-loop control (CLC) techniques to critical care medicine may offer possible solutions for such environments. Here, feedback of a monitored variable or group of variables is used to control the state or output of a dynamic system. Some potential advantages of CLC in patient management include limiting task saturation when there is simultaneous demand for cognitive and active clinical intervention, improving quality of care through optimization of the titration of medications, conserving limited consumable supplies, preventing secondary insults in traumatic brain injury, shortening the duration of mechanical ventilation, and achieving appropriate goal-directed resuscitation. The uses of CLC systems in critical care medicine have been increasingly explored across a wide range of therapeutic modalities. This review will provide an overview of control system theory as applied to critical care medicine that must be considered in the design of autonomous CLC systems, and introduce a number of clinical applications under development in the context of deployment of such applications to austere environments. © 2008 Lippincott Williams & Wilkins, Inc.