Real-time Projected Gradient-based Nonlinear Model Predictive Control with an Application to Anesthesia Control

Medical drug infusion problems pose a combination of challenges such as nonlinearities from physiological models, model uncertainty due to inter- and intra-patient variability, as well as strict safety specifications. With these challenges in mind, we propose a novel real-time Nonlinear Model Predictive Control (NMPC) scheme based on projected gradient descent iterations. At each iteration, a small number of steps along the gradient of the NMPC cost is taken, generating a suboptimal input which asymptotically converges to the optimal input. We retrieve classical Lyapunov stability guarantees by performing a sufficient number of gradient iterations until fulfilling a stopping criteria. Such a real-time control approach allows for higher sampling rates and faster feedback from the system which is advantageous for the class of highly variable and uncertain drug infusion problems. To demonstrate the controller's potential, we apply it to hypnosis control in anesthesia of two interacting drugs. The controller successfully regulates hypnosis even under disturbances and uncertainty and fulfils benchmark performance criteria

Depth of anesthesia control using internal model control techniques

The major difficulty in the design of closed-loop control during anaesthesia is the inherent patient variability due to differences in demographic and drug tolerance. These discrepancies are translated into the pharmacokinetics (PK), and pharmacodynamics (PD). These uncertainties may affect the stability of the closed loop control system. This paper aims at developing predictive controllers using Internal Model Control technique. This study develops patient dose-response models and to provide an adequate drug administration regimen for the anaesthesia to avoid under or over dosing of the patients. The controllers are designed to compensate for patients inherent drug response variability, to achieve the best output disturbance rejection, and to maintain optimal set point response. The results are evaluated compared with traditional PID controller and the performance is confirmed in our simulation

Closed-loop control of anesthesia : survey on actual trends, challenges and perspectives

Automation empowers self-sustainable adaptive processes and personalized services in many industries. The implementation of the integrated healthcare paradigm built on Health 4.0 is expected to transform any area in medicine due to the lightning-speed advances in control, robotics, artificial intelligence, sensors etc. The two objectives of this article, as addressed to different entities, are: i) to raise awareness throughout the anesthesiologists about the usefulness of integrating automation and data exchange in their clinical practice for providing increased attention to alarming situations, ii) to provide the actualized insights of drug-delivery research in order to create an opening horizon towards precision medicine with significantly improved human outcomes. This article presents a concise overview on the recent evolution of closed-loop anesthesia delivery control systems by means of control strategies, depth of anesthesia monitors, patient modelling, safety systems, and validation in clinical trials. For decades, anesthesia control has been in the midst of transformative changes, going from simple controllers to integrative strategies of two or more components, but not achieving yet the breakthrough of an integrated system. However, the scientific advances that happen at high speed need a modern review to identify the current technological gaps, societal implications, and implementation barriers. This article provides a good basis for control research in clinical anesthesia to endorse new challenges for intelligent systems towards individualized patient care. At this connection point of clinical and engineering frameworks through (semi-) automation, the following can be granted: patient safety, economical efficiency, and clinicians' efficacy

Modelling, Optimisation and Explicit Model Predictive Control of Anaesthesia Drug Delivery Systems

The contributions of this thesis are organised in two parts. Part I presents a mathematical model for drug distribution and drug effect of volatile anaesthesia. Part II presents model predictive control strategies for depth of anaesthesia control based on the derived model. Closed-loop model predictive control strategies for anaesthesia are aiming to improve patient's safety and to fine-tune drug delivery, routinely performed by the anaesthetist. The framework presented in this thesis highlights the advantages of extensive modelling and model analysis, which are contributing to a detailed understanding of the system, when aiming for the optimal control of such system. As part of the presented framework, the model uncertainty originated from patient-variability is analysed and the designed control strategy is tested against the identified uncertainty. An individualised physiologically based model of drug distribution and uptake, pharmacokinetics, and drug effect, pharmacodynamics, of volatile anaesthesia is presented, where the pharmacokinetic model is adjusted to the weight, height, gender and age of the patient. The pharmacodynamic model links the hypnotic depth measured by the Bispectral index (BIS), to the arterial concentration by an artificial effect site compartment and the Hill equation. The individualised pharmacokinetic and pharmacodynamic variables and parameters are analysed with respect to their influence on the measurable outputs, the end-tidal concentration and the BIS. The validation of the model, performed with clinical data for isoflurane and desflurane based anaesthesia, shows a good prediction of the drug uptake, while the pharmacodynamic parameters are individually estimated for each patient. The derived control design consists of a linear multi-parametric model predictive controller and a state estimator. The non-measurable tissue and blood concentrations are estimated based on the end-tidal concentration of the volatile anaesthetic. The designed controller adapts to the individual patient's dynamics based on measured data. In an alternative approach, the individual patient's sensitivity is estimated on-line by solving a least squares parameter estimation problem.Open Acces

Model based control strategies for a class of nonlinear mechanical sub-systems

This paper presents a comparison between various control strategies for a class of mechanical actuators common in heavy-duty industry. Typical actuator components are hydraulic or pneumatic elements with static non-linearities, which are commonly referred to as Hammerstein systems. Such static non-linearities may vary in time as a function of the load and hence classical inverse-model based control strategies may deliver sub-optimal performance. This paper investigates the ability of advanced model based control strategies to satisfy a tolerance interval for position error values, overshoot and settling time specifications. Due to the presence of static non-linearity requiring changing direction of movement, control effort is also evaluated in terms of zero crossing frequency (up-down or left-right movement). Simulation and experimental data from a lab setup suggest that sliding mode control is able to improve global performance parameters

Optimizing robust PID control of propofol anesthesia for children; design and clinical evaluation

Objective: The goal of this study was to optimize robust PID control for propofol anesthesia in children aged 5-10 years to improve performance, particularly to decrease the time of induction of anesthesia while maintaining robustness.Methods: We analyzed results of a previous study conducted by our group to identify opportunities for system improvement. Allometric scaling was introduced to reduce the interpatient variability and a new robust PID controller was designed using an optimization based method. We evaluated this optimized design in a clinical study involving 16 new cases.Results: The optimized controller design achieved the performance predicted in simulation studies in the design stage. Time of induction of anesthesia was median [Q1, Q3] 3.7 [2.3, 4.1] minutes and the achieved global score was 13.4 [9.9, 16.8]. Conclusion: Allometric scaling reduces the interpatient variability in this age group, and allows for improved closed-loop performance. The uncertainty described by the model set, the predicted closedloop responses and the predicted robustness margins are realistic. The system meets the design objectives of improved speed of induction of anesthesia while maintaining robustness, improving clinically relevant system behavior.Significance: Control system optimization and ongoing system improvement are essential to the development of a clinically relevant commercial device. This paper demonstrates the validity of our approach, including system modeling, controller optimization and pre-clinical testing in simulation

The Role of Perceived Uncertainty, Ego Identity, and Perceived Behavioral Control in Predicting Patient's Attitude Toward Medical Surgery

Medical surgery has sometimes become the only best choice for a patient's well-being. Unfortunately, not all patients have the willingness to live it. Often, therapeutic failure is caused by uncooperative attitudes of the patients which originate from their negative attitudes toward the surgery. This research is aimed at finding a theoretical model to explain psychological factors forming the patient's attitudes. This predictive correlational research was conducted on 99 patients suffering heart disease and cancer continuum who require medical surgery in DKI Jakarta, Indonesia. Research results showed that a commitment aspect of ego identity is able to indirectly predict attitude toward medical surgery through mediation of perceived uncertainty. Perceived behavioral control directly predicts the attitude in a negative direction. This research concludes that patients' commitment towards their identity plays a significant role as they deal with medical surgery