RESUMEN
Agitation is a significant problem in the Intensive Care Unit (ICU), affecting 71% of sedated adult patients during 58% of ICU patient-days. Subjective scale based assessment-methods focused primarily on assessing excessive patient motion are currently used to assess the level of patient agitation, but are limited in their accuracy and resolution. This research quantifies this approach by developing an objective agitation measurement from patient motion that is sensed using digital video image processing. A fuzzy inference system (FIS) is developed to classify levels of motion that correlate with observed patient agitation, while accounting for motion due to medical staff working on the patient. Clinical tests for five ICU patients have been performed to verify the validity of this approach in comparison to agitation graded by nursing staff using the Riker Sedation-Agitation Scale (SAS). All trials were performed in the Christchurch Hospital Department of Intensive Care, with ethics approval from the Canterbury Ethics Committee. Results show good correlation with medical staff assessment with no false positive results during calm periods. Clinically, this initial agitation measurement method promises the ability to consistently and objectively quantify patient agitation to enable better management of sedation and agitation through optimised drug delivery leading to reduced length of stay and improved outcome.
Asunto(s)
Sedación Consciente , Lógica Difusa , Unidades de Cuidados Intensivos , Agitación Psicomotora/diagnóstico , Grabación en Video , Reacciones Falso Positivas , Humanos , Tiempo de Internación , Monitoreo Fisiológico/métodos , Movimiento , Sistemas de Atención de Punto , Procesamiento de Señales Asistido por ComputadorRESUMEN
In many recent human motor control models, including feedback-error learning and adaptive model theory (AMT), feedback control is used to correct errors while an inverse model is simultaneously tuned to provide accurate feedforward control. This popular and appealing hypothesis, based on a combination of psychophysical observations and engineering considerations, predicts that once the tuning of the inverse model is complete the role of feedback control is limited to the correction of disturbances. This hypothesis was tested by looking at the open-loop behavior of the human motor system during adaptation. An experiment was carried out involving 20 normal adult subjects who learned a novel visuomotor relationship on a pursuit tracking task with a steering wheel for input. During learning, the response cursor was periodically blanked, removing all feedback about the external system (i.e., about the relationship between hand motion and response cursor motion). Open-loop behavior was not consistent with a progressive transfer from closed- to open-loop control. Our recently developed computational model of the brain--a novel nonlinear implementation of AMT--was able to reproduce the observed closed- and open-loop results. In contrast, other control-systems models exhibited only minimal feedback control following adaptation, leading to incorrect open-loop behavior. This is because our model continues to use feedback to control slow movements after adaptation is complete. This behavior enhances the internal stability of the inverse model. In summary, our computational model is currently the only motor control model able to accurately simulate the closed- and open-loop characteristics of the experimental response trajectories.