MAN vs MACHINE: PROVIDER DIRECTED vs PRECISION AUTOMATED CRITICAL CARE MANAGEMENT (PACC-MAN) IN A PORCINE MODEL OF DISTRIBUTIVE SHOCK.

BACKGROUND:Critical care management of shock is a labor-intensive process. Precision automated critical care management (PACC-MAN) is an automated closed-loop system incorporating physiologic and hemodynamic inputs to deliver interventions while avoiding excessive fluid or vasopressor administration. To understand PACC-MAN efficacy, we compared PACC-MAN to provider-directed management (PDM). We hypothesized that PACC-MAN would achieve equivalent resuscitation outcomes to PDM while maintaining normotension with lower fluid and vasopressor requirements. METHODS:Twelve swine underwent 30% controlled hemorrhage over 30 minutes, followed by 45 minutes of aortic occlusion to generate a vasoplegic shock state, transfusion to euvolemia, and randomization to PACC-MAN or PDM for 4.25 hours. Primary outcomes were total crystalloid volume, vasopressor administration, total time spent at hypotension (MAP <60 mmHg), and total number of interventions. RESULTS:Weight-based fluid volumes were similar between PACC-MAN and PDM, median and IQR are reported (73.1 mL/kg [59.0-78.7] vs. 87.1 mL/kg [79.4-91.8] p = 0.07). There was no statistical difference in cumulative norepinephrine (PACC-MAN: 33.4 mcg/kg [27.1-44.6] vs. PDM: 7.5 [3.3-24.2] mcg/kg, p = 0.09). The median percentage of time spent at hypotension was equivalent (PACC-MAN: 6.2% [3.6-7.4] and PDM: 3.1% [1.3-6.6], p = 0.23). Urine outputs were similar between PACC-MAN and PDM (14.0 mL/kg vs. 21.5 mL/kg, p = 0.13). CONCLUSION:Automated resuscitation achieves equivalent resuscitation outcomes to direct human intervention in this shock model. This study provides the first translational experience with the PACC-MAN system versus PDM.