{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:31:38Z","timestamp":1774571498666,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T00:00:00Z","timestamp":1661558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"U.S. Army Medical Research and Development Command"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Trauma and hemorrhage are leading causes of death and disability worldwide in both civilian and military contexts. The delivery of life-saving goal-directed fluid resuscitation can be difficult to provide in resource-constrained settings, such as in forward military positions or mass-casualty scenarios. Automated solutions for fluid resuscitation could bridge resource gaps in these austere settings. While multiple physiological closed-loop controllers for the management of hypotension have been proposed, to date there is no consensus on controller design. Here, we compare the performance of four controller types\u2014decision table, single-input fuzzy logic, dual-input fuzzy logic, and proportional\u2013integral\u2013derivative using a previously developed hardware-in-loop test platform where a range of hemorrhage scenarios can be programmed. Controllers were compared using traditional controller performance metrics, but conclusions were difficult to draw due to inconsistencies across the metrics. Instead, we propose three aggregate metrics that reflect the target intensity, stability, and resource efficiency of a controller, with the goal of selecting controllers for further development. These aggregate metrics identify a dual-input, fuzzy-logic-based controller as the preferred combination of intensity, stability, and resource efficiency within this use case. Based on these results, the aggressively tuned dual-input fuzzy logic controller should be considered a priority for further development.<\/jats:p>","DOI":"10.3390\/bioengineering9090420","type":"journal-article","created":{"date-parts":[[2022,8,28]],"date-time":"2022-08-28T21:22:56Z","timestamp":1661721776000},"page":"420","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Hardware-in-Loop Comparison of Physiological Closed-Loop Controllers for the Autonomous Management of Hypotension"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0293-4937","authenticated-orcid":false,"given":"Eric J.","family":"Snider","sequence":"first","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2286-3846","authenticated-orcid":false,"given":"David","family":"Berard","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saul J.","family":"Vega","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3516-2766","authenticated-orcid":false,"given":"Evan","family":"Ross","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zechariah J.","family":"Knowlton","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9337-185X","authenticated-orcid":false,"given":"Guy","family":"Avital","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"},{"name":"Trauma & Combat Medicine Branch, Surgeon General\u2019s Headquarters, Israel Defense Forces, Ramat-Gan 52620, Israel"},{"name":"Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv 64239, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7180-2842","authenticated-orcid":false,"given":"Emily N.","family":"Boice","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020). 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Available online: https:\/\/www.iso.org\/cms\/render\/live\/en\/sites\/isoorg\/contents\/data\/standard\/04\/41\/44104.html."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/9\/9\/420\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:16:33Z","timestamp":1760141793000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/9\/9\/420"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,27]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["bioengineering9090420"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering9090420","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,27]]}}}