{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:43:18Z","timestamp":1775043798726,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Closed-loop vasopressor systems integrate real-time blood pressure monitoring with automated decision logic to support hemodynamic stability in perioperative and critical care environments. These technologies sit at the intersection of biomedical sensing, signal processing, and clinician-supervised automation: the quality, latency, and failure behavior of the monitoring input can directly shape controller performance, safety margins, and clinical usability. In this comprehensive review, we synthesize the major closed-loop vasopressor architectures reported in the literature, examine how sensor modality and signal integrity influence algorithm behavior, and summarize recurrent reliability vulnerabilities spanning sensors, control logic, and device integration. We organize the field through an end-to-end information pipeline\u2014monitoring input, signal conditioning and quality assessment, decision and control strategy, actuation via infusion technology, and supervisory safety layers\u2014highlighting common performance metrics used to benchmark control quality. We then discuss clinical validation patterns across settings, emphasizing practical considerations for deployment and the evidence gaps that remain most relevant to high-risk populations. Finally, we propose reporting and validation priorities for future studies, with a focus on sensor robustness, transparency of algorithm design, integration safeguards, and standardized documentation of failures and overrides.<\/jats:p>","DOI":"10.3390\/s26072180","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:09:21Z","timestamp":1775038161000},"page":"2180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Monitoring Inputs, Control Architectures, and Failure Modes in Closed-Loop Vasopressor Systems: A Comprehensive Review"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6666-5418","authenticated-orcid":false,"given":"Vitor","family":"Felippe","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, National Cancer Institute (INCA), Rio de Janeiro 20230-130, RJ, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiorrana Sousa","family":"Dias","sequence":"additional","affiliation":[{"name":"School of Medicine, Centro Universit\u00e1rio Christus (UNICHRISTUS), Fortaleza 60192-345, CE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0464-7990","authenticated-orcid":false,"given":"Carlos Darcy Alves","family":"Bersot","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Santa Casa de Miseric\u00f3rdia de Campos dos Goytacazes, Campos dos Goytacazes 28030-002, RJ, Brazil"},{"name":"Postgraduate Program in Translational Medicine, Paulista School of Medicine (EPM-UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo Guimaraes","family":"Torres","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Hospital Universit\u00e1rio Pedro Ernesto, State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, RJ, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Wegner","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90610-264, RS, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1788-8514","authenticated-orcid":false,"given":"Gabriel Lemos","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-330, RJ, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Wegner","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Fronteira Sul (UFFS), Passo Fundo 99010-200, RS, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcos Adriano","family":"Lessa","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Xiao, F., and Zhang, W. 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