Physiological Closed-Loop Control (PCLC) Systems: Review of a Modern Frontier in Automation

Over the past decade, there has been an unprecedented international focus on improved quality and availability of medical care, which has reignited interest in clinical automation and drawn researchers toward novel solutions in the field of physiological closed-loop control systems (PCLCs). Today, multidisciplinary groups of expert scientists, engineers, clinicians, mathematicians, and policy-makers are combining their knowledge and experience to develop both the next generation of PCLC-based medical equipment and a collaborative commercial/academic infrastructure to support this rapidly expanding frontier. In the following article, we provide a robust introduction to the various aspects of this growing field motivated by the recent and ongoing work supporting two leading technologies: the artificial pancreas (AP) and automated anesthesia. Following a brief high-level overview of the main concepts in automated therapy and some relevant tools from systems and control theory, we explore -- separately -- the developments, challenges, state-of-the-art, and probable directions for AP and automated anesthesia systems. We then close the review with a consideration of the common lessons gleaned from these ventures and the implications they present for future investigations and adjacent research.