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J Crit Care. 2015 Jun;30(3):652.e1-7. doi: 10.1016/j.jcrc.2015.01.019. Epub 2015 Jan 30.

Engineering control into medicine.

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Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA; Center for Wireless Health, University of Virginia School of Engineering and Applied Science, Charlottesville, VA. Electronic address:
Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address:
Huntington Medical Research Institutes, Pasadena, CA. Electronic address:


The human body is a tightly controlled engineering miracle. However, medical training generally does not cover "control" (in the engineering sense) in physiology, pathophysiology, and therapeutics. A better understanding of how evolved controls maintain normal homeostasis is critical for understanding the failure mode of controlled systems, that is, disease. We believe that teaching and research must incorporate an understanding of the control systems in physiology and take advantage of the quantitative tools used by engineering to understand complex systems. Control systems are ubiquitous in physiology, although often unrecognized. Here we provide selected examples of the role of control in physiology (heart rate variability, immunity), pathophysiology (inflammation in sepsis), and therapeutic devices (diabetes and the artificial pancreas). We also present a high-level background to the concept of robustly controlled systems and examples of clinical insights using the controls framework.


Artificial pancreas; Autoimmune disease; Control systems; Heart rate variability; Sepsis

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