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Ventilation inhomogeneity in CDH infants – A new attitude within a simulation study

Stankiewicz Barbara, Mierzewska-Schmidt Magdalena, Górczyńska Krystyna, Pałko Krzysztof J., Baranowski Artur, Kozarski Maciej, Darowski Marek

Biocybernetics and Biomedical Engineering

2021

Vol. 41, no. 4

1378--1389

Congenital Diaphragmatic Hernia (CDH) is a serious newborn defect requiring mechanical ventilation. Initial ventilation settings should take into account the severity of lungs inhomogeneity (LI), but it is not assessed in everyday clinical practice. We present a new LI index that can be easily determined at the bedside. It is based on a comparison of resistive-elastic properties of lungs and defined as a ratio of time constants T1 T2_1 of gas flows in both lungs (T1 = R1∙C1, T2 = R2∙C2). We hypothesised that T1 T2_1 index increase causes a rise of lungs impedance (Z) and requires elevation of peak inspiratory pressure (PIP), mean airway pressure (MAP), and work of breathing (WOB). Infant hybrid (numerical-physical) respiratory simulator and a ventilator were used to simulate conventional ventilation of homogeneous and inhomogeneous lungs, and to measure PIP, MAP and WOB. A high correlation was found between Z, WOB, PIP, MAP and the T1T2_1 index (r = 0.9, P < 0.001). The increase of T1T2_1 index from 1 to 20 resulted in significant rise of WOB, PIP and MAP, e.g. at RR = 60 bpm, the WOB (1.05 → 1.49∙J_l), PIP (15.2 →20.5 cmH2O) and MAP (6.8 → 8.4 cmH2O), P < 0.005. It seems that T1T2_1 index could be used for prediction of PIP and MAP required to achieve effective ventilation in CDH infants; it also may affect the choice of ventilation strategy (CMV or HFV) as well as ventilator settings on CMV. We show how the relationships between WOB, PIP, MAP and the T1T2_1

An introduction to the hybrid simulation – the conception of the simulation system

Foit K.

Journal of Achievements in Materials and Manufacturing Engineering

2010

Vol. 39, nr 2

176-183

Purpose: of this paper: The aim of this paper is to present a simple hybrid simulation system, which is composed of virtual reality software and a mathematically oriented application. From the engineer’s point of view, an important possibility is to link together the mathematical software programs with these for creating presentation graphics or virtual reality, in order to create a simulation system with the large customisability. Design/methodology/approach: The coupling of mathematical and virtual reality system can be done in several different ways, using mechanisms for the Interprocess Communication. Findings: It has been assumed that EonX control will be used in a program conceptually similar to the EON Viewer, but equipped with support of basic interprocess communication interfaces in order to maximize flexibility and possibility of data exchange with different applications. Research limitations/implications: The one of specific requirements is to create an appropriate virtual world in EON Studio with use of external events nodes. Practical implications: The simple application named SockED has been created for testing purposes. The SockED application, which is hosting EonX control, acts as DDE server. As an external application any mathematical program that supports the DDE communication can be used (eg. Microsoft Excel, Matlab). There is also theoretical possibility of use the Programmable Logic Controller in similar manner like in case of SCADA application, but this case was not tested yet. Originality/value: There is no program on the market that allows complicated mathematical computation along with high resolution, 3D presentation graphics. The creation of SockED application allowed combining a mathematical program with the powerful graphics engine from EON Reality.