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Ventilator Nomenclature - Semantic Architecture - Overview

Ventilator Nomenclature - Semantic Architecture - Overview. JWG-d4jw. Contents. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG. 2. Vent Modal nomenclature –ontological perspective - relational.

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Ventilator Nomenclature - Semantic Architecture - Overview

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  1. Ventilator Nomenclature - Semantic Architecture - Overview • JWG-d4jw

  2. Contents ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 2

  3. Vent Modal nomenclature –ontological perspective - relational The following relation shows several ventilation “modalities” (rows) vs. differentiators (columns), which are ontological classes, properties, and attribute constructs. Most notation is conventional/”legacy”, although some new notations are introduced; see Notation Table. Multi-, esp. concurrent intra- and inter-breath variations and objectives induce “phasing” and feedback control. Breath Type values are typical, although progressively describe the semantic range of the sub-table (/column) in a relational sense. [Instrum*  Method spec’n, including relevant “settings” [setup/init and dynamic [on change].] Elements generally are relationships with other attributes (/columns); may be “Group”ed for efficiency ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 3

  4. Vent Modal nomenclature – ontological perspective – OO (1) The notions of “specialization”, “property”, “attribute”, and “pre-” and “post-” “coordination are depicted for key modalities, e.g. the Mode class progression iiA—>iiS. Class i  same “BT” delivered Specialization: “predicated” on occurrence of sensation by instrument of subject [inhalatory] effort, aka “patient ‘trigger’” In “S/T” variant, Insp Term type is predicated on Insp Init type and therefore is a form of “post-coordination” [of Term Type as f(Init Type)]. Specialization is delivery of alternative BT’s. Further specialization allows for “concurrent” [property] “spontaneous” breathing and delivery of alternative BT’s; “ordering” is attributed to “Mode”. Multi (bi==2) Breath , multi- wave array Concurrency variations induced by each [sub-]breath and related phasing, i.e. for “synch” or “synergy” purposes; multiple intra- and inter-phase variations, e.g. VC, PC, PCa ( multi- [bi==2] {V[t,m], …, WoB} variable synergy [ ”SCADA”  “CDS”] ) [Further] Specialization: T is “pre-coordinated” (== f/60 [sec]), i.e. will occur at “mandated” interval but may be delayed for dTwindow  “synchronization” [property] Support “Spont”  Min WoBv, Max WoBp ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 4

  5. Vent Modal nomenclature – ontological perspective – OO (2) The notions of “specialization”, “property”, “attribute”, and “pre-” and “post-” “coordination are depicted for key modalities, e.g. the Mode class progression iiA—>iiS. Optimization generalization; stability  concurrent achievement of control objectives [typ. VtpBr [Tidal Vol per Br; statistical variants required and may be settable  “Tuning” Init(Modal[Phasing[) Intercom [Br2Br]  [near]RT Intercom [Init] Comm: Modal [Re]Setup  context-sensitive; Br2Br  [near]RT + Events ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 5

  6. Vent Modal nomenclature – Application examples (1) The general regimen of annotation reporting is shown in the following examples. The top “time line” shows the progression of a subject to ICU, with 3 Vent Mode time epochs (e.g. i, iA, and iiS), each of which is detailed as a time epoch within which several communication info strings are shown, as follows: Mode initialized, identifying MT and BT with relevant settings; Steady state waveforms; Patient-triggered vent breath occurrences (T=time ref; X=method); Natural (spontaneous) breath occurrences. [Note: settings list abbreviated for simplicity; waveforms are typical for heuristic purposes. AoI(Feature) == AoI(z) ] .1 .2 .3 .4 Timeline HR [24] ED PACU ICU OR MIN [60] i iA iiS AoI(z) SEC [60] i iA .3 iiS .3 .4 .1 .2 .1 .2 .1 .2 {i , {T, FC(f=10,q=50[lpm]), VC}} {iA , {T, FC(f=10,q=50[lpm]), VC}} {iiS ,{T, FC(f=10,q=50[lpm]), VC},{PS}} .1 .1 .1 N N .2 .2 .2 x x x Same as iA. .3 {<time ref>,X} Patient triggered [X=method] .3 {<time ref>,N} Natural (spontaneous) breath .4 ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 6

  7. Vent Modal nomenclature – Application examples (2) Additional use contexts to characterize: iiSB, iii. Clinical modalities: [Co-]Ventilation:Oxygenation Optimization, Maneuvers, Weaning. iiSB includes several variations, as noted: e.g. VC, PC, PCa ( multi- [bi==2] {V[tidal,minute], …, WoB} variable synergy) iiSB Optimization iii  Weaning iiS iiS AoI(z) iiS iiS .3 .4 .3 .4 .1 .2 .1 .2 See particular examples slide AoI(Feature) List AoI(Feature) List ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 7

  8. Vent Modal nomenclature – Context definition (1) Top table: definitions for key dimensions and indexes. Bottom table: spreadsheet for capturing cases. It is particularly important to provide for recursion when considering multiple concurrent state machines! Phase { Mode <type> Index ; in general, it is assumed that inter-br [incl. multi-br has a ‘modal’ context to consider before next br ; and has a ‘phasic’ context to consider before next phase; this enables recursion and statefulness ;  Modal context; [Inter-breath context] ; Assumed that Breath <type> spec’n and initiatization as appropr;  Inter-breath context { Breath <type> Index Mixer { Var Variations { Concurrency <type> Index Mono (Binary); Multi( Bi (Unary, Dual), other (e.g. HFV)) ;  Concurrency context { Gradiency <type> index {Intra-, Inter-} * [concurrency, breath}; Inter-br is modal ! ;  Gradiency context (f(co Cases Unary 1) Mode i and “simple” Mode ii Binary 2) Mode iiB* Exclusive 2)) Non-concurrent; alternating (but not necessarily toggling) Inclusive [2]a) Concurrent, “Bi-Level”, Concurrent; (Several variations w.r.t. patient inhl/exh during insp/exp). Refer to following slides for particular extended cases, esp. Bi-Level. … Other: higher-level granularity, for example, HFV to reuse and/or embed previously defined … } ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 8

  9. Vent Modal nomenclature – Context definition (2) Top table: generic relation for a number of “legacy” functions. Bottom table: generic table for indexing related identifiers and extending definition. The phasing and inter-Variation characteristics need to be clarified for each function and then common and specialized [feedback (FB)-]control variable settings nomenclature can be specified (see Appendix A) for VAPS case.  Nomenclature metrological “discriminant”. Intra-BrInter-Br Intra-PhaseInter-Phase I:ER-basedOtherMinuteVol-basedOther most PRVCAPRVS/TVAPSMMV(f) MMV(χ) ”Adaptive” “Smart” Breath class Artificial Virtual (“Set”) Instrumental -- Functional) Compensation ATC P f(ETT(d,l)) Transduction PAV, NAVA P f(CRG) Calibration Pbar=f(Cal(P)) Natural Each specialization needs a spec/clarification as to phasing/gradiency behavior, esp. intra-/inter-breath. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 9

  10. Vent Modal nomenclature – Appendix A – Notations Glossary (1) Notations are summarized in the following tables. [Note: these tables need to be updated, as this document includes diagrams from several development documents and is not correlated with “Annotations”.] ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 10

  11. Vent Modal nomenclature – Appendix A – Notations Glossary (2) This table extends the previous one based on the relational perspective. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 11

  12. Vent Modal nomenclature – Appendix B-1 – Template – Mode iA (“A/C”) – Morphology In Mode iA (“A/C”, or “A/M”), Ventilator Inspiration may be initiated by either Ventilator-internal (e.g. Timer) or –external (e.g. Patient inhalation initiation) means. Morphology (top) is typically characterized by Pressure and Flow (also Volume) “wave”forms. Initiation event timing is shown in the bottom diagram.. Refer to next slide for Settings and Annotations perspectives. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 12 Insp - Breath 3 (PS) Conc.insp - Breath 2 (PS) Conc.insp - Breath 2 (PS) TPHi Breath 1 (PCa) Tbl Breath 1 (PCa) TEbl Breath 1 (PCa) elevated bl press-end 20/baseline press-start 23 baseline press-end 5/ elevated bl press-start 10 elevated bl press-end10/baseline press-start 15 baselime press-end 15/evated bl press-start 20 insp-start 21(20) Iinsp-end 16(15)/exp-start 17 (15) Insp-end 11(10)/ exp-start 12 (10) insp-end 13 (10)/ exp-start 14 (10) insp-start 16 (15) insp-start 11 (10) exp-end 17(15)/insp-start 18 (15) insp-end 18(15)/exp-start 19 (6) insp-end 22(20)/exp-start 23 (20) exp-end 12(10)/ insp-start 13 (10)

  13. Vent Modal nomenclature – Appendix B-1 – Template – Mode iA (“A/C”) - Settings & Annotations “Settings” related to iMode Morphology (see previous slide) are summarized at left, and .Annotations are shown at right. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 13 Insp - Breath 3 (PS) Conc.insp - Breath 2 (PS) Conc.insp - Breath 2 (PS) TPHi Breath 1 (PCa) Tbl Breath 1 (PCa) TEbl Breath 1 (PCa) elevated bl press-end 20/baseline press-start 23 baseline press-end 5/ elevated bl press-start 10 elevated bl press-end10/baseline press-start 15 baselime press-end 15/evated bl press-start 20 insp-start 21(20) Iinsp-end 16(15)/exp-start 17 (15) Insp-end 11(10)/ exp-start 12 (10) insp-end 13 (10)/ exp-start 14 (10) insp-start 16 (15) insp-start 11 (10) exp-end 17(15)/insp-start 18 (15) insp-end 18(15)/exp-start 19 (6) insp-end 22(20)/exp-start 23 (20) exp-end 12(10)/ insp-start 13 (10)

  14. Vent Modal nomenclature – Appendix B-2 – Template – Mode iiS (“SIMV”) - Morphology Mode iiS (“SIMV”) Morphology (top) and Inspiration Initiation event (bottom) perspectives. See next slide for Settings and Annotations perspectives. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 14 Insp - Breath 3 (PS) Conc.insp - Breath 2 (PS) Conc.insp - Breath 2 (PS) TPHi Breath 1 (PCa) Tbl Breath 1 (PCa) TEbl Breath 1 (PCa) elevated bl press-end 20/baseline press-start 23 baseline press-end 5/ elevated bl press-start 10 elevated bl press-end10/baseline press-start 15 baselime press-end 15/evated bl press-start 20 insp-start 21(20) Iinsp-end 16(15)/exp-start 17 (15) Insp-end 11(10)/ exp-start 12 (10) insp-end 13 (10)/ exp-start 14 (10) insp-start 16 (15) insp-start 11 (10) exp-end 17(15)/insp-start 18 (15) insp-end 18(15)/exp-start 19 (6) insp-end 22(20)/exp-start 23 (20) exp-end 12(10)/ insp-start 13 (10)

  15. Vent Modal nomenclature – Appendix B-2 – Template – Mode iiS (“SIMV”) Morphology From Norman’s diagrams. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 15 Insp - Breath 3 (PS) Conc.insp - Breath 2 (PS) Conc.insp - Breath 2 (PS) TPHi Breath 1 (PCa) Tbl Breath 1 (PCa) TEbl Breath 1 (PCa) elevated bl press-end 20/baseline press-start 23 baseline press-end 5/ elevated bl press-start 10 elevated bl press-end10/baseline press-start 15 baselime press-end 15/evated bl press-start 20 insp-start 21(20) Iinsp-end 16(15)/exp-start 17 (15) Insp-end 11(10)/ exp-start 12 (10) insp-end 13 (10)/ exp-start 14 (10) insp-start 16 (15) insp-start 11 (10) exp-end 17(15)/insp-start 18 (15) insp-end 18(15)/exp-start 19 (6) insp-end 22(20)/exp-start 23 (20) exp-end 12(10)/ insp-start 13 (10)

  16. Vent Modal nomenclature – Appendix B-3 – Template – BiLevel 1 – Settings & Annotations In “BiLevel 1”, Ventilator and Patient contributions are temporally exclusive: Perspectives include Morphology (lower-left), Settings (upper left), and Annotations (right). ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 16 Insp - Breath 3 (PS) Conc.insp - Breath 2 (PS) Conc.insp - Breath 2 (PS) TPHi Breath 1 (PCa) Tbl Breath 1 (PCa) TEbl Breath 1 (PCa) elevated bl press-end 20/baseline press-start 23 baseline press-end 5/ elevated bl press-start 10 elevated bl press-end10/baseline press-start 15 baselime press-end 15/evated bl press-start 20 insp-start 21(20) Iinsp-end 16(15)/exp-start 17 (15) Insp-end 11(10)/ exp-start 12 (10) insp-end 13 (10)/ exp-start 14 (10) insp-start 16 (15) insp-start 11 (10) exp-end 17(15)/insp-start 18 (15) insp-end 18(15)/exp-start 19 (6) insp-end 22(20)/exp-start 23 (20) exp-end 12(10)/ insp-start 13 (10)

  17. Vent Modal nomenclature – Appendix B-4 – Template – BiLevel 2 - Morphology In “BiLevel 2”, Ventilator and Patient contributions are temporally inclusive: the diagram below shows breath pattern morphology in terms of Pressure and Flow “wave”form expected values. See following slide for Settings and Annotations perspectives. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 17

  18. Vent Modal nomenclature – Appendix B-4 – Template – BiLevel 2 – Settings & Annotations “BiLevel 2” Settings (left) and Annotations (right) characterizations. See previous slide for Morphological perspective. ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 18

  19. Vent Modal nomenclature – Appendix C-1 – Hybrid Breath Type characterization “Volume-Assisted Pressure Support (VAPS)” ventilation is an example of a “hybrid” pressure-flow control [inspiratory] Breath Type with [breath-to-breath] “volume targeting”, which is typically applied in Mode iA, technically becoming Mode IA-vtPS. “Hybrid”, or “Dual” : switch between PC and VC breaths Switch within a single breath: VAPS (see below) Switch between breaths – Volume Support – Pressure-Regulated Volume Control (PRVC) ISO/IEC/IEEE/IHE/IHTSDO Vent Nomen JWG 19

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