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ClinicalModdality-Emulation-VPT-MDIB-DBtools_2jw

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					          Clinical Modality
     - Emulation use context
- Ventilated Patient Transfer (VPT)
        - Ventilator Modality
             - DCM RDC
              - DB tools
             - Overview


     D2-jw ClinicalModality-Emulation-VPT-MDIB-DBtools. Prepared by Jan Wittenber,
   JWG ISO /IEC/IHE PCD RTM-VentilatorNomenclature_DPI-ICE-PAC/IEEE11073 MDDL/PHD




        JWG-VentilatorHarmonization- DB tools                                        1
                                                                              Introduction

           This document has two main parts, the first, about an “MDIB Emulator” DB tool, being a follow-on to
           the second, about a [Ventilator] semantic architecture/nomenclature design DB tool.

           In between were a number of in-depth and collaborative work with an inter-disciplinary, inter-
           standards “joint working group (JWG)” focusing on Ventilator Nomenclature and related clinical and
           medical device-based networked systems.

           This document does not cover substantial DB tool work at NIST, with several related tools, including
            - the “ICS Generator” for modeling medical devices with IEEE 11073 (MDC) MDDL using a GUI
           diagram-oriented editing capability,, currently upgrading; and
            -- the “RTM MS (Rosetta Terminology Mapping)” tool under development.

           Hopefully, harmonization “connects the dots”, so to speak, with reusable threads! After all, “gaps”
           are often configuration-related, so the more safe and effective “rapid” that can be, would
           undoubtedly help serve as a platform for extending into other applications on a systematic basis.




1   Based on Microsoft Access 2007; available from author through and for use in Vent Nomenclature JWG

                                                          JWG-VentilatorHarmonization- DB tools                   2
           Clinical Modality
     - Emulation use context
- Ventilated Patient Transfer (VPT)
        - Ventilator Modality
               - DCM RDC
                - DB tools
         - Overview – Part 1
              - MDIB tool
              - Overview



                   D1-jw ClinicalModality-Emulation-VPT-MDIB-DBtools.
   JWG ISO /IEC/IHE PCD RTM-VentilatorNomenclature_DPI-ICE-PAC/IEEE11073 MDDL/PHD




       JWG-VentilatorHarmonization- DB tools                                        3
                                                                              Introduction

           This [sub-+document is an extension of the “Ventilatory Modality – Dbtool” document, adding a
           “Clinical Modality – Emulation DB tool”, focusing on “Ventilated Patient Transfer (VPT), as part of a
           harmonization effort spanning several standards groups, as ID’d in the title page. Life is too short to
           elaborate on all this right now.

           Since this covers a substantial “dynamic range”, it takes a number of perspectives and often
           elaboration and abstraction simultaneously. Sorry about that; seriously– but that’s why there’s a
           real need for a flexible and systematic “name space”, which these tools attempt to embody, based
           on adapting the ontological perspective to clinical and esp. ventilatory management workflow.

           The Emulator tool described facilitates automated definition, interchange, and integration in a
           “Medical Device Info Base (MDIB)”, which is sized initially exactly for 7 OpSettings described in
           harmonization documents.

           The remainder of the paper is the initial Ventilatory Modality Dbtool paper; it will be updated after
           and possibly annotated where any significant differences exist that affect Emulator use.




1   Based on Microsoft Access 2007; available from author through and for use in Vent Nomenclature JWG

                                                          JWG-VentilatorHarmonization- DB tools                      4
                                                                               Background
           There are several E size vsd diagrams that have been developed1 and can be used for an overview of
           Clinical workflow modeling, including DCM/DAM in UML, clinical work flowcharts focusing on
           Ventilator and infusion (e.g. PCA) device participation in clinical activities.

           The Emulator tool covers functionality in a sequence of “MDIB” generation and management
           capabilities, as follows.

           • Preparation of originating EVent Report Info (EVRI) from SDO standard doc (e.g. IEEE 11073-PHD)
           • Export to spreadsheet format
           • Interchange [through email]
           • Import from [saved email]
           • Show/edit MDIB [RDB query on linked imported EVRI]
           • Extend (Local and/or Global) MDIB for collaborative work (in VPT RDC use context/cases).




1   Based on Microsoft Access 2007; available from author through and for use in Vent Nomenclature JWG

                                                          JWG-VentilatorHarmonization- DB tools                 5
                               Emulator tool – Overiew – GUI
       An attempt will be made to be able to do clicks or Enters to pace composition of the GUI.


 1) To start:
  Dbl-click
Switchboard




       2) Click
   “RDC Emulation”
      to launch
 “MDIB “Splashboard”
      window


                                                                                         3) MDIB form has a
                                                                                       procedural orientation
                                                                                       with pushbuttons. Size,
4) Remaining area is used
                                                                                        subview and position
for dynamic sub-windows
                                                                                          on screen can be
 invoked by pushbuttons
                                                                                        adjusted dynamically



                                   JWG-VentilatorHarmonization- DB tools                                     6
 Emulator tool – Overview – GUI – MDIBs in VPT Clinical Use Context
The MDIB contains the (relative) Vent OpSettings Vector at a given topological node in the VPT system.




The main table is an
                                                                                              The vector
editable Form of the
                                                                                             chronology
    relational DB                                                                         terminates in ICU
  transform of the                                                                        and can become a
      OO MDIB.                                                                             “Medical Record
                                                                                           Element (MRE)”
  The OpSettings Metric                                                                     recording the
 *value+ Set, or “vector”,                                                                     episode.
 originates in [OR/]PACU
  and is exported to an
   intermediary, e.g. a
      Transport Vent


     The vector may be used for settings continuity and adjustment during transport.

                                 JWG-VentilatorHarmonization- DB tools                                        7
             Ventilator – Domain Model – Dynamic basic concepts
 Base concepts are focal points, or Areas of Interest (AoI) in function-phase space for variables related to
 SCADA, CDS, EMR, and other application scopes. Notation faciliates specification of “Set” Breath (Expected
 Value) Patterns, as well as recognition of resultant Breath Patterns through Observations. A major
 simplification is treating “inflation” as a transform in which either P or Q (Flow) are constant over Insp.

                                                                                                                    APNEA CRITERIA
Breath Control Frame
sequence for an “SIMV                                                                                               ∑ BR Annot’ns 
”-like Ventilation                                Ven                                          Ven Ven              MultiBeat
                            A
pattern.                                          tN
                                                   Br                                          t Br t N
                                                                                                      Br
                                                                                                                    Patterns, e.g.
                                                                   CPAP                                             Dyspnea




                                                              C
                                                              T
                                                              A
                                                                                                                    BREATH RATE
             MT_BT                                                                                                  TOTALS and
                                                             INVERSE I:ER
                                                                                                                L   related
             ii                                 dT : { I, E, I+E, I:E }                                             STATISTICS
                                                                                                                e
                                                                          ↑AssurLevel,
                                                                          WoBv                                  a   Various
             Eff                                                                                                k   Intervals can be
             Aff                                                                                                    defined and
                                Mandated                                        AssurLevel,                    c   measured for
                                 Int(Art)                                      ↑ WoBp                          o   pattern
            MINUTE VOLUME                                                                                           measurements.
                                preempts                                         Synch’z’n                      m
                                 Ext(Nat)                                                                       p
                                                                  PHASE         SYNCHRONY           STATS
                                                                                                                e
            TIDAL VOLUME                                                                                        n
                                                                 Directed dT between partial Flow zero          s
                                    B                  B                                                    B
            AIRWAY FLOW
                                                                 crossings constitutes a Breath . There         ’
                                                                 are Int and Ext inducements.                   n
                                                 “APRV”
            AIRWAY PRESS



            ATC                                  NAVA(CRG)
            BAROM PRESS                 JWG-VentilatorHarmonization- DB tools                                                          8
            CALIBRN
                   Emulator tool – Overview – GUI – PDU Generation
         PDU generation format is compatible with infrastructural [integrated clinical! : ] environment (no
         caps! ; ).
                                      Spreadsheet format before
    Fully                                 optimizing format
compressed
   format
turns 4 hex
  chars to
   SHORT



     Since the                                                                                       SHOW MDER
 “Output File” is                                                                                      HEXATEXT
 a .txt file, it can                                                                                  “Concrete”
 be operated on                                                                                     Syntax displays
  in CMD mode                                                                                     optimized output
                                                                                                   in “hexatextual”
                                                                                                   format. File is a
                                                                                                     .txt exported
                                                                                                  from spreadsheet
                                                                                                   using MDIBtool.
    Ditto, operated from
     RUN mode via DB                Function modules exported from Macros
    RunCommand Macro                are adaptaqble in ‘native’ code (e.g. VB)


                                     JWG-VentilatorHarmonization- DB tools                                        9
               Emulator tool – Overview – GUI – “Std To PDU (S2pdu)”
Initial EVRI intermediate transforms are by text copy/paste from Std spec, in this case IEEE 11073-20601 PHD
(H.2.4.1) Metric Numeric sequence, adapted for this purpose (exporting Vent Mode (e.g. PSV) OpSettings.

 SDO standard is a pdf in media distribution
     DIR (c:\Temp \MDIB-Emulation\)




  Optimized
  format (at
     left).

   DB query-
     linked-
 intermediate
   format (at
      right)




   STD source can be
  displayed from Temp                                                       MDER “hexatextual” source
   DIR via Cmd line or                                                       format; Format has OID
   operated on as any
      other pdf file.
                                  JWG-VentilatorHarmonization- DB tools                                        10
Emulation tool – “MDIR*…MDIB+” – DIRectory structure




                                         Local RDC partition working directory
                                          contents. Only the .txt is needed to
                                       interchange optimized payload, which is
                                        presently MDER but “is architected” for
                                      additional presentation methods, esp. PER

                                     XML transformation is available throughout
                                                the [R]DB platform..


                                     The upper namespace partition is a metrastructure
                                       for developmental and functional operational
                                        constructs, such as this Emulator; it is “DIR”-
                                                          oriented.

                               D2bjwThe lower partition is for operational objects
                                      distributed in a clinical context. As shown,
                                         several DIRectories are co-located for
                                           distribution/integration efficiency.

             JWG-VentilatorHarmonization- DB tools                                    11
                                    Clinical Modality
                              - Emulation use context
                         - Ventilated Patient Transfer (VPT)
                                 - Ventilator Modality
                                       - DCM RDC
                                        - DB tools
                                  - Overview – Part 2
                                         - DB tool
                                       - Overview
This part needs updating overall
  based on development; some
stickies like this may be added in
         particular places.

                                               D2bjw




                             JWG-VentilatorHarmonization- DB tools   12
                                                                              Introduction
           The “DB Tool” is a relational DB1 that comprises a set of tables, queries, forms and reports
           substantiating the Vent “Modality” Framework to facilitate development. Overview slides:

             • Modality Frmwk
                       • Data entry “Form”
                       • Examples
                                  • “Standard”
                                        • MT (i), BT(FC): aka “A/C”
                                        • MT (ii), BT (PCPS): aka “SIMV”
                                        • MT (iii), BT(PS): aka “PSV”
                                  • Mfr-specific, based on MT(ii) BT(BPAP/CPAP), value-adding
                                        • “VM targeting Auto/Feedback Control (AFC) function.
             • Schema
             • Table Examples
                  • Inspiration
                       • Initiation
                       • Breath Type
                             • Inflation
                             • Termination
                  • Variables
             • Background
                  • MT and BT depictions
1   Based on Microsoft Access 2007; available from author through and for use in Vent Nomenclature JWG

                                                          JWG-VentilatorHarmonization- DB tools           13
                               Modality Framework editing “Form”
   The following Figure is a composition of the “ModalityFrmwk” Form, which is used to facilitate editing. Several
   “sub-Forms” are used to group Properties allow management of details. Several Modalities in the DB are
   shown in subsequent slides.

“NOS” (Not Otherwise                                    “Drop-down List Selector” controls are used to select choices from
Specified”) is used for                                 underlying *relational+ Tables; Selector “window” shows “Mnemonic” of
unspecified values or                                   term selected. Various other attributes are shown during selection.
template purposes.


 “Modality”:”Mode                                                                                      “Variables” table listing;
 Type (MT)” relation                                                                                   use Scroll Bars to review
                                                                                                       entire table contents.

“Inspiration Init”                                                                                     Inter-/Multi-Breath “
sub-Phase                                                                                              Automatic Feedback
                                                                                                       Control (AFC)”-related
“*Insp] Breath Type                                                                                    content,
(BT) relation,
comprising                                                                                             AFC “Method” and
“Inflation” and                                                                                        Variables “Vector”
“Termination” sub-                                                                                     relations
Phases.


             Note @ provision for
                                                                 “Expiration” Phase
             “Intra-Breath AFC”.




                                     JWG-VentilatorHarmonization- DB tools                                                      14
                    Modalities – MT(i) – Example: “aka A/C”
“A/C” typically comprises a regular pattern of assured breaths, typically “Flow Controlled” (FC).




                                                This sub-view is shadowed since it is
                                                the same as the “<NOS>” Template




                                  JWG-VentilatorHarmonization- DB tools                             15
                  Modalities – MT(ii) – Example: “aka SIMV”
“SIMV” typically comprises a regular, alternating pattern of assured and unassured breaths, in this case
BT(PCPS).

                                 “Sequence No.” denotes
                                 expected sequence after
                                 regular “assured” BT.




                                  JWG-VentilatorHarmonization- DB tools                                    16
                   Modalities – MT(iii) – Example: “aka PSV”
“PSV” typically comprises a *ir]regular pattern of unassured breaths, typically “Pressure Supported”, BT(PS).




                                  JWG-VentilatorHarmonization- DB tools                                         17
           Modalities – MT(ii) - “aka BPAP/CPAP Mfr-VMtarg”
Customization can be done in several ways. In this example, a specialized, “Manufacturer-specific”
“Auto/Feedback Control (AFC)” function is used to achieve Minute Volume Targeted optimization, based on a
“standard” template for MT(ii)-BT(BPAP/CPAP).


                            A “standard” Type may be used as a starting
                            “Template” to define a “custom” Modality




                                                                                     Mfr-specific type is one
                                                                                     of several AFC Types


                                                                                     SETting, MANipulated,
                                                                                     PROcess, and ERRor
                                                                                     Variables may be
                                                                                     associated for definition
                                                                                     purposes.




                                 JWG-VentilatorHarmonization- DB tools                                    18
                                                 Schema
Various Tables are defined and related, as shown in the following “Relationships” table/view. This view is used
in various Queries to join together related information, based on the [SQL] Query specification. Following
slides show the content of various key Tables.

                                                                    “*Insp] Breath Type (BT) relation,
 “Mode Type (MT)” table                                             comprising “*Insp+ Inflation” and
                                                                    “*Insp+ Termination” sub-Phases.




                                                                                                   “Expiration” Phase
                                                                                                   table


 “Inspiration Init”
 sub-Phase




                                                                                                “Variables” relations
                                                                                                not shown

                                                Inter-/Multi-Breath “Automatic Feedback
                                                Control (AFC)”-related content.




                                  JWG-VentilatorHarmonization- DB tools                                             19
                              Table Examples - [Insp] Initiation
Columns of the Table serve a variety of relational purposes, including numerical identification (“InspInit_ID-Num”), Phase context (“InspInit_ID-
Seq”), notational abbreviation (“InspInitID-Mnem”), general description (“InspInit_Desc”, and functional rationale (“InspInit_Rationale”, as
shown in the following listing, which is a “basic Report” from the DB.




                                                JWG-VentilatorHarmonization- DB tools                                                               20
                                   Table Examples - [Insp] Breath Type
     Key attributes of the Breath Type (BT) table are shown. BT comprises Inspiration Inflation and Termination sub-phases and is provisioned for an
     intra-breath AFC element.



                                                                  These are “pointers” to records of
                                                                  the related “Type” tables.




“HF” type
variations should
probably be
managed in a
separate Profile.




                                                     JWG-VentilatorHarmonization- DB tools                                                             21
                               Table Examples - [Insp] Inflation
Key attributes of the Inspiration Inflation phase table are shown.


                                                                                         Rationales should be
                                                                                         added to clarify purposes
                                                                                         of transfer function.




                                                 JWG-VentilatorHarmonization- DB tools                               22
                              Table Examples - [Insp] Termination
Key attributes of the Inspiration Termination phase table are shown.




                                                                             Rationales should be carefully defined.
                                                                             *An update is pending…+




                                                JWG-VentilatorHarmonization- DB tools                                  23
                            Table Examples - Variables
Key attributes of the Variables table are shown. Checkboxes are used to denote that VARiations are “discriminated”, e.g. “MEASured”,
“SETTing”, or “High/Low Limit Alert” TYPEs. Dimensions, or Units of Measurement, may be added; note that some variations may pertain to
Units of Msmt, which could easily be captured in the table for clarity.




                                             JWG-VentilatorHarmonization- DB tools                                                        24
                                                            Background - Mode Type
       Mode Types are shown with Breath Types as analogous with “black boxes”, denoting that *virtually+ any BT may be substituted, per Ontology.




                                                  A/C
                                                  [FC]                   [FC]                     [FC]                         [FC]


                                                                                                                                                               Increasing level of
                                                                                                                                                                  Assurance of
                                                                                                                                                               Delivered Breaths
                                                        SIMV
                                                         [PC]                                     [PS]                            [PC]
                                                                                                                                                                  Increasing
                                                                                  CPAP                                                                          Patient Work of
                                                                                                                                                               Breathing (WoBp)




                                                                                                                                        BT “boxes” should be revised to better
                                                                         [PS]                   [PS]                                    interleave “inter-breath” intervals,
                                                                                                                                        esp. for BPAP/CPAP BT’s
                                                                                                                          CPAP


This   and the following slides are taken from “Ventilatory Modality – Framework and Overview – d4jw”, as adapted based on review and subsequent discussion.

                                                               JWG-VentilatorHarmonization- DB tools                                                                          25
                               Background- Breath Type - Relationships
Breath Type Control Variable relationships are depicted in the following figure. These are abstracted in the following slides.




                                                                                                                    VTVM may be
                                                                                                                    log scale
                                                                    V                                               VM

                                                                                                                     VT


V
                                     Q




                   P
                                                                    P
                                                                                                                     PIP
                                                                                                                    Pplat
                                                                                                                   PEEP
                                                                                                                   Patm
                                         T                                        Ti                  Te        Tbr
                                                                                             I:ER = Ti/Te         RR = 1/Tbr
      Legend                                                            Note: in 2-D views, waves are shown vertically, synchronized @ T.
                                                                         See also slide “Background – Defining a Breath”.
     V: Volume             Breath Initiation “Window”
     F: Flow           [FC Breath]
     P: Pressure       [PC Breath] [PS Breath
     T: Time           Inspiration Initiation & Termination Impulse types
                            Spontaneous            Mandatory [f(T)]

                                                     JWG-VentilatorHarmonization- DB tools                                                  26
                              Background- Breath Type – Depiction - Overview
Breath Type morphology is depicted in the following figure, with “Ventilator”-related detail opaque and detail shown in the next slide. The figure
is intended as a “lead-in” to showing detail BT definition and specification.

                                                                                            At this level of abstraction, it is easy to “lose”
                                                                                            significance of the distinctions between “SET”
                                                                                                      and “OBServed” “Breaths”.




                                               JWG-VentilatorHarmonization- DB tools                                                                 27
                             Background- Breath Type – Depiction - Detail
Breath Type conduction “path” variations are depicted in the following figure. In the Termination sub-Phase, path branches are denoted with
circled letters for reference purposes. Detail definition is in progress, as part of recent Work Item #2 from 14Apr2010 tCon.




                                                                                                       PEEP/CPAP




                                              JWG-VentilatorHarmonization- DB tools                                                           28
                Clinical Modality
          - Emulation environment
      - Ventilated Patient Transfer (VPT)
              - Ventilator Modality
- Detailed Clinical Modeling (DCM) Ontology




                         D1-jw ClinicalModality-Emulation-VPT-MDIB-DBtools.
         JWG ISO /IEC/IHE PCD RTM-VentilatorNomenclature_DPI-ICE-PAC/IEEE11073 MDDL/PHD




             JWG-VentilatorHarmonization- DB tools                                        29
                                               Introduction
Some additional views are included to place this in the context of harmonizing standards activities.

Ontological views are intended to facilitate derivation of a systematic if not formal semantic architecture, which is
another way of saying “namespace”, or naming framework.

The Ventilatory domain spans a significant number of orders of magnitude of space-time, or “4D”, ranging from
closed loop control with millisecond latencies to etiological characteristics of chronic respiratory disease with multi-
year time constants of pathology evolution.

Compounding the problem is that procedures using ventilators are in the more challenging realm of safety and
essential performance, and reliance on distributed data communication for support of the “mission” function, i.e.
patient ventilation, is a major target in tradeoff analysis.

Viewing ventilator dynamic operation in the small time constant RT domain as a clinicological function-phase relation
helps to focus systematic RT relationships among major system components, mostly ventilator, but patient and
operator or clinician as well.

Ventilators must also pursue multiple RT objectives within the RT spectrum. As a result, in order to visualize
phenomena, the resulting ontology must be able to be “navigated” efficiently, which leads to identifying the main
nomenclature identities. These identities are typically “base concepts” around which related variables cluster and
from which specialized, or differentiated concepts derive, usually predicated on some fundamental relstionships with
other base concepts and derivatives.

The next slides describe a dynamic ontological perspective, extending the previous slides in a more “finite state
element/model (FSE/FSM)” and “object orientation” (OO) to gain simplification of generalization/specialization and
scalability through hierarchical and relational structures.




                                 JWG-VentilatorHarmonization- DB tools                                                     30
                      Ventilator – Domain Model – “Breath*ing+” Patterns
      Mode Type (MT) and Breath Type (BT) variations are systematized into 3 MT (e.g. I – iii) and several fundamental BT’s (Vol-
      assured (e.g. aka VC, PC), and Pressured Supported (PC). In general, the interventional goal is to maximize “assurance” of
      needed ventilation but eventually to minimize Ventilator “Work of Breathing” while maintaing patient stability.

MT        BT :     typ vol-assured and Vent-initiated and –terminated (@ dT) but may be Pat-On/Offset facilitated.

I
                    Vent                                         Vent                                   Vent
                     Br                                           Br                                     Br




Ii      BT :     typ. alternating vol-assured and/or press-support (may be multi-phasic); typ. Sync’d if coincidental


                    Vent                           Vent
                                                    Pat                                                 Vent
                                                                                                                Vent
                                                                                                                 Pat
                     Br                             Br
                                                    Br                                                   Br      Br
                                                                                                                 Br
                                                                        CPAP



iii     BT :     typ. Press. Supported with CPAP; relatively long up to inverse I:E ratio (“Press Rls”) variations.


                                                          Vent
                                                           Pat                  Vent
                                                                                 Pat                            Vent
                                                                                                                 Pat
                                                           Br
                                                           Br                    Br
                                                                                 Br                              Br
                                                                                                                 Br
                                                                        CPAP



                                            JWG-VentilatorHarmonization- DB tools                                                   31
             Ventilator – Domain Model – Dynamic basic concepts
 Base concepts are focal points, or Areas of Interest (AoI) in function-phase space for variables related to
 SCADA, CDS, EMR, and other application scopes. Notation faciliates specification of “Set” Breath (Expected
 Value) Patterns, as well as recognition of resultant Breath Patterns through Observations. A major
 simplification is treating “inflation” as a transform in which either P or Q (Flow) are constant over Insp.

                                                                                                                    APNEA CRITERIA
Breath Control Frame
sequence for an “SIMV                                                                                               ∑ BR Annot’ns 
”-like Ventilation                                Ven                                          Ven Ven              MultiBeat
                            A
pattern.                                          tN
                                                   Br                                          t Br t N
                                                                                                      Br
                                                                                                                    Patterns, e.g.
                                                                   CPAP                                             Dyspnea




                                                              C
                                                              T
                                                              A
                                                                                                                    BREATH RATE
             MT_BT                                                                                                  TOTALS and
                                                             INVERSE I:ER
                                                                                                                L   related
             ii                                 dT : { I, E, I+E, I:E }                                             STATISTICS
                                                                                                                e
                                                                          ↑AssurLevel,
                                                                          WoBv                                  a   Various
             Eff                                                                                                k   Intervals can be
             Aff                                                                                                    defined and
                                Mandated                                        AssurLevel,                    c   measured for
                                 Int(Art)                                      ↑ WoBp                          o   pattern
            MINUTE VOLUME                                                                                           measurements.
                                preempts                                         Synch’z’n                      m
                                 Ext(Nat)                                                                       p
                                                                  PHASE         SYNCHRONY           STATS
                                                                                                                e
            TIDAL VOLUME                                                                                        n
                                                                 Directed dT between partial Flow zero          s
                                    B                  B                                                    B
            AIRWAY FLOW
                                                                 crossings constitutes a Breath . There         ’
                                                                 are Int and Ext inducements.                   n
                                                 “APRV”
            AIRWAY PRESS



            ATC                                  NAVA(CRG)
            BAROM PRESS                 JWG-VentilatorHarmonization- DB tools                                                      32
            CALIBRN
                           Ventilator – Domain Model – Ontological perspective
           Applied MDIB object and related naming patterns follow function-phase dynamic relational model.
           Annotations are being defined as key features that characterize definition of “set” Mode and Breath
           Types, as well as related Observations used to support clinicology, esp. diagnostic and therapeutic
           management using Ventilators and related modalities.




1   Based on Microsoft Access 2007; available from author through and for use in Vent Nomenclature JWG

                                                          JWG-VentilatorHarmonization- DB tools                  33
                         Ventilator – Activity Model – Clinicological perspective
           Ventilation and related nformation are closely tied to related clinical modalities, such as
           oxygenation, in a networked pattern of clinical modalities and collaborative and shared information
           processing and artifacts, such as event report and medical record components of which they
           facilitate detailed definition.


            “Reasoning” logic
          follows physiological
         relationships between
           optimization loops




                                                                                                            Operational realization of VPT
                                                                                                           focusing on “Maintaing Relative
                                                                                                             Stability” using optimjization
                                                                                                            dynamics as a reference/guide.


                                                                                                         Ventilation optimization involves
                                                                                                             tuning settings using key
                                                                                                          ventilatory control variables as
                                                                                                         well as adapting to oxygenation
                                                                                                                     dynamics
1   Based on Microsoft Access 2007; available from author through and for use in Vent Nomenclature JWG

                                                          JWG-VentilatorHarmonization- DB tools                                         34

				
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