The Respiratory System class handles the analysis and storage of data related the respiratory physiology and pathology. More...

#include <Respiratory.h>

Inheritance diagram for biogears::Respiratory:

[legend]

Public Member Functions
virtual	~Respiratory () override

const char *	classname () const override

size_t	hash_code () const override

void	Clear () override

void	Initialize () override
	Initializes system properties to valid homeostatic values. More...

virtual bool	Load (const CDM::BioGearsRespiratorySystemData &in)

virtual CDM::BioGearsRespiratorySystemData *	Unload () const override

void	AtSteadyState () override
	Respiratory system at steady state. More...

void	PreProcess () override
	Respiratory system preprocess function. More...

void	Process () override
	Respiratory system process function. More...

void	PostProcess () override
	Respiratory system postprocess function. More...

bool	CalculatePulmonaryFunctionTest (SEPulmonaryFunctionTest &pft)
	Populate the Pulmonary Function Test Assessment. More...

SEScalar &	CalculateRespirationSOFA ()

Public Member Functions inherited from biogears::SERespiratorySystem
	SERespiratorySystem (Logger *logger)

	~SERespiratorySystem () override

const SEScalar *	GetScalar (const char *name) override

const SEScalar *	GetScalar (const std::string &name) override

bool	Load (const CDM::RespiratorySystemData &in)

Tree< const char * >	GetPhysiologyRequestGraph () const override

bool	HasAlveolarArterialGradient () const

SEScalarPressure &	GetAlveolarArterialGradient ()

double	GetAlveolarArterialGradient (const PressureUnit &unit) const

bool	HasCarricoIndex () const

SEScalarPressure &	GetCarricoIndex ()

double	GetCarricoIndex (const PressureUnit &unit) const

bool	HasEndTidalCarbonDioxideFraction () const

SEScalarFraction &	GetEndTidalCarbonDioxideFraction ()

double	GetEndTidalCarbonDioxideFraction () const

bool	HasEndTidalCarbonDioxidePressure () const

SEScalarPressure &	GetEndTidalCarbonDioxidePressure ()

double	GetEndTidalCarbonDioxidePressure (const PressureUnit &unit) const

bool	HasExpiratoryFlow () const

SEScalarVolumePerTime &	GetExpiratoryFlow ()

double	GetExpiratoryFlow (const VolumePerTimeUnit &unit) const

bool	HasInspiratoryExpiratoryRatio () const

SEScalar &	GetInspiratoryExpiratoryRatio ()

double	GetInspiratoryExpiratoryRatio () const

bool	HasInspiratoryFlow () const

SEScalarVolumePerTime &	GetInspiratoryFlow ()

double	GetInspiratoryFlow (const VolumePerTimeUnit &unit) const

bool	HasMeanPleuralPressure () const

SEScalarPressure &	GetMeanPleuralPressure ()

double	GetMeanPleuralPressure (const PressureUnit &unit) const

bool	HasPulmonaryCompliance () const

SEScalarFlowCompliance &	GetPulmonaryCompliance ()

double	GetPulmonaryCompliance (const FlowComplianceUnit &unit) const

bool	HasPulmonaryResistance () const

SEScalarFlowResistance &	GetPulmonaryResistance ()

double	GetPulmonaryResistance (const FlowResistanceUnit &unit) const

bool	HasRespirationDriverFrequency () const

SEScalarFrequency &	GetRespirationDriverFrequency ()

double	GetRespirationDriverFrequency (const FrequencyUnit &unit) const

bool	HasRespirationDriverPressure () const

SEScalarPressure &	GetRespirationDriverPressure ()

double	GetRespirationDriverPressure (const PressureUnit &unit) const

bool	HasRespirationMusclePressure () const

SEScalarPressure &	GetRespirationMusclePressure ()

double	GetRespirationMusclePressure (const PressureUnit &unit) const

bool	HasRespirationRate () const

SEScalarFrequency &	GetRespirationRate ()

double	GetRespirationRate (const FrequencyUnit &unit) const

bool	HasSpecificVentilation () const

SEScalar &	GetSpecificVentilation ()

double	GetSpecificVentilation () const

bool	HasTargetPulmonaryVentilation () const

SEScalarVolumePerTime &	GetTargetPulmonaryVentilation ()

double	GetTargetPulmonaryVentilation (const VolumePerTimeUnit &unit) const

bool	HasTidalVolume () const

SEScalarVolume &	GetTidalVolume ()

double	GetTidalVolume (const VolumeUnit &unit) const

bool	HasTotalAlveolarVentilation () const

SEScalarVolumePerTime &	GetTotalAlveolarVentilation ()

double	GetTotalAlveolarVentilation (const VolumePerTimeUnit &unit) const

bool	HasTotalDeadSpaceVentilation () const

SEScalarVolumePerTime &	GetTotalDeadSpaceVentilation ()

double	GetTotalDeadSpaceVentilation (const VolumePerTimeUnit &unit) const

bool	HasTotalPulmonaryVentilation () const

SEScalarVolumePerTime &	GetTotalPulmonaryVentilation ()

double	GetTotalPulmonaryVentilation (const VolumePerTimeUnit &unit) const

bool	HasTotalLungVolume () const

SEScalarVolume &	GetTotalLungVolume ()

double	GetTotalLungVolume (const VolumeUnit &unit) const

bool	HasTranspulmonaryPressure () const

SEScalarPressure &	GetTranspulmonaryPressure ()

double	GetTranspulmonaryPressure (const PressureUnit &unit) const

Public Member Functions inherited from biogears::SESystem
	SESystem (Logger *logger)

virtual	~SESystem ()

bool	Load (const CDM::SystemData &in)

Public Member Functions inherited from biogears::Loggable
	Loggable ()

	Loggable (Logger *log)

virtual	~Loggable ()

virtual Logger *	GetLogger () const

Static Public Member Functions
static size_t	TypeHash ()

static constexpr char const *const	TypeTag ()

Static Public Member Functions inherited from biogears::SERespiratorySystem
static size_t	TypeHash ()

static constexpr char const *const	TypeTag ()

Static Public Member Functions inherited from biogears::SESystem
static const SEScalar *	GetScalar (const char name, std::vector< SESystem > *systems)

static const SEScalar *	GetScalar (const std::string &name, std::vector< SESystem * > *systems)

Protected Member Functions
	Respiratory (BioGears &bg)

virtual void	Unload (CDM::BioGearsRespiratorySystemData &data) const

void	SetUp () override
	Initializes parameters for Respiratory Class. More...

void	ProcessOverride ()
	determine override requirements from user defined inputs More...

void	OverrideControlLoop ()

Protected Member Functions inherited from biogears::SERespiratorySystem
void	Unload (CDM::RespiratorySystemData &data) const

Protected Member Functions inherited from biogears::SESystem
void	Unload (CDM::SystemData &data) const

Protected Member Functions inherited from biogears::Loggable
virtual void	Debug (const char msg, const char origin="") const

virtual void	Debug (const std::string &msg, const std::string &origin=empty) const

virtual void	Debug (std::ostream &msg, const std::string &origin=empty) const

virtual void	Info (const char msg, const char origin="") const

virtual void	Info (const std::string &msg, const std::string &origin=empty) const

virtual void	Info (std::ostream &msg, const std::string &origin=empty) const

virtual void	Warning (const char msg, const char origin="") const

virtual void	Warning (const std::string &msg, const std::string &origin=empty) const

virtual void	Warning (std::ostream &msg, const std::string &origin=empty) const

virtual void	Error (const char msg, const char origin="") const

virtual void	Error (const std::string msg, const std::string origin=empty) const

virtual void	Error (std::ostream &msg, const std::string &origin=empty) const

virtual void	Fatal (const char msg, const char origin="") const

virtual void	Fatal (const std::string &msg, const std::string &origin=empty) const

virtual void	Fatal (std::ostream &msg, const std::string &origin=empty) const

Protected Member Functions inherited from biogears::BioGearsSystem
virtual void	LoadState ()

Static Protected Member Functions
static auto	make_unique (BioGears &bg) -> std::unique_ptr< Respiratory >

Protected Attributes
BioGears &	m_data

Protected Attributes inherited from biogears::SERespiratorySystem
SEScalarPressure *	m_AlveolarArterialGradient

SEScalarPressure *	m_CarricoIndex

SEScalarFraction *	m_EndTidalCarbonDioxideFraction

SEScalarPressure *	m_EndTidalCarbonDioxidePressure

SEScalarVolumePerTime *	m_ExpiratoryFlow

SEScalar *	m_InspiratoryExpiratoryRatio

SEScalarVolumePerTime *	m_InspiratoryFlow

SEScalarPressure *	m_MeanPleuralPressure

SEScalarFlowCompliance *	m_PulmonaryCompliance

SEScalarFlowResistance *	m_PulmonaryResistance

SEScalarFrequency *	m_RespirationDriverFrequency

SEScalarPressure *	m_RespirationDriverPressure

SEScalarPressure *	m_RespirationMusclePressure

SEScalarFrequency *	m_RespirationRate

SEScalar *	m_SpecificVentilation

SEScalarVolumePerTime *	m_TargetPulmonaryVentilation

SEScalarVolume *	m_TidalVolume

SEScalarVolumePerTime *	m_TotalAlveolarVentilation

SEScalarVolumePerTime *	m_TotalDeadSpaceVentilation

SEScalarVolume *	m_TotalLungVolume

SEScalarVolumePerTime *	m_TotalPulmonaryVentilation

SEScalarPressure *	m_TranspulmonaryPressure

Protected Attributes inherited from biogears::SESystem
std::stringstream	m_ss

Protected Attributes inherited from biogears::Loggable
Logger *	m_Logger

Private Member Functions
void	TuneCircuit ()
	Run the circuit standalone for a little to get it into a good starting state. More...

void	COPD ()
	Chronic Obstructive Pulmonary Disease (COPD) More...

void	ImpairedAlveolarExchange ()
	Impaired Alveolar Exchange. More...

void	LobarPneumonia ()
	Lobar Pneumonia. More...

void	UpdatePleuralCompliance ()
	Chest wall compliance modifier. More...

void	AcuteRespiratoryDistress ()

void	AirwayObstruction ()
	Airway obstruction. More...

void	BronchoConstriction ()
	Bronchoconstriction. More...

void	BronchoDilation ()
	Bronchodilation PD effects. More...

void	Intubation ()
	Esophageal Intubation. More...

void	Pneumothorax ()
	Tension pneumothorax. More...

void	ConsciousRespiration ()
	Conscious respiration. More...

void	ProcessConsciousRespiration (SEConsciousRespirationCommand &cmd)
	Process conscious respiration. More...

void	MechanicalVentilation ()
	Modifies the pressure and/or flow at the mouth. More...

void	Apnea ()
	Apply apnea action. More...

void	RespiratoryDriver ()
	Respiratory driver pressure source. More...

void	ProcessDriverActions ()
	Process actions that affect respiratory driver. More...

void	UpdateObstructiveResistance ()
	Update obstructive (airway) resistance. More...

void	UpdateIERatio ()
	Update the inspiratory-expiratory ratio. More...

void	UpdateAlveoliCompliance (double dCompilanceScalingFactor, double dLeftLungFraction, double dRightLungFraction)
	Update Alveoli Compliance. More...

void	UpdateGasDiffusionSurfaceArea (double dFractionalArea, double dLeftLungFraction, double dRightLungFraction)
	Update Gas Diffusion Surface Area. More...

void	UpdatePulmonaryCapillaryResistance (double dResistanceScalingFactor, double dLeftLungFraction, double dRightLungFraction)
	Update Pulmonary Capillary Resistance. More...

void	DoLeftNeedleDecompression (double dFlowResistance)
	Left Side Needle Decompression. More...

void	DoRightNeedleDecompression (double dFlowResistance)
	Right Side Needle Decompression. More...

void	ProcessAerosolSubstances ()
	Compute deposited mass, update localized PD effects. More...

void	CalculateVitalSigns ()
	Calculates key respiratory physiological parameters. More...

Private Attributes
std::string	m_TuningFile

double	m_InitialExpiratoryReserveVolume_L

double	m_InitialFunctionalResidualCapacity_L

double	m_InitialInspiratoryCapacity_L

double	m_InitialResidualVolume_L

double	m_OverrideRRBaseline_Per_min

bool	m_bNotBreathing

double	m_TopBreathTotalVolume_L

double	m_TopBreathAlveoliVolume_L

double	m_TopBreathDeadSpaceVolume_L

double	m_TopBreathPleuralPressure_cmH2O

double	m_LastCardiacCycleBloodPH

double	m_PreviousTotalLungVolume_L

RunningAverage	m_BloodPHRunningAverage

bool	m_BreathingCycle

double	m_ArterialO2PartialPressure_mmHg

double	m_ArterialCO2PartialPressure_mmHg

RunningAverage	m_ArterialO2Average_mmHg

RunningAverage	m_ArterialCO2Average_mmHg

double	m_BreathingCycleTime_s

double	m_BreathTimeExhale_min

double	m_DefaultDrivePressure_cmH2O

double	m_DriverPressure_cmH2O

double	m_DriverPressureMin_cmH2O

double	m_ElapsedBreathingCycleTime_min

double	m_IEscaleFactor

double	m_InstantaneousFunctionalResidualCapacity_L

double	m_MaxDriverPressure_cmH2O

double	m_PeakRespiratoryDrivePressure_cmH2O

double	m_VentilationFrequency_Per_min

double	m_VentilationToTidalVolumeSlope

bool	m_ConsciousBreathing

double	m_ConsciousRespirationPeriod_s

double	m_ConsciousRespirationRemainingPeriod_s

double	m_ExpiratoryReserveVolumeFraction

double	m_InspiratoryCapacityFraction

double	m_ConsciousStartPressure_cmH2O

double	m_ConsciousEndPressure_cmH2O

bool	m_HadAirwayObstruction

bool	m_HadBronchoconstriction

double	m_dt_s

double	m_dt_min

bool	m_hadApnea

double	m_dDefaultOpenResistance_cmH2O_s_Per_L

double	m_dDefaultClosedResistance_cmH2O_s_Per_L

double	m_PleuralComplianceSensitivity_Per_L

double	m_dRespOpenResistance_cmH2O_s_Per_L

double	m_dRespClosedResistance_cmH2O_s_Per_L

double	m_VentilatoryOcclusionPressure_cmH2O

double	m_AverageLocalTissueBronchodilationEffects

double	m_arterialPHBaseline

SEPatient *	m_Patient

SEPatientActionCollection *	m_PatientActions

SEGasCompartment *	m_Environment

SELiquidCompartment *	m_AerosolMouth

SELiquidCompartment *	m_AerosolTrachea

SELiquidCompartment *	m_AerosolLeftBronchi

SELiquidCompartment *	m_AerosolLeftAlveoli

SELiquidCompartment *	m_AerosolRightBronchi

SELiquidCompartment *	m_AerosolRightAlveoli

SELiquidCompartment *	m_LeftLungExtravascular

SELiquidCompartment *	m_RightLungExtravascular

SEGasCompartment *	m_Lungs

SEGasCompartment *	m_Trachea

SEGasSubstanceQuantity *	m_TracheaO2

SEGasSubstanceQuantity *	m_TracheaCO2

SELiquidSubstanceQuantity *	m_AortaO2

SELiquidSubstanceQuantity *	m_AortaCO2

SEGasSubstanceQuantity *	m_LeftAlveoliO2

SEGasSubstanceQuantity *	m_RightAlveoliO2

SEGasSubstanceQuantity *	m_LeftAlveoliCO2

SEGasSubstanceQuantity *	m_RightAlveoliCO2

std::vector< SELiquidCompartment * >	m_AerosolEffects

SEGasCompartment *	m_MechanicalVentilatorConnection

SEFluidCircuit *	m_RespiratoryCircuit

SEFluidCircuitNode *	m_LeftAlveoli

SEFluidCircuitNode *	m_LeftBronchi

SEFluidCircuitNode *	m_LeftPleuralCavity

SEFluidCircuitNode *	m_RespiratoryMuscle

SEFluidCircuitNode *	m_RightAlveoli

SEFluidCircuitNode *	m_RightBronchi

SEFluidCircuitNode *	m_RightPleuralCavity

SEFluidCircuitNode *	m_Ambient

SEFluidCircuitNode *	m_Stomach

SEFluidCircuitPath *	m_TracheaToLeftBronchi

SEFluidCircuitPath *	m_TracheaToRightBronchi

SEFluidCircuitPath *	m_LeftBronchiToLeftAlveoli

SEFluidCircuitPath *	m_RightBronchiToRightAlveoli

SEFluidCircuitPath *	m_RightPleuralCavityToRespiratoryMuscle

SEFluidCircuitPath *	m_LeftPleuralCavityToRespiratoryMuscle

SEFluidCircuitPath *	m_DriverPressurePath

SEFluidCircuitPath *	m_LeftDriverPressurePath

SEFluidCircuitPath *	m_MouthToTrachea

SEFluidCircuitPath *	m_MouthToStomach

SEFluidCircuitPath *	m_EnvironmentToLeftChestLeak

SEFluidCircuitPath *	m_EnvironmentToRightChestLeak

SEFluidCircuitPath *	m_LeftAlveoliLeakToLeftPleuralCavity

SEFluidCircuitPath *	m_RightAlveoliLeakToRightPleuralCavity

SEFluidCircuitPath *	m_LeftPleuralCavityToEnvironment

SEFluidCircuitPath *	m_RightPleuralCavityToEnvironment

SEFluidCircuitPath *	m_RightAlveoliToRightPleuralConnection

SEFluidCircuitPath *	m_LeftAlveoliToLeftPleuralConnection

SEFluidCircuitPath *	m_RightBronchiToRightPleuralConnection

SEFluidCircuitPath *	m_LeftBronchiToLeftPleuralConnection

SEFluidCircuitPath *	m_RightPulmonaryCapillary

SEFluidCircuitPath *	m_LeftPulmonaryCapillary

SEFluidCircuitPath *	m_ConnectionToMouth

SEFluidCircuitPath *	m_GroundToConnection

SEFluidCircuitCalculator	m_Calculator

SEGasTransporter	m_GasTransporter

SELiquidTransporter	m_AerosolTransporter

Friends
class	BioGears

class	BioGearsEngineTest

Additional Inherited Members
Static Public Attributes inherited from biogears::Loggable
static const std::string	empty

static const char *	empty_cStr

Detailed Description

The Respiratory System class handles the analysis and storage of data related the respiratory physiology and pathology.

The goal of the Respiratory System class is to handle the analysis and storage of data representing the ventilation and gas exchange of the human respiratory system. The class handles the analysis of changes in the lungs volume and pressure data during the flow and transfer of gases between the lungs, the blood and the outside environment. The class updates the volume and volume fractions of gases in the lungs, and ensures the integration and flow of data between the respiratory system and the anesthesia machine during mechanical ventilation.

Constructor & Destructor Documentation

biogears::Respiratory::Respiratory ( BioGears & bg )

protected

biogears::Respiratory::~Respiratory ( )

overridevirtual

Member Function Documentation

void biogears::Respiratory::AcuteRespiratoryDistress ( )

private

void biogears::Respiratory::AirwayObstruction ( )

private

Airway obstruction.

Various factors can trigger upper airway obstruction. The Biogears engine handles airway obstruction that arise from the partial or complete obstruction of the upper airways by foreign objects. The model accounts for such obstruction by setting the flow resistance of the trachea compartment in proportion to the severity of the obstruction. The function updates the tracheal flow resistance by modifying the resistance across the airway to Trachea node path.

void biogears::Respiratory::Apnea ( )

private

Apply apnea action.

Parameters

None

Returns: void

This reduces the respiratory driver pressure source amplitude by the percentage defined by the action severity.

void biogears::Respiratory::AtSteadyState ( )

overridevirtual

Respiratory system at steady state.

Initializes respiratory conditions if any are present.

COPD
Lobar Pneumonia
ImpairedAlveolarExchange

Reimplemented from biogears::BioGearsSystem.

void biogears::Respiratory::BronchoConstriction ( )

private

Bronchoconstriction.

Bronchoconstriction involves the tightening of smooth muscles surrounding bronchi. The effect of such airway constriction is the reduction of air flow or increase of flow resistance of the lower airways. The Biogears model handles bronchoconstriction by increasing the flow resistances of the bronchi compartments. The function updates the bronchial resistances in proportion to the severity of the bronchoconstriction.

void biogears::Respiratory::BronchoDilation ( )

private

Bronchodilation PD effects.

This reduces the bronchi resitances based on drug PD effects (i.e., plasma concentrations).

bool biogears::Respiratory::CalculatePulmonaryFunctionTest ( SEPulmonaryFunctionTest & pft )

Populate the Pulmonary Function Test Assessment.

Parameters

pft pft data

Returns: success true, if everything worked out

Todo:: Insert more PFT calculations here

SEScalar & biogears::Respiratory::CalculateRespirationSOFA ( )

void biogears::Respiratory::CalculateVitalSigns ( )

private

Calculates key respiratory physiological parameters.

Calculates the respiration rate and tidal volume. For each breathing cycle, the tidal volume is calculated by identifying the peaks in the total lung volume. The tidal volume of a particular breathing cycle is then calculated by taking the difference between the maximum and minimum values of the total lung volume. The respiration rate is calculated by measuring the duration for one complete breathing cycle and then converting the duration to the number of breaths per minute.

Event:: Patient: Start of exhale/inhale

Event:: Patient: Severe ARDS: Carrico Index is below 100 mmHg

[273]

Event:: Patient: Acute Respiratory Distress: Carrico Index is below 200 mmHg

[273]

Event:: Patient: Acute Lung Injury: Carrico Index is below 300 mmHg

[273]

Event:: Patient: End ARDS: Carrico Index is above 305 mmHg

Todo:: Move to blood chemistry

Event:: Patient: Bradypnea: Respiration rate is below 10 breaths per minute The patient has bradypnea.

[252]

Event:: Patient: End Bradypnea Event. The respiration rate has risen above 10. The patient is no longer considered to have bradypnea.

Event:: Patient: Tachypnea: Respiration rate is above 20 breaths per minute. The patient has tachypnea.

Event:: Patient: End Tachypnea Event. The respiration rate has fallen below 19.5. The patient is no longer considered to have tachypnea.

Event:: Patient: Respiratory Acidosis: event is triggered when blood pH is below 7.36 The patient has respiratory acidosis.

Event:: Patient: arterial blood ph has dropped below 6.5.

Irreversible:: Extreme respiratory Acidosis: blood pH below 6.5.

Event:: Patient: End Respiratory Acidosis Event. The pH value has risen above 7.38. The patient is no longer considered to have respiratory acidosis.

Event:: Patient: Respiratory Alkalosis: event is triggered when blood pH is above 7.45 The patient has respiratory alkalosis.

Event:: Patient: arterial blood ph has gotten above 8.5.

Irreversible:: Extreme respiratory Alkalosis: blood pH above 8.5.

Event:: Patient: End Respiratory Alkalosis Event. The pH value has has fallen below 7.45. The patient is no longer considered to have respiratory alkalosis.

const char* biogears::Respiratory::classname ( ) const

inlineoverridevirtual

Reimplemented from biogears::SERespiratorySystem.

void biogears::Respiratory::Clear ( )

overridevirtual

Reimplemented from biogears::SERespiratorySystem.

void biogears::Respiratory::ConsciousRespiration ( )

private

Conscious respiration.

Parameters

None

Returns: void

This method determines when to process a conscious respiration command and removes the command from the stack.

void biogears::Respiratory::COPD ( )

private

Chronic Obstructive Pulmonary Disease (COPD)

Parameters

None

Returns: void

This method handles the COPD condition. It determines if the patient has COPD, and if so, calculates a set of multipliers to model the various symptoms. This method should only run once per simulation. Note that the bronchitis symptom (airway obstruction) is handled by another method that is called every time-step in pre-process.

void biogears::Respiratory::DoLeftNeedleDecompression ( double dFlowResistance )

private

Left Side Needle Decompression.

Parameters

dFlowResistance - Resistance value for air flow through the needle

Used for left side needle decompression. this is an intervention (action) used to treat left side tension pneumothorax

void biogears::Respiratory::DoRightNeedleDecompression ( double dFlowResistance )

private

Right Side Needle Decompression.

Parameters

dFlowResistance - Resistance value for air flow through the needle

Used for right side needle decompression. this is an intervention (action) used to treat right side tension pneumothorax

size_t biogears::Respiratory::hash_code ( ) const

inlineoverridevirtual

Reimplemented from biogears::SERespiratorySystem.

void biogears::Respiratory::ImpairedAlveolarExchange ( )

private

Impaired Alveolar Exchange.

Parameters

None

Returns: void

This method handles the Impaired Alveolar Exchange condition.

Error:: Fatal: The Impaired Alveolar Exchange action must include either a surface area of fraction.

Error:: Error: The Impaired Alveolar Exchange action cannot have both an impaired surface area and impaired fraction defined. Defaulting to the surface area value.

void biogears::Respiratory::Initialize ( )

overridevirtual

Initializes system properties to valid homeostatic values.

Reimplemented from biogears::BioGearsSystem.

void biogears::Respiratory::Intubation ( )

private

Esophageal Intubation.

During mechanical ventilation, one of the clinical complications of endotracheal intubation is esophageal intubation. This involves the misplacement of the tube down the esophagus. Such event prohibits air flow into or out of the lungs. The Biogers circuit handles this respiratory distress by manipulating the tracheal resistance. When esophageal intubation incidence is triggered, significantly large resistance is assigned to the trachea compartment. Otherwise, the esophageal compartment resistance is set to be significantly large value under normal condition.

Todo:: Make this a modifier (i.e. multiplier), instead of setting it directly

bool biogears::Respiratory::Load ( const CDM::BioGearsRespiratorySystemData & in )

virtual

void biogears::Respiratory::LobarPneumonia ( )

private

Lobar Pneumonia.

Parameters

None

Returns: void

This method handles the lobar pneumonia condition. It determines if the patient has lobar pneumonia and calculates a set of multipliers to model the various symptoms. This method should only run once per simulation.

auto biogears::Respiratory::make_unique ( BioGears & bg ) -> std::unique_ptr<Respiratory>

staticprotected

void biogears::Respiratory::MechanicalVentilation ( )

private

Modifies the pressure and/or flow at the mouth.

Handles the mechanical ventilation action that adds a flow and pressure source to instantaneously set the respiratory connection (mouth) to user specified values.

void biogears::Respiratory::OverrideControlLoop ( )

protected

void biogears::Respiratory::Pneumothorax ( )

private

Tension pneumothorax.

Pneumothorax is an abnormal accumulation of air in the pleural cavity. Tension pneumothorax occurs when air escapes into the pleural space on inspiration, but cannot return on expiration. Different types of pneumothorces are known. The Biogears engine models open (sucking chest wound) and closed (intact thoracic cage) pnumothoraces whereas occlusive dressing and needle decompression are modeled as interventions. The function models pneumothorax and needle decompression by opening respiratory circuits that allow air flows into and out of the pleural cavity. Under normal condition, the path between the lung node or the outside environment and the intrapleural cavity is blocked via significantly high resistances that serve as open switches. When open or closed pneumothorax is triggered, these resistances are reduced in proportion to the severity of the pneumothorax. This reduction permits air flow into the pleural cavity a and cause respiratory and cardiovascular distress. The function allows the selection of tension pneumothorax and/or needle decompression events on the left or right lung side. The effects on the cardiovascular system parameters is accounted through modifiers that scale in proportion to the accumulated gas.

Error:: Patient: Cannot perform an intervention if Tension Pneumothorax is not present on that side.

Error:: Patient: Cannot perform an intervention if Tension Pneumothorax is not present on that side.

Error:: Patient: can't process needle decompression if no pneumothorax is present

Error:: Patient: can't process a chest occlusive dressing if no pneumothorax is present

void biogears::Respiratory::PostProcess ( )

overridevirtual

Respiratory system postprocess function.

Updates the current values of the gas volume fraction and gas volumes for the nodes in the respiratory circuit or the nodes in the combined (respiratory + anesthesia machine) circuit when the anesthesia machine is turned on.

Implements biogears::BioGearsSystem.

void biogears::Respiratory::PreProcess ( )

overridevirtual

Respiratory system preprocess function.

Calculates the muscle pressure source that drives the respiratory system. Updates airway resistance to account for changes arising from factors like drugs and respiratory insults and interventions. Updates the chest wall variable compliance. Handles all respiratory insults and actions.

Implements biogears::BioGearsSystem.

void biogears::Respiratory::Process ( )

overridevirtual

Respiratory system process function.

Ensures the selection of the respiratory system with or without the anesthesia machine. Handles the integration of the anesthesia machine to the respiratory system when the anesthesia machine is turned on. The integration of the anesthesia machine to the respiratory system is handled at run time by constructing a combined circuit of the respiratory and anesthesia machine. Handles lung volume changes during alveolar gas transfer. Calculates physiological parameters such as respiration rate, tidal volume and others that belonging to the respiratory system.

Implements biogears::BioGearsSystem.

void biogears::Respiratory::ProcessAerosolSubstances ( )

private

Compute deposited mass, update localized PD effects.

For each aerosol get the SIDE coefficient to determine deposited mass in each respiratory compartment. Adjust the resistances between compartments as a function of deposited mass to reach validated data. Liquid and solid aerosols are handled here.

void biogears::Respiratory::ProcessConsciousRespiration ( SEConsciousRespirationCommand & cmd )

private

Process conscious respiration.

Parameters

cmd	- Conscious respiration command

Processes conscious respiration commands.

void biogears::Respiratory::ProcessDriverActions ( )

private

Process actions that affect respiratory driver.

The tidal volume calculated from the target ventilation returned by the Chemoreceptor feedback can attenuated by many factors. Currently, we have a cardiac arrest effect, drug effects in the form of neuromuscular blockers and sedatives, sepsis effects, and pain effects. Process these actions here instead of in the RespiratoryDriver to clean up the code and have a dedicated place for future actions that change driver output.

void biogears::Respiratory::ProcessOverride ( )

protected

determine override requirements from user defined inputs

User specified override outputs that are specific to the cardiovascular system are implemented here. If overrides aren't present for this system then this function will not be called during preprocess.

void biogears::Respiratory::RespiratoryDriver ( )

private

Respiratory driver pressure source.

Calculates the muscle pressure source pressure by using the chemical stimuli as feedback control mechanism. The method reads the arterial O2 and CO2 partial pressures. Using these partial pressures, the method calculates the alveolar ventilation from which the method calculates the target breathing frequency. The target breathing frequency is used in the equation for muscle pressure source. The muscle pressure source is used as a driver for ventilation. This method also calculates the drug modifiers that adjusts the depth and frequency of respiration.

: Running averages were mostly used for chemoreceptors that have been moved to Nervous. ToDo: However, they are still used in some calculations in CalculateVitals. Should we move/consolidate these?

@cite Albanese2015Integrated--------------------------------------------------------------------------—

void biogears::Respiratory::SetUp ( )

overrideprotectedvirtual

Initializes parameters for Respiratory Class.

Initializes member variables and system level values on the common data model.

Todo:: figure out how to modify these resistances without getting the cv circuit - maybe add a parameter, like baroreceptors does

Implements biogears::BioGearsSystem.

void biogears::Respiratory::TuneCircuit ( )

private

Run the circuit standalone for a little to get it into a good starting state.

keep volume fractions constant

static size_t biogears::Respiratory::TypeHash ( )

inlinestatic

static constexpr char const* const biogears::Respiratory::TypeTag ( )

inlinestatic

CDM::BioGearsRespiratorySystemData * biogears::Respiratory::Unload ( ) const

overridevirtual

Reimplemented from biogears::SERespiratorySystem.

void biogears::Respiratory::Unload ( CDM::BioGearsRespiratorySystemData & data ) const

protectedvirtual

void biogears::Respiratory::UpdateAlveoliCompliance	(	double	dScalingFactor,
		double	dLeftLungFraction,
		double	dRightLungFraction
	)

private

Update Alveoli Compliance.

Parameters

dScalingFactor	Multiplier based on the severity of the condition (lobar pneumonia, COPD, etc)
dLeftLungFraction	Fraction of left lung affected by change in surface area (0 to 1)
dRightLungFraction	Fraction of right lung affected by change in surface area (0 to 1)

Returns: void

This method takes a scaling factor and lung percentages (left and right) as input variables The scaling factor and lung percentages are combined to produce a measure of deviation from compliance baseline. The Alveoli to Pleural compliances are updated to model alveolus membrane damage orchanges to alveolus fluid content

void biogears::Respiratory::UpdateGasDiffusionSurfaceArea	(	double	dFractionArea,
		double	dLeftLungFraction,
		double	dRightLungFraction
	)

private

Update Gas Diffusion Surface Area.

Parameters

dFractionArea	Fractional change in gas diffusion surface area (0 to 1)
dLeftLungFraction	Fraction of left lung affected by change in surface area (0 to 1)
dRightLungFraction	Fraction of right lung affected by change in surface area (0 to 1)

Returns: void

This method takes a percent valve and lung percentages (left and right) as input variables. It updates the gas diffusion surface area in the lungs in order to model the destruction of alveoli membranes and/or lung consolidation.

void biogears::Respiratory::UpdateIERatio ( )

private

Update the inspiratory-expiratory ratio.

Returns: void

The inspiratory-expiratory ratio is modified based on certain actions and conditions, as well as local bronchodilation effects from aerosols.

void biogears::Respiratory::UpdateObstructiveResistance ( )

private

Update obstructive (airway) resistance.

Returns: void

This method takes a resistance scaling factor and lung percentages (left and right) as input variables. It updates the Trachea to Dead Space path resistances in order to model airflow blockage through the bronchi and bronchioles.

void biogears::Respiratory::UpdatePleuralCompliance ( )

private

Chest wall compliance modifier.

Adjusts the chest wall compliance based on the pleural volume. The variable compliance allows some level of tolerance to mechanical stresses that may arise from events like airway obstruction. Currently, a linear relation with an upper bound has been used.

void biogears::Respiratory::UpdatePulmonaryCapillaryResistance	(	double	dResistanceScalingFactor,
		double	dLeftLungPercent,
		double	dRightLungPercent
	)

private

Update Pulmonary Capillary Resistance.

Parameters

dResistanceScalingFactor	Pulmonary capillary resistance multiplier
dLeftLungFraction	Fraction of left lung affected by change in surface area (0 to 1)
dRightLungFraction	Fraction of right lung affected by change in surface area (0 to 1)

Returns: void

This method takes a resistance scaling factor and lung fractions (left and right) as input variables. It updates the pulmonary capillary to pulmonary vein resistance in order to model the destruction of capillaries in the alveolus membrane.

Friends And Related Function Documentation

friend class BioGears

friend

friend class BioGearsEngineTest

friend

Member Data Documentation

std::vector<SELiquidCompartment*> biogears::Respiratory::m_AerosolEffects

private

SELiquidCompartment* biogears::Respiratory::m_AerosolLeftAlveoli

private

SELiquidCompartment* biogears::Respiratory::m_AerosolLeftBronchi

private

SELiquidCompartment* biogears::Respiratory::m_AerosolMouth

private

SELiquidCompartment* biogears::Respiratory::m_AerosolRightAlveoli

private

SELiquidCompartment* biogears::Respiratory::m_AerosolRightBronchi

private

SELiquidCompartment* biogears::Respiratory::m_AerosolTrachea

private

SELiquidTransporter biogears::Respiratory::m_AerosolTransporter

private

SEFluidCircuitNode* biogears::Respiratory::m_Ambient

private

SELiquidSubstanceQuantity* biogears::Respiratory::m_AortaCO2

private

SELiquidSubstanceQuantity* biogears::Respiratory::m_AortaO2

private

RunningAverage biogears::Respiratory::m_ArterialCO2Average_mmHg

private

double biogears::Respiratory::m_ArterialCO2PartialPressure_mmHg

private

RunningAverage biogears::Respiratory::m_ArterialO2Average_mmHg

private

double biogears::Respiratory::m_ArterialO2PartialPressure_mmHg

private

double biogears::Respiratory::m_arterialPHBaseline

private

double biogears::Respiratory::m_AverageLocalTissueBronchodilationEffects

private

RunningAverage biogears::Respiratory::m_BloodPHRunningAverage

private

bool biogears::Respiratory::m_bNotBreathing

private

bool biogears::Respiratory::m_BreathingCycle

private

double biogears::Respiratory::m_BreathingCycleTime_s

private

double biogears::Respiratory::m_BreathTimeExhale_min

private

SEFluidCircuitCalculator biogears::Respiratory::m_Calculator

private

SEFluidCircuitPath* biogears::Respiratory::m_ConnectionToMouth

private

bool biogears::Respiratory::m_ConsciousBreathing

private

double biogears::Respiratory::m_ConsciousEndPressure_cmH2O

private

double biogears::Respiratory::m_ConsciousRespirationPeriod_s

private

double biogears::Respiratory::m_ConsciousRespirationRemainingPeriod_s

private

double biogears::Respiratory::m_ConsciousStartPressure_cmH2O

private

BioGears& biogears::Respiratory::m_data

protected

double biogears::Respiratory::m_dDefaultClosedResistance_cmH2O_s_Per_L

private

double biogears::Respiratory::m_dDefaultOpenResistance_cmH2O_s_Per_L

private

double biogears::Respiratory::m_DefaultDrivePressure_cmH2O

private

double biogears::Respiratory::m_dRespClosedResistance_cmH2O_s_Per_L

private

double biogears::Respiratory::m_dRespOpenResistance_cmH2O_s_Per_L

private

double biogears::Respiratory::m_DriverPressure_cmH2O

private

double biogears::Respiratory::m_DriverPressureMin_cmH2O

private

SEFluidCircuitPath* biogears::Respiratory::m_DriverPressurePath

private

double biogears::Respiratory::m_dt_min

private

double biogears::Respiratory::m_dt_s

private

double biogears::Respiratory::m_ElapsedBreathingCycleTime_min

private

SEGasCompartment* biogears::Respiratory::m_Environment

private

SEFluidCircuitPath* biogears::Respiratory::m_EnvironmentToLeftChestLeak

private

SEFluidCircuitPath* biogears::Respiratory::m_EnvironmentToRightChestLeak

private

double biogears::Respiratory::m_ExpiratoryReserveVolumeFraction

private

SEGasTransporter biogears::Respiratory::m_GasTransporter

private

SEFluidCircuitPath* biogears::Respiratory::m_GroundToConnection

private

bool biogears::Respiratory::m_HadAirwayObstruction

private

bool biogears::Respiratory::m_hadApnea

private

bool biogears::Respiratory::m_HadBronchoconstriction

private

double biogears::Respiratory::m_IEscaleFactor

private

double biogears::Respiratory::m_InitialExpiratoryReserveVolume_L

private

double biogears::Respiratory::m_InitialFunctionalResidualCapacity_L

private

double biogears::Respiratory::m_InitialInspiratoryCapacity_L

private

double biogears::Respiratory::m_InitialResidualVolume_L

private

double biogears::Respiratory::m_InspiratoryCapacityFraction

private

double biogears::Respiratory::m_InstantaneousFunctionalResidualCapacity_L

private

double biogears::Respiratory::m_LastCardiacCycleBloodPH

private

SEFluidCircuitNode* biogears::Respiratory::m_LeftAlveoli

private

SEGasSubstanceQuantity* biogears::Respiratory::m_LeftAlveoliCO2

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftAlveoliLeakToLeftPleuralCavity

private

SEGasSubstanceQuantity* biogears::Respiratory::m_LeftAlveoliO2

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftAlveoliToLeftPleuralConnection

private

SEFluidCircuitNode* biogears::Respiratory::m_LeftBronchi

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftBronchiToLeftAlveoli

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftBronchiToLeftPleuralConnection

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftDriverPressurePath

private

SELiquidCompartment* biogears::Respiratory::m_LeftLungExtravascular

private

SEFluidCircuitNode* biogears::Respiratory::m_LeftPleuralCavity

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftPleuralCavityToEnvironment

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftPleuralCavityToRespiratoryMuscle

private

SEFluidCircuitPath* biogears::Respiratory::m_LeftPulmonaryCapillary

private

SEGasCompartment* biogears::Respiratory::m_Lungs

private

double biogears::Respiratory::m_MaxDriverPressure_cmH2O

private

SEGasCompartment* biogears::Respiratory::m_MechanicalVentilatorConnection

private

SEFluidCircuitPath* biogears::Respiratory::m_MouthToStomach

private

SEFluidCircuitPath* biogears::Respiratory::m_MouthToTrachea

private

double biogears::Respiratory::m_OverrideRRBaseline_Per_min

private

SEPatient* biogears::Respiratory::m_Patient

private

SEPatientActionCollection* biogears::Respiratory::m_PatientActions

private

double biogears::Respiratory::m_PeakRespiratoryDrivePressure_cmH2O

private

double biogears::Respiratory::m_PleuralComplianceSensitivity_Per_L

private

double biogears::Respiratory::m_PreviousTotalLungVolume_L

private

SEFluidCircuit* biogears::Respiratory::m_RespiratoryCircuit

private

SEFluidCircuitNode* biogears::Respiratory::m_RespiratoryMuscle

private

SEFluidCircuitNode* biogears::Respiratory::m_RightAlveoli

private

SEGasSubstanceQuantity* biogears::Respiratory::m_RightAlveoliCO2

private

SEFluidCircuitPath* biogears::Respiratory::m_RightAlveoliLeakToRightPleuralCavity

private

SEGasSubstanceQuantity* biogears::Respiratory::m_RightAlveoliO2

private

SEFluidCircuitPath* biogears::Respiratory::m_RightAlveoliToRightPleuralConnection

private

SEFluidCircuitNode* biogears::Respiratory::m_RightBronchi

private

SEFluidCircuitPath* biogears::Respiratory::m_RightBronchiToRightAlveoli

private

SEFluidCircuitPath* biogears::Respiratory::m_RightBronchiToRightPleuralConnection

private

SELiquidCompartment* biogears::Respiratory::m_RightLungExtravascular

private

SEFluidCircuitNode* biogears::Respiratory::m_RightPleuralCavity

private

SEFluidCircuitPath* biogears::Respiratory::m_RightPleuralCavityToEnvironment

private

SEFluidCircuitPath* biogears::Respiratory::m_RightPleuralCavityToRespiratoryMuscle

private

SEFluidCircuitPath* biogears::Respiratory::m_RightPulmonaryCapillary

private

SEFluidCircuitNode* biogears::Respiratory::m_Stomach

private

double biogears::Respiratory::m_TopBreathAlveoliVolume_L

private

double biogears::Respiratory::m_TopBreathDeadSpaceVolume_L

private

double biogears::Respiratory::m_TopBreathPleuralPressure_cmH2O

private

double biogears::Respiratory::m_TopBreathTotalVolume_L

private

SEGasCompartment* biogears::Respiratory::m_Trachea

private

SEGasSubstanceQuantity* biogears::Respiratory::m_TracheaCO2

private

SEGasSubstanceQuantity* biogears::Respiratory::m_TracheaO2

private

SEFluidCircuitPath* biogears::Respiratory::m_TracheaToLeftBronchi

private

SEFluidCircuitPath* biogears::Respiratory::m_TracheaToRightBronchi

private

std::string biogears::Respiratory::m_TuningFile

private

double biogears::Respiratory::m_VentilationFrequency_Per_min

private

double biogears::Respiratory::m_VentilationToTidalVolumeSlope

private

double biogears::Respiratory::m_VentilatoryOcclusionPressure_cmH2O

private

Public Member Functions

Static Public Member Functions

Protected Member Functions

Static Protected Member Functions

Protected Attributes

Private Member Functions

Private Attributes

Friends

Additional Inherited Members

Detailed Description

Constructor & Destructor Documentation

Member Function Documentation

Friends And Related Function Documentation

Member Data Documentation