PCD RTM 2009-05-13 WebEx

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(Vent TG Main Page)

Meeting Purpose

IHE PCD Rosetta Terminology Mapping (RTM) Ventilator Task Group regular discussion meeting. See the Proposed Agenda below for specific topics.

WebEx Information

Topic: IHE PCD RTM Vent TG

Date: Wednesday, May 13, 2009

Time: 12:00 pm, Eastern Time (GMT -05:00, New York)

Duration: 120 Minutes


Note: Specific web & phone informaiton will be provided via e-mail to group members.

Contact Manny Furst for more information.

Proposed Agenda

1 Update from PCD F2F @ NIST (2009.05.04 - 08) (Cooper)
2 Update on Vent Term Team Direction (Schluter)
3 "Clinical Intent" Discussion
4 Breath Mode Discussion Review (Respironics/VIASYS team)
5 Siemens Waveform Document Review
6 Work Planning

Attachments / Materials

Documents loaded onto the PCD FTP site for this meeting.

Minutes

Participants

Chair/Host: Todd Cooper (Breakthrough Solutions Foundry)
Steven Dain (ISO TC121/SC4), Robert Flanders (GE), Fernando Isaza (Philips/Respironics), Ken Marks (GE), John Rhoads (Philips), Richard Roa (Philips/Respironics), Paul Schluter (GE), Jan Wittenber (Philips)

Discussion

Item Topic Discussion
1 Introductions & Agenda Review
- Chair 		Status/Discussion:

Decisions/Issues:

  • Agenda Reviewed and Approved

Action(s):

2 Discussion Summary Review
- Chair 		Status/Discussion:
  • No specific Vent Term group discussion summary was reviewed.

Decisions/Issues:

Action(s):

3 NIST F2F Update
- Todd 		Status/Discussion:

Decisions/Issues:

Action(s):

4 Vent Term Team Direction Review
- Schluter 		Status/Discussion:
  • Paul provided a brief synopsis of the Vent Term WG's "Levels of Description" that were agreed upon in a previous call as a primary means of breaking the problem into components that could be more easily addressed:
- Clinical Intent: What are the therapeutic objectives that a clinician has when configuring a ventilator in a particular operational mode?
- Machine Intent: What are the control settings that determine the ventilator's overall multi-breath operation?
- Breath-to-Breath (BTB) Control: What are the single breath control settings (may be multiple sets!)?
- Monitored Parameters & Waveforms: How is the ventilator actually operating?
  • This list should be addressed in reverse order (easiest to most difficult).
  • Development of a Ventilator Phamphlet focusing on waveform examples and the monitored parameters and control settings is the best approach for developing consensus behind the new proposed set of terms.

Decisions/Issues:

Action(s):

5 "Clinical Intent" Discussion
- Group 		Status/Discussion:
  • Per the first item on the above Levels of Description list, there was a general discussion regarding the relevance of establishing 'clinical intent, and its relevance to the discussion at hand.
  • A key question was: "How do you qualify what the physician is intending? Especially since waveforms from various configurations may end up looking the same!"
  • General Discussion:
- (Schluter) Intent can be expressed by a set of enumerations or desired end state. Ultimately this could be an order from an intelligent CDSS (or ICE Supervisor fuction).
- (Marks) Need to engage both CE/BMET experts with clinicians to come up with a useful list for clinical intent.
- (Schluter) Perhaps taking a clinical use case (workflow) approach for the analysis would be beneficial. In other words, associate a given "clinical intent" enumeration (or enumeration set) with a specific therapeutic workflow.
- (Roa) Since multiple you can have multiple intents active simultaneously, there should be support for an ordered list, including primary and secondary intents.
- (Dain) Should first define breaths & sequences, then define goals later. It could be that the clinician says, "I want to do <X>" and the vent determines the mode & breath types. In other words, clinically oriented control variables or "care plan", especially related to PCLC ventilators or CDSS support.
- (Dain) Sample list of clinical intents:
  • Optimize oxygenation
  • Minimize WOB
  • Optimize CO2 clearance
  • Optimize hemodynamics
  • ...
  • (Marks) Keep focus on expressed needs from ventilator customers: settings, measurements & waveforms (w/ annotations) -in this prioritized order!
  • (Wittenber) Perhaps we should develop a "report" along the lines of what the IDC Team has done that would capture the clinically oriented information, but it wouldn't come from the vent itself, though it would include the vent settings...

Decisions/Issues:

Action(s):

6 Vent Mode Discussions Review
- Fernando 		Status/Discussion:
  • Reviewed a breath mode document developed at a number of F2F discussions in San Diego between representatives of Philips/Respironics & Cardinal/VIASYS (primarily Francisco, Richard & Pete).
NOTE: This review was originally scheduled for the PCD F2F @ NIST the previous week but was deferred to this meeting.
  • General discussion:
- "O" = optional, "X" = mandatory setting parameter
- Note: Some cells have a red triangle in the upper right corner - this indicates the presence of notes related to "Strategy" + parameter optionality.
- For "Exhalation Valve State", we should add a 3rd state indicating that there is no valve present (e.g., ,"No Valve"); Fernando indicated that they were trying to focus on virtual vs. physical exhalation valves; (see Decision below)
- Multi-breath "Strategy Names" PCV/PSV/VCV cover the breath types
- Description of a "mode" is a composite of all the allowed breath types
- (Dain) "trigger" and "cycle" have caused problems in the past, perhaps usage of "initiation of inspiration" and "initiation of exhalation" would be clearer. (see Decision below)
- Note: Maneuvers are within a breath

Decisions/Issues:

  • Exhalation Valve State: Add a "not present" state = "open"
  • Use Inspiratory Trigger & Expiratory Trigger OR Beginning of Inspiration Method & Beginning of Exhalation Method

Action(s):

7 Siemens Waveform Document Review
- Dain 		Status/Discussion:
  • (Schluter) May want to capture annotations on P/V Loops
  • Approval will be needed if the group is goint to use content from mthis document for its "pamphlet."

Decisions/Issues:

Action(s):

8 Work Plan Review
- Cooper 		Status/Discussion:

Decisions/Issues:

  • Focus on machine reporting
  • Defer addressing "clinical intent" - THOUGH THE LIST ABOVE SHOULD BE CAPTURED & EXPANDED!
  • Add maneuvers - this could be a parallel channel of annotations or parallel time interval events
  • Develop a booklet / pamphlet that contains waveforms w/ annotations & descriptions.

Action(s):

9 Next Meeting
- Chair 		Status/Discussion:

Decisions/Issues:

Action(s):

Next Meeting

2009-05-27 Vent WebEx Session


(Reviewed & approved by PCD RTM Vent TG 2009-06-03 Vent WebEx Session)


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