Difference between revisions of "PCD RTM Vent Modes"

Latest revision as of 09:38, 9 July 2008

Ventilator Operational Configuration Semantic Model

A key item in the Vent TG's discussion is to identify the core semantic components that make up a ventilator's operational modality. This in turn can be used to organize a device's settings, waveform annotations, etc. It is understood that the actual labels associated to a given mode will vary from vendor's device to device, and should eventually be harmonized with related activities such as the work being done within ISO TC121/SC 4 (Joint with IEC/SC62D) Critical Care Ventilators. Component semantics should be flexible enough to support all of these usages, though.

Note: This is also intended to result in an update to the existing ventilator operational modality terminology standard contained in ISO/IEEE 11073-10101 Health informatics - Point-of-care medical device communication - Nomenclature document, as well as a mapping to any "glossary" developed within ISO TC121/SC4.

Operational Configuration Data Set

Given the complexity and versatility of how a ventilator is configurated, mapping all the operational settings concepts into a single term or semantic model is a fairly intractable proposition. To address this complexity, a set of parameters has been proposed to convey how a device's operation has been configured.

**Ventilatator Operational Configuration Data Set**
Atrribute	Description	Enumerations
Patient Interface	Indicates the general mechanical connection between the patient and the ventilator.	IV- Invasive, e.g. endotracheal tube NIV- Non-Invasive
Delivery Method	Overall approach for achieving gas delivery. Note: This mode setting may end up selecting a different set of "operational mode" enumerations. Those listed below are specifically related to Positive Pressure delivery method, which is used for conventional mechanical ventilation.	PP- Positive Pressure NP- Negative Pressure HF- High Frequency
Operational Mode	General intra- and inter- breath sequencing.	See Operatinal Mode below
Backup Mode	Mode that is actived when an apnea condition is detected.	See Operatinal Mode below

Operational Mode Attributes (Positive Pressure)

For conventional "positive pressure" mechanical ventilation, the following table captures the key attributes that may be used to describe its operational mode.

Note: These attributes are listed in the preferred sequential precedence.

**Ventilatator Operational Mode Attributes (Positive Pressure)**
Atrribute	Description	Discussion
Breathing Pattern	<general semantic attribute description> CMV - Continuous Mandatory Ventilation: IMV - Intermittent Mandatory Ventilation: CSV - Continuous Spontaneous Ventilation:	...
Breath Shape	<general semantic attribute description> P - Pressure): F - Flow): PF - Pressure transitioning to Flow: FP - Flow transitioning to Pressure: V - Volume...integral of flow: T - Time):	Is BreathShape::Time redundant since time is ALWAYS a component? Are all combinations of trigger & cycle methods accounted for in these enumerations?
Adaptive Targets	<general semantic attribute description> NOS - Not Otherwise Specified: MMV - Mandatory Minute Volume: V - Volume: FQ - Frequency: EtO2 - Control for O2 content: EtCO2 - Control for CO2 content:	Multiple targets may be active during any given operational mode. To account for this, should there be a primary Adaptive Target and then a separate list of the set of adaptive targets?
Assist Augmentation	<general semantic attribute description> TBD - ...:	Note: During the 2008-05-15 WebEx it was decided to add another Attribute to this table - "Assist/Support Breath Augmentation" (final name TBD).

Reference Documents

RTM Vent Page Background Materials and Suggested References List

Initial mode table proposal from Cambridge Meetings

Aphorisms of Mode Classification (Chatburn, 2008.06.23)

Analysis of Aphorisms (Chatburn, 2008-06-02 tcon)

Breath Mode Taxonomy (Weismann, 2008.06.22)

Breath Model Taxonomy- Excel (Weismann, 2008.06.22 tcon)

Furniss ventilator mode discussion document

Furniss ventilator mode taxonomy matrix (updated 2008.07.07)

Updated mode table proposal with Chatburn Mappings

Mode Issues / Action Items List

The following table captures the current issues that need to be resolved regarding the above model:

Item	Submitters	Attr	Topic	Description	Discussion/Disposition
1	Berryhill	Breath Shape	PF or is it really PV?	Mark wanted to know if the BREATH SHAPE item should be classified as Pressure-Flow or Pressure-Volume. In his opinion, in a volume assured breath, you set the pressure, then maintain a flow until you reach the assured volume-Joel	.
2	tbd	.	.	.	.

Mode Mapping Sandboxes

The table below may be used to try out mapping specific vent modes (real modes provided on real vents!) and to discuss issues with the model above - gaps, adjustments, etc.

NOTE: A sample table has been provided - copy that heading and table and then use it as a sandbox for your own mappings.

Mode Sandbox Table: (Sample)

Mode Name	P/I	D/M	B/P	B/S	A/T	B/M	Description/Notes
High Freq	IV	HF	n/a	n/a	n/a	n/a	...
tbd	tbd	tbd	.	.	.	.	...

@@ Line 1: / Line 1: @@
 {{TOCright}}
-==Ventilator Operational Mode Semantic Model==
+==Ventilator Operational Configuration Semantic Model==
-A key item in the Vent TG's discussion is to identify the core semantic components that make up a ventilator's operational modality.  This in turn can be used to organize a device's settings, waveform annotations, etc.  It is understood that the actual labels associated to a given mode will vary from vendor's device to device, and should eventually be harmonized with related activities such as the work being done within [http://www.iso.org/iso/standards_development/technical_committees/list_of_iso_technical_committees/iso_technical_committee.htm?commid=52012 ISO TC121/SC 3/JWG 1 (Joint with IEC/SC62D) Critical Care Ventilators].  Component semantics should be flexible enough to support all of these usages, though.
+A key item in the Vent TG's discussion is to identify the core semantic components that make up a ventilator's operational modality.  This in turn can be used to organize a device's settings, waveform annotations, etc.  It is understood that the actual labels associated to a given mode will vary from vendor's device to device, and should eventually be harmonized with related activities such as the work being done within [http://www.iso.org/iso/standards_development/technical_committees/list_of_iso_technical_committees/iso_technical_committee.htm?commid=52024 ISO TC121/SC 4 (Joint with IEC/SC62D) Critical Care Ventilators].  Component semantics should be flexible enough to support all of these usages, though.
-Note:  This is also intended to result in an update to the existing ventilator operational modality terminology standard contained in ''ISO/IEEE 11073-10101 Health informatics - Point-of-care medical device communication - Nomenclature document''.
+Note:  This is also intended to result in an update to the existing ventilator operational modality terminology standard contained in ''ISO/IEEE 11073-10101 Health informatics - Point-of-care medical device communication - Nomenclature document'', as well as a mapping to any "glossary" developed within ISO TC121/SC4.
-The following table illustrates the current model being proposed:
-[[Image:IHE_PCD_RTM_Vent_Modes_Proposal_Table_r1.png|center|Vent Mode Semantic Components Table]]
+== Operational Configuration Data Set ==
+Given the complexity and versatility of how a ventilator is configurated, mapping all the operational settings concepts into a single term or semantic model is a fairly intractable proposition.  To address this complexity, a set of parameters has been proposed to convey how a device's operation has been configured.
 {|border="2"
-|+ <big>'''Ventilatator Operational Mode Attributes''' </big>
+|+ <big>'''Ventilatator Operational Configuration Data Set</big>
 |-
 ! width="15%"  align="center"   |Atrribute
 ! width="45%"  align="left"     |Description
-!              align="left"     |Discussion
+!              align="left"     |Enumerations
 |-
 | align="center" | '''Patient Interface'''
-| <general semantic attribute description>
+| Indicates the general mechanical connection between the patient and the ventilator.
-:Option('''IV'''-Invasive):
+|
+:'''IV'''- Invasive, e.g. endotracheal tube
-:Option('''NIV'''-Non-Invasive):
+:'''NIV'''- Non-Invasive
-| ...
 |-
 | align="center" | '''Delivery Method'''
-| <general semantic attribute description>
+| Overall approach for achieving gas delivery.
-:Option('''PP'''-Positive Pressure):
+Note:  This mode setting may end up selecting a different set of "operational mode" enumerations.  Those listed below are specifically related to Positive Pressure delivery method, which is used for conventional mechanical ventilation.
+|
+:'''PP'''- Positive Pressure
+:'''NP'''- Negative Pressure
+:'''HF'''- High Frequency
+|-
+| align="center" | '''Operational Mode'''
+| General intra- and inter- breath sequencing.
+|
+:See [[#Operational_Mode_Attributes_Positive_Pressure | Operatinal Mode below]]
+|-
+| align="center" | '''Backup Mode'''
+| Mode that is actived when an apnea condition is detected.
+|
+:See [[#Operational_Mode_Attributes_Positive_Pressure | Operatinal Mode below]]
+|}
+== Operational Mode Attributes (Positive Pressure) ==
+For conventional "positive pressure" mechanical ventilation, the following table captures the key attributes that may be used to describe its operational mode.
-:Option('''NP'''-Negative Pressure):
+Note:  These attributes are listed in the preferred sequential precedence.
-:Option('''HF'''-High Frequency):
-| ...
+{|border="2"
+|+ <big>'''Ventilatator Operational Mode Attributes (Positive Pressure)''' </big>
+|-
+! width="15%"  align="center"   |Atrribute
+! width="45%"  align="left"     |Description
+!              align="left"     |Discussion
 |-
 | align="center" | '''Breathing Pattern'''
 | <general semantic attribute description>
-:Option('''CMV'''-Continuous Mandatory Ventilation):
+:'''CMV''' - Continuous Mandatory Ventilation:
-:Option('''IMV'''-Intermittent Mandatory Ventilation):
+:'''IMV''' - Intermittent Mandatory Ventilation:
-:Option('''CSV'''-Continuous Spontaneous Ventilation):
+:'''CSV''' - Continuous Spontaneous Ventilation:
 | ...
@@ Line 49: / Line 76: @@
 | align="center" | '''Breath Shape'''
 | <general semantic attribute description>
-:Option('''P'''-Pressure):
+:'''P''' - Pressure):
-:Option('''F'''-Flow):
+:'''F''' - Flow):
-:Option('''PF'''-Pressure transitioning to Flow):
+:'''PF''' - Pressure transitioning to Flow:
-:Option('''FP'''-Flow transitioning to Pressure):
+:'''FP''' - Flow transitioning to Pressure:
-:Option('''V'''-Volume...integral of flow):
+:'''V''' - Volume...integral of flow:
-:Option('''T'''-Time):
+:'''T''' - Time):
 |
 * Is ''BreathShape::Time'' redundant since time is ALWAYS a component?
+* Are all combinations of trigger & cycle methods accounted for in these enumerations?
 |-
 | align="center" | '''Adaptive Targets'''
 | <general semantic attribute description>
-:Option('''NOS'''-Not Otherwise Specified):
+:'''NOS''' - Not Otherwise Specified:
-:Option('''MMV'''-Mandatory Minute Volume):
+:'''MMV''' - Mandatory Minute Volume:
-:Option('''V'''-Volume):
+:'''V''' - Volume:
-:Option('''FQ'''-Frequency):
+:'''FQ''' - Frequency:
-:Option('''EtO2'''-Control for O2 content):
+:'''EtO2''' - Control for O2 content:
-:Option('''EtCO2'''-Control for CO2 content):
+:'''EtCO2''' - Control for CO2 content:
-| ...
+|
+* Multiple targets may be active during any given operational mode.  To account for this, should there be a primary Adaptive Target and then a separate list of the set of adaptive targets?
 |-
 | align="center" | '''Assist Augmentation'''
 | <general semantic attribute description>
-:Option('''TBD'''-...):
+:'''TBD''' - ...:
 | Note:  During the [[PCD_RTM_2008-05-15_WebEx|2008-05-15 WebEx]] it was decided to add another Attribute to this table - "Assist/Support Breath Augmentation" ''(final name TBD)''.
 |}
 == Reference Documents ==
-:* ''<add references to documents that are related to this vent mode analysis>''
+:[[PCD_RTM_Ventilator | RTM Vent Page Background Materials and Suggested References List]]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/IHE_PCD_RTM_Vent_Modes_Proposal_Table_r1.pdf Initial mode table proposal from Cambridge Meetings]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/Aphorisms_of_Mode_Classification-Chatburn_2008-06-23.doc Aphorisms of Mode Classification (Chatburn, 2008.06.23)]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/Analysis_of_Aphorisms_06-02-08_Chatburn.doc Analysis of Aphorisms (Chatburn, 2008-06-02 tcon)]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/Breath_mode_taxonomy_2_2008-06-22_Weismann.doc Breath Mode Taxonomy (Weismann, 2008.06.22)]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/Breath_mode_taxonomy_1_2008-06-22_Weismann.xls Breath Model Taxonomy- Excel (Weismann, 2008.06.22 tcon)]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/20080529_tcon/Breath%20mode%20model%20.doc Furniss ventilator mode discussion document]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/Breath_mode_taxonemy_6-5-08_wwf_2.xls Furniss ventilator mode taxonomy matrix (updated 2008.07.07)]
+:[ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Vent/Background/VentModeProposal.2008-07-08.table.doc Updated mode table proposal with Chatburn Mappings]
 == Mode Issues / Action Items List ==
@@ Line 118: / Line 163: @@
 | .
 |}
 == Mode Mapping Sandboxes ==
@@ Line 123: / Line 169: @@
 ''NOTE:  A sample table has been provided - copy that heading and table and then use it as a sandbox for your own mappings.''
 === Mode Sandbox Table: (Sample) ===