Overview of Dynamic Variables in Respiratory Ventilation Nomenclature

1. Resp/Vent Nomenclature – Modeling dynamic variables IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG D3G_9Sep14

2. Overview • Scope is limited to defining dynamic variables, i.e. breath types, rates, and volumes • Purpose • Primary purpose is to define a fundamental set based on ISO SC4 methodology that can be used as a basis for data logging of ‘dynamic’ variables, i.e. breath types, rates, and volumes, such as tidal and minute volume. • Secondary purpose is to show how fundamental breath type variables can be used to explain ‘traditional’ connotations such as ‘spont[aneous]’ and ‘mand[atory]’. • Approach • Harmonization is based on alternative modeling perspectives • Synergy: breaths are viewed as holistic, or system-level co-actions of patient and ventilator. • Phasing: features are viewed as phased element-level actions of patient and ventilator Compositional correspondence: several Rate variables are related to [four] fundamental breath types. • Several application examples are described: • Rate: variables are summated w.r.t. a typical modal pattern (e.g. SIMV) • Nomenclature: RefID formulation is shown for common RESP_RATE variations. • Volume: several variables related to “Exhaled Minute Volume” are derived Modal correspondence: several key variables are related to common Ventilator Modes. IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

3. Synergy perspective • Breath types represent fundamental co-action patterns w.r.t. patient and ventilator. • Refer to following diagram for derivation of breath types and table for identification of key rate relationships • Breath types are composites of co-active relationships and named according to common usage. • Rates may be ascribed to various elements or subsets of graph in the diagram. IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

4. Phasing perspective • Breath types represent fundamental phasing relationships, primarily w.r.t. initiation. “SD” refers to “Start” and “Delivery” phasing elements. • Refer to following table for derivation of breath types • Breath types are n-tuple composites of phasing sequences, e.g. n=2 (for S & D) in the following table; precision may be increased by extension, for example, by adding an “E” (End) phase • SD Type correspondence as shown in previous diagram, e.g. Unassisted (P), Supported (S), Assisted (A), Controlled (C). • Rates may be ascribed to time-ordered occurrences as shown in the annotated diagram beneath the table. IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

5. Relational correspondence The following table shows a relation mapping terms based on the alternative perspectives. IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

6. Example applications – Rate Note: See below for annotation key for this particular (preliminary) diagram. IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

7. Example applications: Nomenclature RefID Application for defining Nomenclature “Reference IDs” is characterized in the following example, for key “Resp Rate” variations. Discriminator tags (“P”, “S”, “A”, “C”} shown in the “Phasing perspective” table are formed into a char string denoting summary formulation, in order to facilitate systematic computation. Base term: MDC_VENT_RESP_RATE [existing term code 2::20514] REFID (as observations, not settings)Equivalent to MDC_VENT_RESP_RATE_BTSD_PS BTSD = patient | supported (aka ‘traditional spontaneous’) MDC_VENT_RESP_RATE_BTSD_AC BTSD = assisted | controlled (aka ‘traditional mandatory’) MDC_VENT_RESP_RATE_BTSD_PSA BTSD = patient | supported | assisted MDC_VENT_RESP_RATE_BTSD_C BTSD = controlled IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

8. Example applications – Volume Several volume-related term derivations and relationships to rate terms are listed in the following table. IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f

9. Modal context correspondence Context-sensitive, modal relationships are shown in the following table. [Note: ID tags are used only for concise reference in the table.] IEEE 11073-ISO SC4 19223-IHE PCD RTM JWG d3f