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User`s Manual (SW 3.5)

1. Enc 1 signal CAL ON Vortex 86DX CPU O2 sample Press transducer l z BUTE CAL signal 16 bit A D converter 7 Simulation ON Fast signal I O Mod 2kHz motion paramagnetic l controller O2 transducer Systems inter connect Thermolinear net board work thermistor SO Universal input Universal input switching power supply switching power supply 5V 412V 48 V Rev 3 5 2014 Figure 12 6 Schematic Overview ASL 5000 System 108 S LOZ P JeoIpew sewsul ZAY S E MS 000S ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 13 Theory of Operation 13 1 Introduction to Ventilatory Mechanics For the purposes of this discussion the ventilatory system is subdivided into the pulmonary system and the chest wall The pulmonary system comprises the lungs usually two and their associated airways leading to the airway opening the mouth and nares The chest wall comprises all of the passive extrapulmonary mechanical structures that participate in the production of a breath These include the rib cage the ribs sternum and spinal column and the respiratory muscles among them the diaphragm intercostals abdominals and scalene in their tonic state Thus as used here the ventilatory system encompasses all the passive mechanical properties involved in breathing e g compliances resistances and so forth On the other ha
2. Figure 13 13 Simulator Concept The hardware implementation of the model works via a pressure feedback control loop that takes care of moving the piston inside the simulator cylinder in such a fashion that the set values of R C and chest wall profiles can be observed externally 119 120 Theory of Operation Ventilatory Model Types 13 3 Ventilatory Model Types 13 3 1 Single compartment Model Click on diagram to select a model Baal Figure 13 14 Single Compartment Model The single compartment model consists of a single linear or parabolic resistor and a single linear compliance The icon of this model symbolizes this configuration The differential equation for this setup is see page 110 Equation 4 AP ot Pro Pes APmus V Cio R Oy with Pao Pgs Paw external ventilator pressure at the airway and AP internal pressure patient effort As an enhancement to the model the value of R can be chosen independently for inspiratory and expiratory flow direction see next page Compliance and Resistance parameters may also be modeled as time varying parameters with small adjustments being made in a breath by breath fashion please see Advanced Model Settings Time Varying Parameters TVP page 37 1 Please note that for better visibility the trace for Muscle in the Central RunTime pressure waveform plots as well as the graphs in the Patient Effort Model Step 3 of t
3. Figure 13 19 Patient Effort Model Flow Trigger Flow trigger generates a constant flow defined by duration and amplitude where the pressure profile is calculated internally from the desired flow amplitude Please note that the flow profile is generated for a no load situation open port and flow levels will be influenced by negative pressure in the circuit in case of delayed flow delivery from a ventilator This is because of the fact that the system is still operating within the context of a lung simulation with feedback pressure and the model is therefore designed to respond to external pressure signals If flow patterns independent from pressure changes are needed you may use the SmartPump Mode page 126 NOTE All pressures of the Patient Effort Model are plotted inversed negative trace producing an inspiration See also the footnote on page 120 Inspiration Cycle Time 100 Simple Flow Trigger Figure 13 20 Flow Trigger Effort Detail 13 4 3 Sinusoidal Breath Profile Figure 13 21 Patient Effort Model Sinusoidal The sinusoidal pressure profile can be used to generate more realistic patient breaths and is defined by a peak negative pressure the breath frequency bpm and the time percentages for the pressure drop inspiratory the pressure maintaining time hold and relaxation expiratory In addition to the inspiratory effort to produce an inhalation it is also possib
4. E ta ees O a Sh SO s T trae aime A Respiratory Simulation Specialists INGMAR MEDICAL This page intentionally left blank User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Legal Information Product Warranty Educational tools and test instruments manufactured or distributed by IngMar Medical Ltd are fully warranted covering materials and workmanship for a period of one year from the date of shipment except for products with stated warranties other than one year IngMar Medical reserves the right to perform warranty service s at its factory at an authorized repair station or at the customer s installation IngMar Medical s obligations under this warranty are limited to repairs or at IngMar Medical s option replacement of any defective parts of our equipment except fuses and batteries without charge if said defects occur during normal service Claims for damages during shipment must be filed promptly with the transportation company All correspondence concerning the equipment must specify both the model name and number and the serial number as it appears on the equipment Improper use mishandling tampering with or operation of the equipment without following specific operating instructions will void this warranty and release IngMar Medical from any further warranty obligations The above is the sole wa
5. Figure 8 2 Utilities ASL 5000 Data File Conversion Clicking on any of the blue buttons on the top of the window opens a file dialog for choosing the file set or directory to be processed When translating files using the lt Advanced gt option it is the responsibility of the user to properly assign extensions In this case it is strongly recommended to follow the file naming convention for the ASCII files generated shown in the list above with respect to their extensions NOTE The bra breath parameter files are easily imported into Microsoft Excel Use the text file setting for the import and make sure that All Files are enabled Excel s Text Import Wizard will detect that the file is tab delimited and will guide you through the import process When importing waveform data rwa or dta into a spreadsheet keep in mind that each second of data will generate as many as 512 rows Reducing the data sample rate before the start of a simulation in Step 2 of the Simulation Editor for a vr3 file is usually a good idea if any length of waveform is to be processed in a spreadsheet GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 8 2 AUX Channel Resampling AUX1 and AUX2 signals recorded by the ASL 5000 don t provide natively equidistant data points The frequency with which they are recorded varies based on the pr
6. ccccscssssssessssessssssceeoees 25 LICENSE KEY Sxtcsnic sasticcmsiiaw aca vomatsesmbapenauien 25 Screen NaVIS ANON senii asa a 25 Welcome Window and Window Manager 25 PIOIECE FILE TOON arser a saseeetcorenecids 26 Full Choice Welcome Window 064 28 Window Manager Tabs Overview 29 Modeling Using the Simulation Editor Environment 31 Working with the Simulation Script Editor 31 Manipulating SCripts csitiescessanageessiaetices 32 Using TOKENS caiit S 33 Modeling Using a Scenario Script 34 Step by Step Script Generation Without Using a Scenario Script 35 Step 1 Select Simulation Parameter Set 35 bung MOGEW Type Serene ai 36 Advanced Model Settings Compensa NONS erei Kteconiiesiemeine eens 36 Advanced Model Settings Time Varying Parameters TVP necces 37 Advanced Model Settings Parabolic Linear Resistors eeeeeeeeeeees 39 Advanced Model Settings Independent Inspiratory and Expiratory Resistor Settings 39 Advanced Model Settings Non Linear Compliances eeeeeeees 40 Step 3 Choose a Patient Effort Model 41 Step 4 Save Simulation Parameter Set 42 Running Simulations From the Run Time Home Display ccseeeees 43 Initializing the ASL 5000 Simulator 44 Starting a SIMUNAON wae eres eener 44 Pausing a Running Script eeessecesecereceree 45 Display Options of the Run Time Home
7. 10 5 10 6 10 6 1 10 6 2 10 6 3 10 6 4 10 6 5 10 6 6 10 7 11 11 1 12 12 1 12 2 12 3 12 4 Test Automation Interface 90 TAI OvervieW eeecsssssseccecosssscecosssesecosssoe 90 Using ASL Utilities 92 Exporting Data Files ccsssssssssseees 92 AUX Channel Resampling cc000 93 RespiSim File Conversion ssssssseees 93 Using the Patient Flow Data PrOCOSSOT icsstscswasacorecssvacss a E ES 94 Using the Pressure Profile Resampling Utility 0oooooooeeesessseesssesee0 96 TCP Data Broadcast 97 Breath Parameter Broadcast cc0000 97 Waveform BroadCast ccccccccssssssssseees 97 ODUONS sddscceonsdsessossissceredineciac 98 Simulator Bypass and Leak Valve Module SBLVM ssssscccccsssssscccecesssssees 98 Using the Cylinder Temperature Controller CTO scncdivnnieitincienn nies 100 Using the Fast Oxygen Measurement Option FOM cccccessees 100 Using the Auxiliary Gas Exchange Cylinder AGEC 00000000000000000000000000000 101 Chest Rise MOdUle ccccccsssssssceeceees 101 Preemie Lung Cylinder Kit ss00e 102 tended USC ss icisenasdeesewerseomamactecrnndaded 102 PISSEIMOIY 352 assem dacs oariannion tania 102 Software Adjustments eeeeeeeeeeeeeees 102 Firmware Adjustments oi secede bieriieesawelss 103 Operation with Attached Preemie Cyl
8. Figure 13 23 Trapezoidal Breath Profile The trapezoidal breath profile is configured in the same fashion as the sinusoidal setup with a peak negative pressure the breath frequency bpm and the time percentages for pressure drop inspiratory pressure maintaining time hold and relaxation expiratory The only difference to the sinusoidal profiles is that in the trapezoidal pattern straight ramps are used for pressure buildup and release NOTE All pressures of the Patient Effort Model are plotted inversed negative trace producing an inspiration See also the footnote on page 120 Theory of Operation Patient Effort Model Cycle Time 100 Trapezoidal Half Wave Figure 13 24 Trapezoidal Effort Detail NOTE For rates faster than 24 bpm the diagram indicating the effort profile will show two or for bpm gt 48 three breaths For these faster rates only every 2nd or 3rd respectively breath is actually updated in order to allow enough time for the download of the profile to the simulator and several breaths are rolled into one In this case Repeats in the Script Editor refer to these multiple breaths In order to accomplish 10 breaths with a breath rate of 28 the correct setting in the Script Editor is therefore 5 13 4 5 Patient Backing Off The following description of the two control parameters Pmus modified by Paw applies to both sinusoidal and trapezoidal patient efforts Two data en
9. C to 45 C Part no 31 00 600 Bag in bottle external cylinder approximately 3 0 L accommodates bags bellows up to 4 5 inches Part no 31 00 730 Pneumatic controller for manikin simulator chest rise pillow 141 142 Technical Data Performance Specifications Compatibility designed for use with Laerdal SimMan Classic and 3G RespiSim VIK Part no Principle Ventilator data capture via RS 232 to WiFi interface Ventilator Please see table on the following Compatibility page S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Technical Data Performance Specifications RespiSim Ventilator Interface Kit VIK Compatibility and Communications Settings Ventilator Configuration Adapters Configuratii Settings Black MDH male Fusion Wireless Adapter 5 Set to Medibus Drager adult vents to be used with all ventilator 9 Baud 9600 amp bits adapters Panty Mone 1 stop bit Set Printer to Drager Babylog Medibus Baud 9600 B bits Parity None 1 stop bit Baud 19200 7 bits Odd Parity 1 stop bit Part no 31 10631 Part no 31 10632 GE Versamed Vent Both None 1 step rem bit Drager adult vents Drager Infinity V500 USB drive with ASL except Infinity 500 GE Versamed iVent S000 host comers Hamilton Galileo Fre set plug and play Dr ger Babylog Puritan Bennett 840 USB pen drive labeled Even Par
10. Single Compartment Dual Compartment rach ine Chung Rais 1 Row 9 P mus 7 T Atmosphere Figure 13 12 Simulation Model Electrical Analog where Paw airway pressure cmH20 Ptrach tracheal pressure cmH20 across Rtrach AP mus transalveolar muscle pressure cmH20 Ciot total compliance mL cmH20 R Overall airway resistance cmH20O L s flow 1 In the lung model window and graphs Apmys is simply called Pmus but it still refers to the muscle pressure difference Please note that in these model compositions there is no distinction made between chest wall compliance and lung compliance instead they are lumped together so that in the simplified case of the single compartment model C represents the total Compliance see page 110 or CCC Cw 5 and similarly in the case of non uniform lungs C Cu CWC Cw C C CWC Cw Theory of Operation Introduction to Modeling 13 2 2 Limitations of the Model The model as implemented in the simulator controller software does not take into account any neural response to external ventilation Further extensions should allow implementation of some approximate ventilatory responses based on patient characteristics and disease states that would enhance the spontaneously breathing patient mode 13 2 3 Realization of the Model J SSacsscseeeeee JS SS a Paes Host Computer Embedded l Controller Pressure i Position
11. for example when different panels need to be visible simultaneously This structure optimizes the user interface for improved user software interactions Operation Getting Started 4 1 3 Welcome Window and Window Manager After launching the software a software loading screen is presented Please wait while ASL 5000 Software is loading Figure 4 1 ASL Software Loading When the software has been loaded a Welcome window will appear that allows you to quick launch with the last settings used saved in a Project File Alternatively you can switch to the Full Choice Menu see Full Choice Welcome Window page 28 for more options Additionally you may also launch the software in Demo Mode PC only no ASL hardware attached which will include the Virtual Ventilator feature if this option is licensed for your installation P ingMar Medical ASL 5000 Welcome E m Respiratory Simulation Specialists Ai ADL JUVY Sreatning SIYE Quick Launch Menu on cursor typing Ctrl H or by selecting this feature from the drop down menu C Program Files x86 ASL Software 3 5 Current ASL are 3 Project File ini Figure 4 2 ASL Quick Launch Menu 25 26 Operation Getting Started 4 1 4 Project File Tool Beginning with software 3 4 basic settings for your work environment are stored in a Project File Clicking on the lt Modify Load ASL 5000 Project File gt button will open a window for l
12. 57 Operation Running Simulations Using the Interactive Control Panel ICP 4 5 6 Closed Loop CO2Y Tab HNG SIMU GLO Pe e he j ain EN a i un Time Home AENA INGMAR MEDICAL o ai Control esl Present 228 nee i d E 20 000 Figure 4 77 Interactive Control Panel Closed Loop CO2Y Tab In this mode Pmax and bpm settings are manipulated NOTE Itis important to keep in mind that depending automatically Upper and lower limits may be set for on the restrictions imposed by limit thresholds as well both parameters to keep adjustments within a as by external conditions it will not always be possible physiologically relevant range to actually reach the required value of minute ventilation for attaining a particular EtCO2 value Before opening this tab please make sure that the slide switch on the left of the ICP window is set to CO2Y otherwise a reminder will show up on the tab stating that Lung Is passive or CO2Y is not active Figure 4 78 No Loop S LOZ PHT JeoIpaw sewsu O ZAY FE MS 000S ISV enuey sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 5 7 Patient Library Tab 3E IngMar Medical ASL 5000 Window Manager Fie Windows Help Customize INGMAR MEDICAL Run Time Home Interactive Control INGMAR MEDICAL Operation Running Simulations Using the Interactive Control Panel ICP Script Patient Model Real Time Analysis ASE SU
13. Figure 4 28 Tokens Exchange with Configured Token If a token is used that does not refer to an existing file path the script segment will be highlighted in red lt ASLVarsDirectory gt tests C20_R20_step_P15 vr3 lt ASLVarsDirectory gt testsSC50_R5_step_ P10 vr3 BE Token and Path Selection Token lt not a good path gt Token to Replace lt not a good path gt Figure 4 29 Token Configuration Errors In this case you can still double click on the script segment and then navigate to an actually existing parameter file Generally scripts can be generated in one of two ways using preconfigured scenarios or manually from scratch 4 2 4 Modeling Using a Scenario Script The first method is to select the preferred patient parameters by making a choice from the list specifying different patient types and disease states in the Scenario Scripts tab of the Simulation Script Editor __ S SS S Maroua tesa asso woon ana asa cee nny ScriptFile ParameterFile Windows Help Customize 3 ASL JUUN INGMAR MEDICAL Run Time Home INGMAR MEDICAL Simubkition Directory h C Program Files x86 ASL Software 3 5 vars scenarios Directory Contents Double click to change Script sct file Adult_ChBronch sct Adult_Emphys sct Adult_frequent_apnea sct Adult_normal sct Adult_severe_apnea sct Adult_severe_asthma sct Neonatal sct Neonatal_apnea sct Neonatal_asth
14. Flow waveform generator SmartPump mode 3 1L 2 to 2500 mL 100 1500 mL 200 mL 6 9 L 2 to 6000 mL 100 1500 mL 200 mL 0 4 L 0 5 to 200 mL 100 150 mL 25 mL O to 150 min infant Vt better than 15 Hz 10 cm passive response to HF ventilation 270 L min for units with 4mm 180 L min for units with 2 5 mm pitch ball screws tooflow lt 50 ms lt 1 L min 3 to 500 cmH20O L s linear and parabolic 1 or 2 compartment 0 5 to 250 mL cmH2O overall Leak Active Model Chestwall pressure profiles Pressure Measurement Airway Barometric Gas Temperature Servo System update rate Fast Oxygen Module FOM Option Principle O2 Meas Range Oz2Error Response time Cylinder Temperature Controller CTC Option Principle Wall temperature setting Auxiliary Gas Exchange Cylinder AGEC Option Principle Volume Chest Rise Module Option Principle Technical Data Performance Specifications on SBLVM avail option approx 4 9 15 L min at 20 cmH2O0 leak orifices exchangeable Pressure trigger flow trigger sinusoidal trapezoidal user file defined error lt than 1 fso error lt 1 1 kPa error lt 0 5 C 20 45 C 2048 Hz Part no 31 00 300 Paramagnetic partial pressure measurement O to 100 O2 less than 40 5 O2 lt 350 msec t90 21 to 100 O2 Part no 31 OO 400 PID controlled foil heater on cylinder circumference ambient 5
15. Heat Production Exp Work zero otherwise Inspiratory time counted from the minimum to the maximum volume positive flow is detected A ventilator performance parameter If known in advance for example because it is a ventilator setting this parameter may be set via an override in the Post Analysis Data Re Processing window From start of expiration to end of expiration A Total System Work parameter Expiratory Definition changed with sw 3 3 An external imposed WOB parameter Expiratory Added parameter in sw 3 3 An external imposed WOB parameter Expiratory Added parameter in sw 3 3 An external imposed WOB parameter Expiratory Added parameter in sw 3 3 An external imposed WOB parameter Inspiratory Added parameter in sw 3 3 An external imposed WOB parameter Inspiratory Added parameter in sw 3 3 Parameter definition changed in sw 3 5 An external imposed WOB parameter Inspiratory Added parameter in sw 3 3 A Total System Work parameter Expiratory Between Point A and Point E or just before F 133 134 Parameter Definitions Parameters in the brb Breath Parameter File Ins Settling Time Insp Breath Type Insp Elastic Work Insp Mean Squared Error Insp Overshoot Insp Res Work Insp T90 Insp Target Insp Vt Inspiratory time ae Expiratory time Time from Start Insp at which inspiratory steady state insp pressure or flow between 0 9 1 1 of tar
16. PN LCM GC C s i cn A Random Amp is the max min amplitude limit Seed values are limited to positive integers Figure 4 43 TVP Curve Editing Uniform Distribution S LOZ PI JeoIpew ewU O ZA S E MS 000S ISV ENUeW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Gaussian Distribution with Thresholds Curve Type Equation Random Gaussian Distribution M Gaussian Distribution About Mean ei lee SS Ee eS ae ae ee le 2 Ar be Se ee Sie oe peu RTT Fal ool Lot Mee oll MINE Lani ff ey Rt H Figure 4 44 TVP Curve Editing Gaussian Distribution The number of repetitions in a sequence of parameter segments in the TVP Editor does not necessarily have to match the number of breaths assigned to the lung model vr3 file segment in the Script Editor In case of diverging breath numbers either the transient described for the particular parameter in the Parameter Curve Segment Editor will be curtailed or the parameter will be continued with the last value of the transient curve definition if the number of repeats in the Script Editor is higher than that for the curve segment The TVP environment also allows a simple method to generate static model parameters Choosing a number of repeats of one and the appropriate start value for a Linear type segment in the Parameter Curve Segment Fditor will continue that value for any number of repetitions Once you have defined
17. Project File but can be modified at any time A file header txt located in ASL Software 3 5 ASL Reports is used as a container for a institution specific header You can place text there that you would like to always appear at the top of each report Editing of this header is done via the Project File Tool Output Data Settings tab see Figure 4 5 page 26 NOTE The lt Create Report gt button will only be available after the number of breaths to be included in the report have actually elapsed in the simulation A typical report might look like this flew ASL Software 2 1 ASL Your DV3TITUTION eater mite cs Rugpert ct Flows umn T BREATH PARAMETERS as selected in Real Time Analysis last of breaths row fe Ingmar Medical ASL 500 Simuta ton Report 212010 8185036 PM Figure 4 85 Sample Report GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 9 Working With the Analog Inputs Your ASL 5000 is equipped with inputs for two analog channels AUX1 and AUX2 The specifications for these inputs are as follows Input range O to 10 V differential input Resolution 2 44 mV 16 bit A D Over voltage up to 30 V protection inputs not opto isolated Max sampling rate 1024 Hz primary control analog input channel 512 Hz secondary analog Input Connector style Hypertronics used for serial no s mates wit
18. RespiSim on page 86 in this manual for more details as well as the separate RespiSim manual RespiPatient is a respiratory feature centered torso manikin with bilateral chest rise and intubation grade normal and difficult airway In addition it allows for training of needle decompression pneumothorax chest tube insertion and cric and tracheotomy procedures Oxygen Saturation SpO2 Simulation generates optical signals corresponding to the level of oxygen saturation in the patient model to be fed into an SoO2 monitor or ventilator The third party device OxSim used for this purpose is connected via RS232 USB directly to the host PC 2 3 System Features The ASL 5000 allows setting controlling the following parameters Compliance linear non linear Resistance linear parabolic mixed inspiratory and expiratory Muscle pressure for defining spontaneous breaths as pressure trigger rectangular pressure waveform flow trigger rectangular flow waveform sinusoidal breath waveform with individually ad justable rise hold and fall as well as expiratory ef fort Breath suppression in the presence of positive pressure ventilation Hering Breuer Effect is select able trapezoidal waveform with individually adjustable rise hold and fall as well as expiratory effort Breath suppression in the presence of positive pres sure ventilation Hering Breuer Effect is selectable externall
19. Total System Work External Work or as Patient Work parameters looking at the muscle pressure and condition in the patient s lungs Click on the box which displays either one of these three terms for a drop down menu that allows you to make a new selection see C__ above The volume referenced work parameters in the rightmost column on the screen use the expiratory volume as reference Please refer to Parameters in the brb Breath Parameter File page 131 for details on the individual parameters displayed in this data view 81 82 Data Analysis Display Performance Analysis Selections Yellow Buttons Total System Work is the combination of Patient Work and External imposed Work Please also refer to an in depth section on WOB in Introduction to Ventilatory Mechanics page 109 Volume corrections are performed for different standard gas conditions BTPS ATPD STPD by clicking inside the control labeled lt Conditions gt As measured i e no correction is the default setting Please also see NOTE on page 69 5 4 2 Trigger Analysis Display E Post Run Analysis Trigger Analysis S a S You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The lt RETURN gt button will bring you back to the main analysis menu screen NOTE
20. Volume corrections may be performed for different standard gas conditions BTPS ATPD STPD by clicking inside the control labeled lt Conditions gt As measured no correction is the default setting Please also see NOTE on page 69 The trend view then allows you to select parameters from the drop down list of available parameters click on the W symbol next to the parameter names in the list above the graph area Please refer to Parameters in the brb Breath Parameter File page 131 for details on the individual parameters displayed in this data view IE wi xi wis Patient Insp Vt mL yw xt f a7 602 1151 1199 195 P_peak cmH20 y If S s 14 9983 4 4061 E 19 2122 17 0484 15 3220 46 5002 LJ S BREL EHA Cursor 0 Trend 1 By Cursor 1 Li Trend 1 The defaults for the four parameters may be selected in the Project File Tool at the beginning or at the end of a simulation session NOTE Changes you make to selections here are also reflected in the left column of parameters in the Breath Detection Real Time Analysis tab parameters see page 60 Scrolling through or selecting a group of breaths is easily performed with the fast forward reverse arrows _ You can also see the lt a gt l current group of breaths highlighted in the graph at the bottom of the window The number of breaths for which the breath parameters are displayed may be selected by directly entering the number i
21. lt RETURN3 gt button will bring you back to the Main Analysis Menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN gt button before you can open any other view from the Post Run Analysis Menu window GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 5 3 5 Continuous Time Based Data Seta r i Raw dat i file path a oo C Program Files CEEA Software 3 5 ASLdata 24 breaths Figure 5 15 Analysis Continuous Time Based Data This option provides a real time chart of up to 4 parameters displaying multiple breaths without breaking data into individual breaths This view is helpful in cases where the breath detection algorithm was not able to detect breaths properly while data still can be explored in this view Scrolling through or selecting a group of breaths is easily pa with the fast forward reverse arrows You can also see the gt gt current group of breaths highlighted in the graph at the bottom of the window You may zoom into a detail area at any time by clicking into the display and dragging open holding mouse button down a detail window To return to the normal alt Data Analysis Display Data Selections Green Buttons J Cursor cursor d 10 000 or view go to the slide rulers for X a
22. reverse engineer sublicense transfer or translate in any way a Software or Documentation except as provided in the following clauses i You may permanently and simultaneously transfer all of the Software Documentation and the License if a you deliver to the transferee the Software and Documentation including updates and upgrades supplied by this Agreement b notify IngMar in writing Sf stich transfer and c destroy any archival backup copy A transfer immediately terminates the License You agree that the transferee must expressly accept all terms and conditions of this Agreement 3 YOU MAY NOT COPY THE SOFTWARE OR DOCUMENTATION provided however that you may make one 1 copy of the Software for archival backup purposes 4 If either the Software or Documentation is used in any way not expressly and specifically permitted by this License then the License shall immediately terminate Upon the termination of the License you shall thereafter make no further use of the Software or Documentation and you shall return to IngMar all licensed materials postage prepaid 5 THE SOFTWARE IS NOT INTENDED TO BE USED FOR ACTUAL ANALYSIS AND DIAGNOSIS OF MEDICAL CONDITIONS OF HUMANS OR ANIMALS WARRANTIES 1 LIMITED WARRANTY ON MEDIA For a period of thirty 30 days following the date of delivery to you as the original licensee if evidenced by your receipt as such the Warranty Period IngMar warrants the Fflash memory device on whi
23. tings see page 39 non linear compliance see page 40 In addition you can also select the waveform sampling rate which is set to its highest value 512Hz by default NOTE Please note that the advanced model settings do not apply to waveform generation in the form of SmartPump models After clicking lt Edit gt you will be working in Step 2 the Lung Model stage describing the passive respiratory mechanics of the patient Compliance and Resistance Figure 4 32 Step 2 Lung Model 35 36 Operation Modeling Using the Simulation Editor Environment 4 2 7 Lung Model Types The simplest single compartment model requires just 3 parameters The value for URC URC Uncompensated Residual Capacity desig nates a baseline volume as measured from the sim ulator piston home position not accounting for the 200 mL in the safety zone or Cylinder Dead space in the very front of the cylinder Please see also NOTE below regarding this parameter One value for Resistance with the additional choice of a second independent value Rout for in dependent setting of resistance during expiration The value for Compliance which represents a com pound patient compliance combining chest wall and lung compliance Alternatively the basic two compartment model consists of 6 parameters 1 The value for URC 2 The value for tracheal resistor Rt which can either be l
24. 1 For further reading on the topic of ventilator mode classifications please see Chatburn Respiratory Care 2007 52 3 301 323 S LOZ PI yeoIpew sewsul ZAY GE MS 000S ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Running Simulations Using the Interactive Control Panel ICP 4 5 Running Simulations Using the Interactive Control Panel ICP A IngMar Medical ASL 5000 Interactive Control Panel File Windows Help Customize INGMAR MEDICAL active patent Figure 4 64 Interactive Control Panel Lung Model Parameters R and C tab Patient settings are usually prepared and altered using the Script and Simulation Editor windows when designing tests and doing research with the ASL 5000 However for a more interactive style of modeling the Interactive Control Panel ICP may be invoked from the Run Time Home tab or from other panels in the software The ICP allows the user to choose the parameters of a patient model interactively manually via automatic parameter adjustment mode for muscle pressure and breath rate based on tidal volume or minute ventilation targets by invoking prepared patient model files at will Additional functionality of the ICP includes the ability to start and stop simulations and to save parameter sets that have been adjusted from within the ICP DEVELOPMENT ntsaperyes Cont Yina Instead of a step through ap
25. 1 Seed 1 Ampl 12 Ampl 12 50 60 Endpoints Reps 50 Start 8 End 50 Random Uniform Reps 50 Mean 50 Seed 1 Ampl 20 50 50 80 Sinusoidal Sinusoidal Sinusoidal Sinusoidal Sinusoidal Sinusoidal Sinusoidal Sinusoidal Theory of Operation Random Random Uniform Uniform Reps 1000 Reps 1000 Mean 15 Mean 11 Seed 1 Seed 1 Ampl 6 Ampl 4 4 Random Random Uniform Uniform Reps 1000 Reps 1000 Mean 15 Mean 7 Seed 1 Seed 1 Ampl 6 Ampl 2 8 15 11 15 11 Endpoints Reps 50 Start 10 End 0 30 M MN 30 30 30 warhie ame Compartment une tin ron c waveiorm ate Pra incense Hold Release 0 0 Patient Model Library 10 10 10 M N 129 130 Parameter Definitions Time Stamps and Parameters 14 Parameter Definitions 70 00 l 0 0116009 Figure 14 1 Timing of Pressure Flow and Volume 14 1 Time Stamps and Parameters Points A F refer to Figure 14 1 above Start Insp Effort End of Expiration of previous Point A breath The time time stamp Serves as the zero point for each breath in the count at which the inspiratory time domain If no spontaneous effort is pressure profile patient effort detected Start of Patient Inspiration will default begins i e the inverse of Pmus _ to the volume minimum before Point B Sol drops below zero Start of Inspiration St
26. 5000 Window Manager File Windows Help Customize INGMAR MEDICAL 12 4 Start Simulation Figure 4 70 ICP Spontaneous Breathing Parameters tab Again setting the parameters of the spontaneous breath component of the patient model may be performed by clicking and positioning dragging the blue pointer on the knobs to the desired setting or by entering numerical values into the field below the knob When making an adjustment to a setting the knob color will change to orange indicating that a new value has not yet been applied Once the new parameter setting has become active usually after a breath cycle the color of the knob will return to green ASL SUV Breathing Sinukitor Version 3 5 hiterietiye Control Vane Figure 4 71 ICP Adjustment Not Yet Applied GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Running Simulations Using the Interactive Control Panel ICP 4 5 3 Trends Tab BE IngMar Medical ASL 5000 Window Manage Fie Windows Help Customize INGMAR MEDICAL Run Time Home Interactive Control r ee ee Figure 4 72 Interactive Control Panel Trends Tab In this tab historical trends are displayed for three parameters Inspiratory tidal volume Vtin Pmus spontaneous profile maximum Pmax Breath Rate If additional trends from a simulatio
27. 7 0 3 0 Rion 10 Tass om T tega Spe f l d 1 07 fA Sa 10 en art s Pa ee ES 5 30 0 0 10 0 0 0 12 s I eiz i soz s H 29 AS 30 i es Reg eee 3 5 fe 5 Si h p Ba Joi bi 4 0 f a ise 957 4 5 m 0 20 0 0 5 0 o ISE 12 Figure 4 63 Virtual Ventilator Panel The Virtual Ventilator may be operated in either Pressure Control PC or Volume Control VC mode When used in VC flow is going to be a dependent variable derived from the set volume and inspiratory flow time It will be indicated on the bottom of the VV panel In PC mode volume will be a function of the lt Peak Pressure gt setting and again timing HOLE BUD Virtifal Venctibitor 15 25 7 0 h es 1 y 30 Se ae jar 8 t 0 trig a 1 trig 1 T 5 35 jea g o 4 r mach mach a SS o n OFF trig a Tey 15 Elfs soo 1000 1200 soo 1400 souks a a koz a i d s HE 2 ic lo 400 1600 SSS amp j aoe UN 4800 rme i o Be i ae i 2 Ls o The Vent Compliance and Resistance Settings represent internal pneumatic properties of the ventilator A reasonably large number for Ce 2 5 mL cmH20 as well as Rino and Rexo at least 2 cmH2O L s is essential for stable operation For more details see Theory of the Virtual Ventilator page 126 Clicking the button will turn the VV off and will close its user interface panel
28. Exporting Data Files 8 Using ASL Utilities The Utilities Selector provides access to a number of file translation and processing modules as well as to examples for data sharing using TCP clients B IngMar Medical ASL 5000 Utilities Selector INGMAR MEDICAL uies Salector Figure 8 1 Utilities Selector 8 1 Exporting Data Files For reasons of speed and reduced file size data generated with the ASL 5000 host software is saved in binary format To make this data available to other software spreadsheets etc a file translation utility is provided It opens by clicking the lt Data File Export gt button top blue button and performs a summary translation of either a single data set or alternatively of a whole directory of captured data You may also choose to manually select an individual file as opposed to a complete data set The following file extensions are used in the ASL 5000 data files and will be processed with this utility the last letter of the extension is used to label either binary b or ASCII a files binary ASCII brb brabreath parameter data file dtb dta processed breath waveform data file rwb rwahigh resolution raw waveform data file avb _ avamodel parameter file ain ainlog file Clicking the lt Data File Export gt button in the File Utilities column opens up the quick conversion utility Path Directory C Program Files ASL Software 3 1 ASLdata data
29. In practice work of breathing is routinely calculated for segments of the breath e g inspiration and or expiration separately Let us begin with inspiration We can rewrite equation 7 after substituting the middle terms of equation 4 as Wim pao Pas APmus d 8 2 E Pro Pas dv AP nus QV i Vei Wye T Wmusitn 9 Theory of Operation Introduction to Ventilatory Mechanics where Va is end inspiratory volume and V is tidal volume In this way we can separately compute the work of the ventilator Wenn and the work of the respiratory muscles Wmas during inspiration We can also substitute the extreme right hand terms of equation 4 into equation 7 to yield Wi J r C Raw dov v_L CL dv JRay bLdv Wainy T Wires 10 Thus the work stored in the elastic components of the ventilatory system Wen Can be separated from the work dissipated or lost in the resistive Components Wes These ideas are illustrated graphically on Figure 13 3 a Ap v plot of the data of Figure 13 2 We can see that except for the initial pressure drop in curve a required to trigger the ventilator the pressure differences and volume changes are both positive on all the curves Thus the calculated work is positive in these regions Positive work corresponds to work done on the ventilatory system by the various pressure differences Negative work corresponds to work done by the ventil
30. Materials Used Inside the Simulator Cylinder Piston plate Piston seal Temperature sensor 8 6 x 16 8 x 12 4 inches 219 x 425 x 315 mm 4 8 x 4 8 x 4 3 inches 123 x 123 x 108 mm not including cable approx 22 Ibs 10 kg in standard configuration 3 5 Ibs 1 6 kg anodized aluminum silicone sealant aluminum closed cell foam pad Teflon Nylon rubber Nylon brass 16 4 Software Specifications to PC host via 10 100 MBit Ethernet units with serial no s gt 0800 alternatively RS 232 at 57600 Baud 8 bit no parity 1 checkbit built in USB converter beginning serial no 1400 Interface LabVIEW modules for modeling simulation data analysis Host Software LabVIEW utilities for breath profile resampling interface module for remote control via external LabVIEW software TCP IP Breath Parameter Client TCP IP Waveform Client 16 5 Environmental Specifications Storage Temperature 10 C to 50 C allow device to reach approximate room temperature before use Humidity 10 to 95 non condensing Temperature 10 C to 40 C Humidity 10 to 95 non condensing Operation NOTE Specifications are subject to change without notice S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn This page intentionally left blank S LOZ PHT JeoIpew seyysu ZAY GE MS 0005 ISV JenueW sasn 145 146 Index A aE E E E
31. NOTE The installation of the Bridgetech database requires Windows XP or Windows 7 on the PC Launch the setup exe file and follow the online instructions as requested by the wizard G J Removeb Endgetech installer Organize Open Burn Hew folder j ST Frores E Desktop b Preegesiies ip Downloads F peupe 1 Recent Places i Figure 3 1 Bridgetech Installer NOTE The installation process for the Microsoft SQL environment might take a few minutes Do not interrupt the process At the end of a successful installation you will see the following screen a a p a Completed Pa AT Sian naib Afe hm aiT i mi lt ete iad ra kbi im mi labe a ra ere adm i rarr Figure 3 1 Completed SQL Installation With this installation you now have two applications on your desktop and in the Start Menu respectively One is called the Autoscan application with its own distinct Icon oon MHT the other one the StudentScan application with a different icon E Preparation Software Installation on the Host PC The AutoScan application performs as its name implies the frequent automatic scans of ventilator data via the VIK This populates a database for ventilator parameters to be included into the simulation data sets The AutoScan application should be launched separately before the RespiSim panel in the ASL host software is opened the first time It may also be launched at any time for che
32. SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 3 3 Pausing a Running Script Besides intervention into a running script via the Interactive Control Panel it is also possible to simply invoke a specific parameter set named pause vr3 via the PAUSE switch on the Run Time Home Display To apply PAUSE click the lt Set Pause gt button in the top right of the Run Time Home Display Simulation EE Figure 4 54 lt Set Pause gt Key The indicator will then show Release Pause Click the button again to return to executing the script The indicator will now show Set Pause again When Pause is active the simulation script is interrupted for example to adjust the experimental setup or to provide additional information to students in an educational setting After releasing a PAUSE the script will be reactivated and continue from where it had been left The patient parameter file pause vr3 located in ASL Software 3 5 vars is active when Pause is set NOTE The content of pause vr3 may be edited just like any other patient model parameter file to accommodate specific needs for these situations 4 3 4 Display Options of the Run Time Home Window The Run Time Home window features two graphical views waveform plots and loop displays In the Waveform View see Figure 4 52 page 43 three individual plot areas show flows pressures and volumes The number of traces for each plot will depend on the model chosen
33. The leftmost tabs of the ICP will set Lung Model Parameters and Spont Breath Parameters 4 5 1 Lung Model Parameters Tab The lung model parameters are displayed as screen images of dial knobs Figure 4 69 Only those parameters that are part of the current model type single versus two compartment etc will show 4 B ingMar Medical ASL 5000 Window Manager ii File Windows Help Customize Setting values for R and C may be performed by clicking and positioning dragging the blue pointer on the knobs to the desired setting or by entering numerical values into the field below the knob When making an adjustment to a setting the knob color will change to orange indicating that a new value has not yet been applied Once the new parameter setting has become active usually after a breath cycle the color of the knob will return to green NOTE When working with the Interactive Control Panel please note that as of sw 3 5 the ICP can be used effectively with pre configured dynamic time varying models from the patient library You may only work with models that do not employ time varying parameters if you intend to manipulate individual settings on the fly INGMAR MEDICAL Figure 4 69 ICP Lung Model Parameters R and C tab Two Compartment 53 54 Operation Running Simulations Using the Interactive Control Panel ICP 4 5 2 Spontaneous Breathing Parameters Tab IngMar Medical ASL
34. The middle third of the control strip will allow you to make basic decisions about setting up a patient model The bottom third contains the controls for starting and stopping the simulation Figure 4 68 ICP Controls Const Vt Const MV and CO2Y refer to additional automatic modes available to control muscle pressure and breath rate in order to achieve a Vt or MV target respectively or an EtCO2 value They are accessed via ICP tabs Closed Loop Vt Closed Loop MV and Closed Loop CO2Y and will make automatic adjustments to the Pmax and breath rate parameters in order to achieve a Vt MV or EtCO2 target respectively In manual mode No Loop the parameters are used as they are set by the user on the tab accessed panels Lung Model Parameters and Spont Breath Parameters to the right S LOZ PHT JeoIpew sewsul O ZA S E MS OOOS ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Running Simulations Using the Interactive Control Panel ICP The automatic parameter adjustment modes are a convenient way to add realism to the model when a ventilator is attached The work of breathing performed by the ventilator is taken into account for setting patient effort WOB done by the ventilator is not simply superimposed resulting in a larger tidal volume or minute ventilation Instead the ventilator intervention will result in a reduced patient effort
35. Window ceeeeeeeeees 45 Lung Fill Indicator Window s s 47 Auxiliary Parameter Displays 00008 47 Modifying Waveform Displays 6 48 Stopping a SIMMUAUON yin is ossotessvertaveseveovents 49 Using the Virtual Ventilator 0008 50 Concept of the Virtual Ventilator 50 S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 5 4 5 1 4 5 2 4 5 3 4 5 4 4 5 5 4 5 6 4 5 7 4 6 4 7 4 8 4 9 4 10 4 11 5 1 5 2 5 3 5 3 1 Se W 3 ee 5 3 4 JR 5 3 0 5 4 5 4 1 5 4 2 5 4 3 6 1 6 1 1 6 1 2 6 1 3 6 2 6 2 1 0 22 6 2 3 6 2 4 Running Simulations Using the Interactive Control Panel ICP 51 Lung Model Parameters Tab 0008 53 Spontaneous Breathing Parameters Tab 54 NEES LaNena E neitad alana ce 55 Closed Loop VET ADs a 56 Closed Loop MV Tad tissanaiausscianactsnespeactens 97 Closed Loop CO2Y Tab 58 Patent Oibtrany TaD auessa eee eenssaees 59 Breath Detection Real Time Analysis Window eooooooossssssssssssssssssssses 60 TCP Broadcast Configuration 6 61 Run Time Home Report Generation ccssssssssssssseees 62 Working With the Analog Inputs 63 Working With the Digital Outputs 63 Exiting the ASL Software ccscss
36. act as a brake on expiratory flow Or they can be negative and compress the system and assist expiratory flow GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Again using Figure 13 2 we can construct a Ap v plot for the expiratory portion of the breath Figure 13 5 Work done by the lungs chest wall and or resp muscles Vei Vee VT on the ventilator negative 3 a o t Vee PAO PBs Work done by the V lungs chestwall and ventilator on the m resp muscles negative Vei Vee VT 6 b W mus insp Ctot x Cg Ctot Cg Vee 0 APmus Figure 13 5 Ap v plots for data in Figure 13 2 with expiration included Theory of Operation Introduction to Ventilatory Mechanics Work done by the lungs and chest wall on the ventilator an resp muscles negative Ctot Vei Vee VT c Work done by the ventilator and or resp muscles on the lungs and chest wall positive Voe Figure 13 6 Ap v plots for data in Figure 13 2 with expiration included As the lung volume decreases the expiratory pathway on the total pressure difference volume plot continues counterclockwise from the end inspiration Va Veet V point on the total compliance curve It eventually meets the v axis at which point Ap is zero and both the ventilator and the respiratory muscles are passive The ventilatory system conti
37. all parasitary volumes volume of the URC the simulator s safety zone and the tubing system as well as resistances the resistance of the connector port and other connected accessories These factors will otherwise render the response of the overall simulator system slightly different from the behavior expected from the selected lung model parameters alone The simulation editor will enter values into the vr3 file that S LOZ P yeoIpew sewsul O ZAY GE MS 000S ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 are correcting for these effects so that looking at the system from the outside it accurately shows the behavior associated with the set model parameters When using the SmartPump mode compensations are always set to 0 the same is true when using non linear compliance models Please remember that compensations entered in the Simulation Editor serve to better match the physical simulator behavior with the theoretical model Compensation settings offered in both the RealTime Analysis or the Post Run Analysis see page 61 on the other hand are used to more accurately determine volumes as they would be reported by a ventilator versus patient volumes taking into account tidal volume absorbed in the patient circuit NOTE For the purpose of calculating tidal volumes the gas compressed in the URC and safety zone are always considered in the ASL analysis and
38. and may include calculated model flow for compartment 1 calculated model flow for compartment 2 calculated total model flow simulator piston flow airway pressure this is the actual pressure measured inside the simulator cylinder calculated tracheal pressure calculated alveolar pressure for compartment 1 calculated alveolar pressure for compartment 2 negative muscle pressure the programmed pressure profile from Step 3 of the simulation editing process calculated model volume for compartment 1 calculated model volume for compartment 2 calculated total model volume simulator piston volume Operation Running Simulations From the Run Time Home Display NOTE No corrections for barometric pressure temperature etc are made at this time to render true BTPS or other standard gas values in the Central Run Time Display waveform or loop graphs Volumes and flows displayed are geometric values at the existing gas temperature shown in the digital display to the right of the plots see also Parameters in the brb Breath Parameter File page 131 and represent piston movement only NOTE Please note that autoscaling is the default in both the waveform and loop view If you prefer to have autoscaling turned off right click on the respective graph and uncheck Autoscale Y in the pop up menu Do NOT uncheck Autoscale X as this will render your graphs invi
39. changes of a simulated patient on the fly In SW 3 5 interactive editing capabilities now nearly match those in the full Patient Model Simulation Editor Additionally you can also invoke autonomously adjusting effort models constant Vt or MV from within the Interactive Control Interactive control represents an overriding mode that can be used during scripted simulation sessions as well as when running RespiSim Curriculum Modules Figure 4 14 Interactive Control Panel NOTE The Interactive Control Panel is by default not active and needs to be started before it becomes active The reason for that is that it supersedes script control as well as RespiSim based control of a simulation Figure 4 15 Start Interactive Control When switching to the Interactive Control tab from the Script Patient Model tab interactive control is automatically started and this step is not necessary 29 30 Operation Getting Started The Real Time Analysis tab is used to view the breath parameters as they are entered into the data stream and to verify proper breath detection More details are given under Breath Detection Real Time Analysis Window page 60 FRR igrl Metical 251 S000 Window Manager I Wirda Cetdgure Hepiiusenee B incMar MemcaL ASL SU treaty itil Bral Tirar Arahi Perd Ean Ainahan List Eskeraren fom rai Bes Tiree Hare Sag alee Montiel Se IncMan METHCAL Save Waveform Data LT Je emren Hreatii P
40. cot tn tai acorctina ENE a tudelnnds 56 W Wal tempera E aeee e 15 47 Waveform sampling rate cccccccccccccscccccceeeceeeeees 35 Z ZOOMIN E kanaan E 73 76 77 83 84 S LOZ PHT yeoIpew sewsul O ZAY FE MS 0005 ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 List of Figures ASL Software Window Manager sssseeeeeeeeeees 5 RespiSim Instructor Dashboard ceeeeeeeeeeeeeees 5 RespiSim Vital Signs MONItOr eee eeeeeeeeeeeeeeeeees 6 Oxygen Saturation UTD UU rasp soars issik arst 6 RES DIP AGM T aeae E buh uees 6 PUNE OMA QV CIV ICW aes ncatd unnan N 14 ASL 5000 with SBLVM and PC ceeeeeeeeeeeeeeeee 14 BriOSeteCm ISta lel ccccntues casnsncens guuedtantecuanedimunthete 19 Completed SQL Installation cc ceeeeeeeeeeeeeeeeeees 19 SBLYM COMMCCUON eroice a a 20 ASL 5000 connector configuration new style dual USB ixenoves Suan see eeatteteuseeyereadetete tees 21 RespiSim Wireless Adapters ceceeeeeeeeeeeeeeees 21 Pneumatic Connections Overview ecseeeceneee 22 Quick Reference Startup Steps 1 and 2 23 Quick Reference Startup Steps 3 and 4 24 ASL Software Loading erreen tanana AE 25 ASL Quick PAM CHIME doucsrsaieniiess buen tinneconoseuctateed 25 Project File Tool Device Identification 26 Project File Tool Graph Colors eceeeeeeees 26 Project Fi
41. individual parameters displayed In this view gains for each parameter can be adjusted individually to adjust the view of multiple graphs click on the W symbol next to the gain factors to view drop down menus of available choices Figure 5 16 Parameter Gains You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The lt RETURN gt button will bring you back to the Main Analysis Menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN gt button before you can open any other view from the Post Run Analysis Menu window S LOZ PHT JeoIpew sewsu O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 5 3 6 Trend Graph Display Post Run Analysis Multi Parameter Tren m lt i imide Data Analysis Display Data Selections Green Buttons Raw data rwb file C Program Files x86 ASL Software 3 5 ASLdata 24_breaths Conditions Display Width Breath 32 E as measured Number of Breaths 72 Figure 5 17 Analysis Trend View In trend view gains can be adjusted individually for each parameter to adjust the view of multiple graphs click the boxes with gain factors to view drop down menus of available choices
42. is not used as instructed the safety protection provided may be impaired 1 1 Definitions 1 1 1 Warnings and Caution Statements WARNING Indicates a potentially harmful condition that can lead to personal injury CAUTION Indicates a condition that may lead to equipment damage or malfunction NOTE Indicates points of particular interest or emphasis for more efficient or convenient operation 1 1 2 Nomenclature Throughout this manual and in the software the word patient is used occasionally to describe a simulated patient as defined by the lung model settings This will correspond to the use of patient in ventilatory patient monitoring in that the lung model is a representation of a patient receiving ventilatory assistance Definitions of breath parameters as they are calculated in the ASL 5000 Analysis Software can be found under Parameters in the brb Breath Parameter File page Dh 1 1 3 Typing Conventions For easy recognition within a sentence file names are typed in italic font e g LASL5000 vars example sct Buttons and controls in the software user interface are designated with lt gt e g lt EXIT gt Drop down menus are shown as lt File gt Items from the drop down menus of the host software are indicated by use of a bold font e g Open Script Software windows or tabs in the user interface are designated in italics and bold font e g Breath Detectio
43. jurisdiction of the Commonwealth of Pennsylvania and agree that any legal proceedings arising out of this Agreement shall be conducted solely in such Commonwealth No action regardless of form arising out of this Agreement may be brought by either party more than one 1 year after a claim has accrued FreeDOS License The FreeDOS operating system running on the ASL5000 CPU is distributed in acccordance with the provisions of the GNU GPL General Public License granted by the FreeDOS Project www freedos org S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 What is New in SW 3 4 3 5 Window Manager Figure 0 1 ASL Software Window Manager Beginning with SW 3 4 all main features of the host PC software are organized under a unified interface based on tabs called the Window Manager Individual windows can be un tabbed by a simple drag operation TCP Waveform Broadcast Traces for the primary analog input and the value of O2 vol have been added to the set of waveforms that can be pulled from this network broadcast In addition there is now the choice of raw or processed data the latter including parameters such as flow as well as the volume correction factors for different volume standards Additional Breath Parameters A number of new parameters has been added to the brb files generated during a simulation These are
44. model requirements This may also be used to invert the signal without having to invert the voltage applied 125 126 Theory of Operation SmartPump Mode 13 5 SmartPump Mode fom Lncompensabed Residual Capacity L Pakit Mot For Fii Pump Micke Made Prerare Pree on Flay Pgfie fl err Wie furor of Piotr Fira Waveforms BETEA H l Fi k Ls gny Ah af ablah che Gre flor the Rage diurai A mato image of pour polie b generated sutomatoslly by the system Figure 13 29 Effort Model Flow Pump The SmartPump Mode covers special cases of a non feedback model Pressure feedback is ignored motion of the simulator piston is exclusively controlled by the programmed breath profile Calibration of the configuration is in units of flow L min or volume L Internally a setting of R 1 is performed so that the numerical value for peak excursion entered in the Chest Wall Model will generate peak flows calibrated in L min Similarly a volume waveform can be created 4th selection in the Lung Model choices where the peak excursion is directly calibrated in Liters In SmartPump Mode only sinusoidal trapezoidal and user defined waveforms are permitted When generating they are always symmetrical i e automatically duplicated as positive pressure profile after the negative pressure flow part of the cycle has been completed EXAMPLE For a continuous sinusoidal flow pump with a peak fl
45. of the SBLVM is that it allows you to set 3 different sizes of leaks This feature can be used to simulate particular patient conditions such as an ET tube leak The leak orifices for these settings may be exchanged for differently sized leak rates The diagram below shows the characteristics of leak flow versus pressure for the standard orifices ASL 5000 Simulator Bypass and Leak Valve Module SBLVM Leak Flow Values 30 2 EE 2 EE 2 Min 22 20 16 1 EE 0 100 orifice 1 8 70 orifice SLPM Leak Flaw da 0 55 orifice 12 10 ho 10 20 20 40 S 60 T 60 emH2Q Figure 10 3 SBLVM Orifice Characteristics 99 100 Options Using the Cylinder Temperature Controller CTC 10 2 Using the Cylinder Temperature 10 3 Using the Fast Oxygen Controller CTC Measurement Option FOM The PID controller for maintaining wall temperature inside the cylinder is a unit that operates independently from the host computer Therefore all settings are made directly on the controller interface on the ASL 5000 and not in the PC host software Figure 10 5Paramagnetic Oxygen Transducer The FOM Option consists of a paramagnetic oxygen sensor with a miniature vane pump for sidestream measurement of oxygen Figure 10 4 Cylinder Temp Controller Front Panel If this option is installed in Data your ASL 5000 simply Enabled To change the temperature setting simply press th
46. online training can be performed with students primarily for the benefit of understanding basic concepts of ventilation before they are exposed to a clinical scenario simulation RespiSim has significantly evolved from sw version 3 3 where it was first introduced to the current sw version 3 5 It creates a fully integrated respiratory simulation experience for training students in the subjects of mechanical ventilation and ventilator management It gives the educator the ability to control a structured multi phase simulation scenario from a dedicated Instructor Dashboard to capture data from a real ventilator as well as from the ASL 5000 Breathing Simulator via the VIK to mark and annotate events and 1 IngMar Medical has partnered with Bridgetech Medical a specialist in electronic charting systems for respiratory care envi ronments to integrate data from a wide range of ventilator manu facturers For more information on Bridgetech Medical solutions for electronic charting please visit www bridgetechmedical com Introduction System Features to replay the compiled recording during debriefing sessions or for classroom instruction RespiSim is designed to bring the advantages of medical simulation accelerated immersive learning training with permission to fail to respiratory care education Preconfigured Curriculum Modules form an integral part of this new method of instruction Please see
47. refer to Technical Data page 141 for ordering information and specifications of the options The Simulator Bypass and Leak Valve Module is an externally connected system component It serves two functions For one it allows ventilation of a simple test lung IngMar Medical QuickLung for example or breathing bag while no simulation is running on the simulator In this way nuisance alarms from connected ventilators are avoided In addition the SBLVM also provides a manual setting of system leaks at three levels Fast Oxygen Measurement is based on a paramagnetic oxygen sensor capable of breath by breath oxygen analysis It is completely integrated into the simulator and the data is fully shared with the analysis software The Cylinder Temperature Controller allows temperature of the simulator cylinder walls to be controlled for calibration type measurements The controller operates independently from the host software on the PC but data on cylinder wall temperature is fully shared with the analysis software The Auxiliary Gas Exchange Cylinder is a bag in bottle external accessory and allows the use of the simulator with aggressive aerosols or anesthetic agents as well as humidified gas Via the new Virtual Ventilator feature the software can be used to demonstrate and evaluate the interaction between a ventilator and a patient without involving the physical hardware either ASL 5000 or actual ventilator In this fashion
48. retrofitted with the necessary connector functionality without CPU upgrade older units require a more complete upgrade including a new CPU for this purpose Please inquire about pricing Introduction Simulator Software 2 5 2 Software Structure The system software running on the Embedded Controller PC in the instrument is assigned the task of calculating the model and giving the appropriate commands for piston movement in real time at the internal control frequency 2 kHz It also sends the essential data to the host running the Windows DLL for displaying parameters during simulation Data is also passed to the Real Time Analysis routines for storage and breath parameter calculation An important task of the host software is to initialize the simulator at the beginning of each simulation and to synchronize the instrument and host PC properly before each simulation run The runtime software module also checks the embedded controller s resident firmware in the instrument and alerts the user to update if a newer version is found on the host NOTE An update is not usually mandatory to run newer host software as long as the installed firmware in the simulator supports version 3 5 of the ASL host software choose Ignore when the update alert pops up Certain features for which firmware support from a newer version would be required might not work in this case NOTE Beginning with SW release 3 1 the system uses 32 bit fi
49. shall not be liable for nor shall buyer be entitled to recover any special incidental or consequential damages or for any liability incurred by buyer to any third party in any way arising out of or relating to the goods Patents The device is protected under US patent 5975748 which it uses under exclusive license Trademarks ASL 5000 RespiSim andQuickLung are trademarks and registered trademarks of IngMar Medical Ltd respectively Windows and MS DOS Microsoft Corporation LabVIEW is a trademark of National Instruments Corporation OxSim is a trademark of Pronk Technologies All other trademarks or registered trademarks are property of their respective owners are registered trademarks of Copyright 1998 2015 IngMar Medical Ltd No parts of this document may be reproduced stored in a retrieval system translated transcribed or transmitted in any form or by any means without identifying its authorship as IngMar Medical Ltd Software License Agreement Acknowledgement of this license agreement is also part of the host software installation process LICENSE AGREEMENT BY INSTALLING AND USING THE SOFTWARE YOU INDICATE ACCEPTANCE OF THE FOLLOWING TERMS AND CONDITIONS ENTIRE AGREEMENT YOU ACKNOWLEDGE THAT YOU HAVE READ THIS AGREEMENT AND UNDERSTAND THIS AGREEMENT THE AGREEMENT IS THE FINAL COMPLETE AND EXCLUSIVE STATEMENT OF THE ENTIRE AGREEMENT BETWEEN INGMAR MEDICAL LTD
50. simulation runs specifically to start and stop simulations select display options such as the FillBar select and view waveforms and loops enable additional parameters print reports and launch the Interactive Control Panel or RespiSim 43 44 Operation Running Simulations From the Run Time Home Display 4 3 1 Initializing the ASL 5000 Simulator Upon launching the host software and selecting Use Software with ASL 5000 or From Current Project File from the Welcome window the host computer will attempt to synchronize with the ASL 5000 The software will continue to keep sending its sync message If no ASL 5000 can be found on the specified communication port either COM port USB or Ethernet port a dialog box opens indicating that no communication of the host with the simulator has been established see also Changing the Default Communications Port page 21 for making a change to the assigned COM port when operating a RS 232 USB connection At this time the user may still switch on or re start the simulator It is however recommended to then wait until the red light in the Motor Enable Disable switch is off before acknowledging the message by clicking OK In this fashion you will ensure that the simulator has properly initialized first before the next attempt at synchronization If still no handshake is achieved after another 20 seconds the user will first need to remedy the
51. step has been taken you may continue to re attempt connection or cancel the operation CLOT PH JedIpew sewsu ZAA GE MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 The status line on the Run Time Home window will tell when the simulator has successfully synchronized with the PC and a simulation may be started executing the current script see Running Simulations From the Run Time Home Display on page 43 i NN CST Waiting for synchronization between host PC and ASL 5000 iteration 69 ig Program Files x86 ASL Software 3 5 vars defaultvr3_ GP Fow 0 000 0 0 Figure 4 12 Run Time Home Sync Message 4 1 6 Window Manager Tabs Overview Opening the Script Patient Model tab allows to select a script to run or to edit its model parameter files see Working with the Simulation Script Editor page 31 VRE UU breil elit Figure 4 13 Script Patient Model Tab Scenario Scripts NOTE All tabs of the Window Manager can be detached and made to float as independent windows for simultaneous viewing Click and drag a tab to create a separate window minimize the window to re attach it to the Window Manager You can also move directly from there to fully interactive models starting the Interactive Control Panel tab or start the RespiSim environment Operation Getting Started The Interactive Control tab allows parameter
52. the data file The Post Run Analysis module enables the user to store analysis results in two types of files a breath parameter file and a time based waveform file The module allows printing and viewing of analysis results in several task specific screen windows The Post Run Analysis Module is automatically loaded and started when the main LabVIEW application is launched To access the Post Run Analysis Main Menu screen click on its tab in the Window Manager NOTE The Real Time Analysis tab is always available as an adjunct to the Run Time module of the ASL 5000 software It is used to monitor data analysis in real time while a simulation is running thus allowing for adjustments of thresholds to ensure that already the initial pass of data analysis yields useful results see Real Time Analysis Tab page 60 NOTE The structure and performance of the Real Time Analysis is very similar to the Post Processing window opened by clicking on the blue lt Process Data gt button in the Post Run Analysis Menu The latter is used to perform a re analysis of previously collected waveform data when necessary In addition data may be analyzed in spreadsheets and other third party software Aside from providing ASCII versions of the data files collected via the Utilities tab and lt Data File Export gt there is even the possibility of third party software connecting directly to the data stream taking advantage of the built in TCP se
53. the ventilator lungs and chest wall positive b Ctot x Cg Ctot Cg au 0 APmus Figure 13 3 Ap v plots for a airway body surface pressure difference b effective muscle pressure difference and c total driving pressure difference each versus ventilatory system lung volume change during inspiration for data in Figure 13 2 Cg is the compressibility of the gas in the ventilatory system PEEP is positive end expiratory pressure Vol Ctot Vei Vee VT ventilator and or resp muscles on the lungs and chest wall positive f Work done by the c PEEP AP tot Figure 13 4 c Ap v plot for c total driving pressure difference However because a simulation permits the calculation of variables that may be unobservable in real life we have the effective muscle pressure difference available here and can plot it directly as in Figure 13 3 b There is no need to resort to plotting Pes Pgs This makes visualization of the various driving pressure differences much clearer Expiratory Work During quiet breathing both spontaneous and assisted the prime mover of expiratory flow is the energy stored in the expanded elastic components of the ventilatory system Complementing this are effective pressure differences if any produced by the respiratory muscles APmus and the ventilator Pao Pss These two pressure differences can be positive in which case they retard or
54. the desired parameter curve segment in the Parameter Curve Segment Editor click lt Ok gt When you have completed setting the time varying behavior for an individual parameter click lt OK gt in the TVP window and move on to the next model parameter When finished editing the desired time varying parameters click lt Done gt in the Time Varying Parameter Menu dialog box This will return you to the Lung Model screen NOTE Model parameters pertaining to the Patient Effort Model spontaneous breathing definitions are set in the same fashion in Step 3 of modeling process when TVP has been chosen see page 41 NOTE As of software 3 5 pre configured TVP patient parameter files can now also be used in conjunction with the Interactive Control Panel ICP Individual control of parameters is then disabled in the ICP tabs 1 Please note that as of SW 3 2 any transients are defined relative to the beginning of the segment Previously they were referring to the beginning of the whole script Operation Modeling Using the Simulation Editor Environment 4 2 10 Advanced Model Settings Parabolic Linear Resistors Parabolic resistor response according to the definitions used in ASTM F1100 may be selected with this switch In the case of a two compartment model this choice applies only to the tracheal resistor Rt In the single compartment configuration the switch setting determines behavior of the single resistor R
55. to be trained in the basic handling of ventilators as well as in recognizing potentially dangerous or challenging patient conditions Scenarios for teaching those skills are also easily within the scope of the RespiSim system and it will require only a creative instructor to implement exercises that will greatly enhance the depth and speed with which such skills can be learned Since the ventilators report alarm limit settings and alarms training modules around these subjects are expected to play an important role already in the near future GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 6 2 Use of RespiSim with Dedicated Educational Modules 6 2 1 Philosophy of Instructor Driven Multi stage Clinical Simulations RespiSim employs a specific approach to immersive simulation described below High level clinical simulations generally have to accomplish two things simultaneously While they are meant to create situations that trainees perceive as realistic at least as far as their task critical aspects are concerned they also need to reign in realism to a degree in order to make a simulation successful An instructor has to be enabled to impart where needed information that the learner needs in order to complete the challenges successfully Except for in high stakes testing trainees are not usually left to their own devices to figure
56. unchecking Enable Analysis it is enabled by default Breath Detection Settings You can also choose to have a digital filter applied to the airway pressure data default setting is a 10 point moving average Figure 4 81 Pressure Filter Choices A 5Hz 2nd order Butterworth filter may be chosen to prepare data during pressure stability tests for CPAP devices ISO 17510 Alternatively filters may be turned off if desired Click the up or down arrow to scroll through the options Breath detection parameters right side of the RTA window should not be modified from their default settings unless you notice that the volume plot in the RTA window does not show properly identified individual breaths G LOZ PI JeoIpew sewsul O ZAY S E MS 000S ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 For neonatal applications on the other hand threshold values should routinely be changed from their value of 5 mL to a smaller setting typically 0 5 mL NOTE As of software 3 2 an adjustment is applied for the amount of both inspiratory and expiratory threshold volume Tidal volumes reported are not diminished by the thresholds Compensations Auxiliary Compensation Parameters set in the RTA window are for properly adjusting calculations with regard to the compressible volume and external resistances introduced to the system via connectors and external circuits The effec
57. using serial communication In order to do so you simply need to make this change in the ASL Project File Tool accessible from the Full Choice Welcome window After saving your change on the PC the host software will store the assigned COM port for communicating with the ASL 5000 instrument in the Project File NOTE Please make sure that the communication port selected actually exists on the PC COM port assignment for the USB RS 232 converter 3 2 5 Communication Setup for the RespiSim Option RespiSim comprises a hardware component the RespiSim Wireless Adapter VIK Bridge that connects directly to a ventilator s serial RS 232 data port please see specifications for a list of compatible ventilators NOTE Please note that some ventilators require more than one connector from the kit There are two types of adapters the original Bluetooth based version left and the second generation WiFi Bridge right Figure 3 3 RespiSim Wireless Adapters Included in the kits are a few pieces of adhesive hook and loop mounting strips for the purpose of conveniently attaching the Bridge to any of the ventilators An optional electronic charting device handheld device Tablet PC running Windows 7 not included in the RespiSim package may be used to install the StudentScan software and to practice proper 21 22 Preparation Connections documentation of a respiratory patient s treatment Please contact I
58. using the software included with the adapter or the Windows Device Manager For changing the default COM port used by the ASL 5000 software please see instructions below Changing the Default Communications Port Please note that IngMar Medical cannot endorse other than the included model of adapters for their feasibility for the specific requirements of the real time communication of the ASL 5000 software Please contact IngMar Medical with questions you may have setting up this type of serial communication The COM port labeled Terminal on older ASL 5000 is used for connecting a PC for service and troubleshooting purposes as a terminal using for example Hyperterminal which is part of MS Windows Accessories under Windows XP or the freeware program PuTTY Using a terminal program allows a technician to directly interface with the embedded PC in the ASL 5000 for troubleshooting or other service purposes On newer devices with dual USB ports the one used as a service port is plugged with a removable rubber insert to avoid attaching the standard communication cable by mistake Figure 3 2 ASL 5000 connector configuration new style dual USB 1 the connection labeled Host Preparation Connections 3 2 4 Changing the Default Communications Port Depending on your PC hardware and other applications installed on your PC it might become necessary to assign a different COM port to connect the ASL 5000 when
59. which we will disregard For the same force produced the most energy is required when the muscle shortens during contraction Less energy is required when the muscle lengthens during contraction The least is used when the muscle does not change length during isometric contractions When the muscle changes length under load work ts involved During Theory of Operation Introduction to Ventilatory Mechanics isometric contraction no work is done no matter how much force is produced Nonetheless energy oxygen is consumed In a similar manner a ventilator or other mechanical device uses energy to produce the pressure difference required to assist or support breathing This energy usually electrical or pneumatic is above and beyond that required to maintain the device in an on or active state During inspiration the vast majority of work done by the respiratory muscles and or the ventilator is positive i e done on the ventilatory system Depending on the wave form breath rate and system mechanical properties a portion of this positive work is stored as potential energy in the elastic elements of the tissues and the remainder is dissipated by the resistive elements as heat to the atmosphere Not all inspiratory work may be positive In those ventilators that require a drop in airway pressure or flow to initiate an assisted breath positive work is performed by the respiratory muscles and the same amount of
60. work energy dissipated lost during expiration in the passive resistive components of the ventilatory system i e airway and tissue resistances This process is the same as occurs during inspiration when work energy represented by area 3 is dissipated lost in the system s resistive elements Over the complete breathing cycle all of the work invested in the breath is ultimately lost as heat S LOZ PHT yeoIpew sewsul O ZAY FE MS 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 13 1 2 Abnormal Lungs Uniform Lungs Ventilatory mechanical abnormalities can manifest themselves in various ways We will consider a few of them here As previously stated the normal ventilatory system acts as a single unit with approximately constant linear mechanical properties C and R It exhibits a single time constant t RC Each of these parameters in a normal system has a value within its respective normal range Abnormality can be inferred by an R C or t either above or below this range AP tot 0 time Figure 13 8 a Volume and flow responses to the same Apia forcing function for ventilatory sys tems with different time constants The time constant of the restricted system Tp is less than that of a normal system ty The obstructed system s time constant To is larger than normal Tp lt Ty lt To Theory of Operation Introduction to Ventilatory Mechani
61. 0 12 ASL Mobile Cart GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 11 Troubleshooting 11 1 Common Errors The following conditions are problems that can be easily identified and remedied by the user NOTE Please also check IngMar Medical s website gt FAQ for an expanding list of frequently asked questions Simulator piston does not move At the simulator power entry module back of the unit check that power is switched on light in the green switch must be lit Verify that the Motor Enable Disable switch on the front panel is not in the disable position red light must be OFF after the initial bootup of the system approxi mately 15 20s If light stays on even after switch is pressed down this indicates a software motor disable The simulator might have disabled the motor because the simulation requested a piston position that resulted in an unacceptable position error tidal volume too large considerable negative pressure applied at the ventilator connection acceleration demands exceeding simulator capabilities etc In order to reset the ASL 5000 in this case switch power off wait a few seconds then switch power back on again The software will also not enable the motor in case of a failed boot procedure Host does not sync up with simulator Check that power is switched on at the simulator power entr
62. 0 DOS Using PuTTY or a similar terminal program on the COM2 serial port of the ASL 5000 labeled Terminal 9600 8 N 1 interrupt the program flow with the button combination Ctrl C Switch to the c prompt type c and change directories to c ung type cd c lung Then execute the command copy ASLNEO25 40 ASL5000 DOS Before use of the ASL 5000 with the standard 7 Adult Cylinder perform the copy command using the file ASLADL70 40 to return to the standard setting copy ASLADL70 40 ASL5000 DOS 10 6 5 Operation with Attached Preemie Cylinder Please keep in mind that maximum flow rates and volumes are reduced by approximately a factor of 8 when using the Preemie Cylinder Patient parameter files vr3 files require settings that are compatible with the physical characteristics of the altered system As a general rule it is the relative size of the piston area rpc rac 0 12755 that is responsible for the differences 1 When using an ASL 5a000 equipped with the most recent CPU Helios user interface cosole redirection first needs to be turned on For this purpose immediately use the lt Esc gt key to enter BIOS mode Options Preemie Lung Cylinder Kit Please make sure that the line for pressure measurement is properly reading the pressure from the cylinder that is in use Use the stopcock orientation as it is indicated on the label on the front of the ASL Figure 10 11 Preemie Cylinder Pressur
63. 15 4 2 5 Step by Step Script Generation Without Using a Scenario Script For the alternate method of selecting different simulation parameter sets and to assemble a script sequence use the Manual Scripting tab directly following the procedure described below ow 3 ca dow Ma ager ScriptFile ParameterFile Windows Help Customize Sa _ ar i anaa baal ae SE i EEEE o 1000 ASLVarsDirectory gt scenarios Adult_normal wr3 Path to parameter file J Program Files x86 ASL 3 5 vars scenarios Adult_normal vr Browse arer of ene goo Figure 4 31 Script Editor Manual Scripting Double click the highlighted script line in the Manual Scripting tab to edit the model This will open the window in Figure 4 31 labeled Step 1 Operation Modeling Using the Simulation Editor Environment 4 2 6 Step 1 Select Simulation Parameter Set In Step 1 you can browse for a different parameter file vr3 file change the number of repetitions that a particular parameter set will run or enter the simulation editor to modify the selected vr3 file by clicking lt Edit gt In the simulation editor several advanced model settings can be selected for the lung models They are compensations see page 36 time varying parameters see page 37 parabolic linear mixed resistors see page 39 independent inspiratory and expiratory resistor set
64. 5 maintenance reminder messages for both calibration and seal replacement are implemented For details about available service subscriptions or extended warranty plans please contact IngMar Medical Customer Care at 1 800 683 9910 or 1 412 441 8228 ext 107 or e mail to customercare ingmarmed com S LOZ PHT yeoIpew sewsul O ZAY FE MS 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 12 3 Firmware Upgrade NOTE The following instructions only apply to devices that have been delivered with or have been already upgraded to a version of SW 3 1 or higher i e a firmware of 4 6 nn or higher Older units first require a 32 bit prep with service firmware In this case please contact IngMar Medical or your local technical representative to perform the necessary steps Switch power to simulator off and after waiting a few seconds back on SE IngMar Medical ASL 5000 Welcome Advancing Respiratory Simulation INGMAR MEDICAL Figure 12 2 Firmware Upgrade Normal SW Launch Re launch the host software 3 5 on your PC and select operation with the simulator via Ethernet recommended or RS 232 from the full choice menu If the software detects a firmware mismatch older firmware on the simulator than what the host software application expects Maintenance Firmware Upgrade the following window will appear Ja aida New Software piran s
65. 5 vars lt ASLDefaultInstallDir gt C Program Files x86 ASL Software 3 5 lt My Tests gt C Program Files x86 ASL Software 3 5 vars tests MH Please select a token and path Figure 4 27 Tokens Relative Path Configuration Tool Clicking lt New gt will let you select a folder location that you may want to give a friendly name to From the Add Edit Relative Path window you can browse to an existing folder that you wish to select The path is entered into the Actual Path space Alternatively you can also write directly into the ActualPath space e g when a folder to be assigned a token has not yet been created you would not be able to browse to it NOTE The tokens lt ASLVarsDirectory gt and lt ASLDefaultInstallDir gt are protected names and cannot be edited After your configurations are complete click on the lt Done gt button to return to the main Simulation Script Editor 33 34 Operation Modeling Using the Simulation Editor Environment Using the lt Exchange with Configured Token gt button now allows to switch between tokens for example to accommodate a new file location for parameter files lt ASLVarsDirectory gt tests C20_R20_step_P15 vrs3 lt ASLVarsDirectory gt tests C50_R5_ step _ P10 vr3 lt ASLVarsDirectory gt tests 50_5PT vr3 BR Token and Path Selection Token lt My Tests gt Path to Replace lt ASLVarsDirectory gt tests
66. 7 Independent R Settings Rin lt gt Rout 4 2 12 Advanced Model Settings Non Linear Compliances If a two compartment lung model Non Linear has been selected the non linear Compliance compliance switch becomes vana available Otherwise it is grayed out and therefore inactive Switching non linear compliance on will mke co add an lt Edit C1 gt and lt Edit C2 gt _jme compartment models button to the screen The original maae ee screen control s for compliance are grayed out and the settings made there become invalidated Figure 4 48 Non Linear C Clicking on the lt Edit C1 gt or lt Edit C2 gt button opens the Non Linear Compliance Editor window where the shape of the compliance response can be modeled by entering numbers in fields or directly into the graph You also have the option to check C1 C2 which will turn the model you define effectively into a uniform model where compartments C1 and C2 represent half of the overall compliance NOTE Internally the ASL 5000 always operates a two compartment model So even in the 1 compartment case you are manipulating two chambers which in this case are maintained identical To help the user keeping this in mind when shaping the pressure volume relationship a second volume scale for the combined compartments is shown on the right side of the Non Linear Compliance Editor graph whenever the C1 C2 option had been selected i ood j J E
67. A RR NJA kalas NJA mK 32 0 Bp 14a on ep ian f on B9 ep saa f Spo SpO2 na a i ae nse va ph 7 29 a a ao 02 o2 02 50 AS Breath Number woos HODI 34 ne seo imna farm foma f unm f Figure 0 4 RespiSim Instructor Dashboard ZE IngMar Medical ASL 5000 Vital Signs Monitor INGMAR MEDICAL ASL 5999 Vie Signs wlouicur Figure 0 5 RespiSim Vital Signs Monitor Optical Output for Oxygen Saturation An interface to supply values of SpO2 to a Pronk OxSim has been added to Software 3 4 This enables RespiSim based simulations to realistically interface with ventilators that take advantage of saturation readings and or heart rate for their advanced control modes 110 115 J 34 nja Figure 0 6 Oxygen Saturation Output S LOZ PI JeoIpew sewsul O ZA S E MS 000S ISV ENUeW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 RespiPatient As part of the RespiSim system IngMar Medical has added a dedicated torso manikin RespiPatient to help with training for more realistic scenarios Cardio pulmonary resuscitation lifelike recoil during chest compressions Intubation orotracheal nasotracheal combitube LMA placement difficult airway tongue edema Bag valve mask ventilation techniques Tension pneumothorax Identification of tracheal deviation and jugular vein distension Either right or left tension pneumothora
68. ASL host software For pre configuration of the TCP waveform client please refer to TCP Broadcast Configuration page 61 It also shows you how to make the choice of either raw or orocessed data to be broadcast 1 Other TCP IP listening applications may be developed by users in different programming environments TCP Data Broadcast Breath Parameter Broadcast S TCP Breath Client ru a O NoMa MEDICAL Respiratory Simulation Specialists IEP hrath Eliant Server TCP IP Address Server TCP IP Port localhost 6342 Table Control Breath Number Breath Type 8 000000E 0 Spontaneous Insp Breath Type Unknown Breath Rate BPM 1 400182E 1 I Time 5 1 144531E 0 Insp 2 670921E 1 Pause Time 5 0 000000E 0 Pause 0 000000E 0 E Time 5 3 240625E 0 ET Y LAADIOS 4 Raw String 1 400182E 1 1 144531 F 0 Waiting for next breath Figure 9 1 TCP Breath Client OOOO Airway Pressure cmH20 Muscle Pressure cmH20 Tracheal Pressure cmH20 Chamber 1 Volume mL Chamber 2 Volume mL Total Volume mL Chamber 1 Pressure cmH20 BM Chamber 2 Pressure cmH20 B Breath File Number Aux1 V Aux 2 V Oxygen Sensor V Breath Detection Server TCP IP Address Jlocalhost gens z Port I I 1 00 01 05 0 00 01 11 3 i 00 01 00 0 Time EFEN a a Run Ti
69. INGMAR AND YOU THIS AGREEMENT SUPERSEDES ANY PRIOR AND CONTEMPORANEOUS PROPOSALS PURCHASE ORDERS ADVERTISEMENTS AND ALL OTHER COMMUNICATIONS IN RELATION TO THE SUBJECT MATTER OF THIS AGREEMENT WHETHER ORAL OR WRITTEN NO TERMS OR CONDITIONS OTHER THAN THOSE CONTAINED IN THIS AGREEMENT AND NO OTHER UNDERSTANDING OR AGREEMENT WHICH IN ANY WAY MODIFIES THESE TERMS AND CONDITIONS SHALL BE BINDING UPON INGMAR UNLESS MADE BY A WRITTEN AGREEMENT EXECUTED BY DULY AUTHORIZED REPRESENTATIVES OF BOTH INGMAR AND YOU SOFTWARE AND DOCUMENTATION LICENSE 1 IngMar hereby grants you a non exclusive non transferable license to use the enclosed computer instrumentation software the Software and any associated printed documentation the Documentation subject to the limitations set forth in this Agreement the License You may use the Software only on one central processing unit with one input terminal at any time All right title and interest to the Software and the Documentation are R remain in IngMar and or its licensor You have no right of access to the source code of the host system software the software running on your PC or the ASL 5000 firmware the software running in the ASL 5000 instrument You are entitled to updates or upgrades of the Software or Documentation only as set forth in your purchase agreement for the ASL 5000 instrument 2 You may not alter assign decompile disassemble distribute lease modify
70. J McElroy MB Silver stone NJ and Radford EP Jr Mechanical Factors in Distribution of Pulmonary Ventilation J Appl Physiol 8 427 1956 S LOZ PHT yeoIpew sewsul O ZAY FE MS 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Figure 13 11 illustrates the effect of increasing breath rate in a two compartment ventilatory system Ctot static u Vee VTo Ctot f asf A Vee VTi Vee VTi 1 lt f2 Vee PEEP APtot Figure 13 11 Ap v relation for a two compartment ventilatory system as breathing frequency is increased The same amplitude Ap is applied at all breathing frequencies but only during inspiration The apparent compliance decreases so that for the same driving pressure difference by either the ventilator or respiratory muscles or both the tidal volume decreases The peak flow can increase 13 1 3 Energetics The mechanical work of inspiration i e the work of deforming the lungs and chest wall and of creating a pressure gradient through which a volume of gas is moved is the primary work related term used to describe the status of the ventilatory system However it does not necessarily account for all the energy expended during inspiration Whenever a muscle actively contracts it uses energy sometimes expressed in terms of oxygen use e g the oxygen cost of muscle activity This is over and above its basal metabolism
71. MEDICAL ASL5000 Software C Program Files w86 ASL Software 3 5 ASLdata data Figure 4 5 Project File Tool Output Settings GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Getting Started Relative paths or path segments can be configured as As a new option in SW 3 5 the settings of the Virtual tokens from the Script Editor Preferences tab when you Ventilator see page 50 are also part of the Project File invoke the Relative Paths Configuration Tool For details Tool on this tool please see Using Tokens page 33 SE ASL Project File Tool INGMAR MEDICAL lt ASLDefaultinstallDir gt C Program Files 86 ASL Software 3 5 lt My Tests gt C Program Files w86 ASL Software 3 5 war ram Files 86 ASL Software 3 5 war ram Files 86 ASL Software 3 5 EDF ram Files x86 ASL Software 3 5 var Figure 4 6 Project File Tool Relative Path Tokens C Program Files x86 ASL Software 3 5 Current ASL Project File ini From the tab Default Analysis Parameters you Can pre Frog x86 A j select the 8 parameters showing in the Real Time Analysis window as well as those for the Post Run Analysis Trends Lost ES l Figure 4 8 Project File Tool Virtual Ventilator Settings After making all edits for a desired project file y
72. Medical website we also offer a section labeled Tips and Tricks http www ingmarmed com support asl 5000 training support tips tricks We recommend looking there for information about a wide range of topics A Virtual Visit live conversation while the customer shares his her screen is a very effective way of accelerating the learning curve of a novice user 3 Hours of this type of support are included wit the purchase of each ASL 5000 Breathing Simulator Please contact Customer Care at 1 800 583 9910 ext 107 about additional support plans that you might be interested in purchasing GoToMeeting Suite GoloMeeting Meet Now Figure 15 2 Online Support Sessions Easy Online Meetings Anytime Anywhere Schedule Meeting My Meetings G LOZ PH JedIpew sewsu O ZAA S E MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 16 Technical Data 16 1 Performance Specifications Modes of Operation Volumes Standard 3 L Cylinder Total Tidal FRC setting Deadspace Volumes 6 L Cylinder Total Tidal FRC setting Deadspace Volumes Preemie Add On Cylinder Total Tidal FRC setting Deadspace Frequencies Spontaneous breath rate Small signal bandwidth Flows Peak flow Flow rise Low flow Passive Model Resistance Compliance Passive Spontaneous Interactive with adjustable re sponse to ventilator breaths
73. N et ia qm j osm haa bistya miasa Mesra imig Torgi Pahami Pine Bas ams Beste Ir _ _ l InchlaR MEDCAL E E ua T E Co Peger Fin PA E mien 27 loans Daaa a ki grea pm PETT AiR frg Figure 4 19 RespiSim Tab S LOZ PI JeoIpew sewsul O ZA S E MS 000S ISV ENUeW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 2Modeling Using the Simulation Editor Environment Full featured modeling is performed from the Simulation Script Editor tab on the Window Manager The following paragraphs explain how parameters are set and their significance in the modeling process For an introduction into the background of the modeling process please refer to Introduction to Modeling page 119 as well as Introduction to Ventilatory Mechanics page 109 NOTE In addition the Interactive Control Panel provides an alternate method of patient parameter manipulation in an interactive fashion while a simulation is running see Running Simulations Using the Interactive Control Panel ICP page 51 The different screens of the Simulation Editor and the associated parameter editors for non linear compliance time varying parameters etc present a structured environment for all parameter settings of the simulated patient Parameter files as well as script files may be called and saved from the Simulation Editor The steps to generate a valid model ar
74. P A T 101 Analog Channel Option aver cides chicken an 63 Ahalo Cale eeo eea a E i 69 Analysis Module starting ssseeeeeeeeeeeeessssssssssssse 66 ANESNEICS wiseana E RS 13 ASLANIN eera i ENN 45 Auxiliary Gas Exchange Cylinder eee 101 B Barometric PreESSUTE seriearen e e e 16 47 Breath Detection Real Time Analysis window 60 C Calibration Intervals eonia aesa 106 CHRONI porran enue NON 18 Central runtime module sosrcceniiiisine 45 AEM Ch cessi a sa eaenasasentureniedcc 45 CHEST wal Model eared aS 41 121 Closed Loop MV kersrosissneasiergni eaan 52 57 Closed 00D VE iaria a eee 52 EE E AEE E ees E I A A E E 58 COM Seal PONE nerra i tue tlucnias 21 Compensations Real Time Analysis window 61 Compliance simulation 3 55 tarnncaessaresl sagt detell areata 14 Configuration voltage for CTC eee 20 CONMECUIONS motan ara tant uetatiee sna 20 elf Gi ere eerste nee tere eer rere tn ere eee ere ener 20 Connections DNeuMalIC cuties cua beans 22 Connector specification for analog channel 63 CONTONE GUSI vaia T 17 CFC gorra ee ETE ER 14 Cylinder Temperature Controller sssssssseseeeseeeeeeess 15 Cylinder Temperature Controller CTC 100 D BENI Sasa ce ators E E A AAA 13 Data Tey OCS aran A alae 92 Data file MANAG sereoo e E E 44 Data files external for pressure profiles 125 Wa Pac MUARY senice e daheue 47 DEERE lt x cae tise cates ce eewe E stat G7 DBI
75. Panel 53 Lungs MONI TON Ml airen hays Nad cxecsvansivas c tries 116 MOINS MINION cca telat te icca E O ces 115 S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 M IMAI MCMAIICE iiacistinnsieeanic ds eemetee chousioks awesuatepetiat 106 MATLA D Neer me eigen erm ern erry ene 69 Measurement fast OXYQEN eee eeeeeeeeceeceeeeeeeeeeneaees 15 Measurement gas temperature ccceeeeeeeeeeeees 16 Model chest Wall asc tscchcvbstethadssacginas Mee a 121 Model dual compartment cccceeeeeeeeeeeeeteeeees 120 Model limitations Of c cece eee eecceecceeeee soe soee 119 MOGE li passie oserei ase 121 Model single compartment ceeeeeeeeeeeeeeeeees 120 Modeling introduction to ssssssssssssssssseeresseeseesees 119 Multi stage Clinical Simulations ccceeeeeeeeeeeeee 89 MV TAN OU series a L 57 N NON SCID cerar EE A E 32 Non feedback model SmartPump mode 126 NOMEE Oa TANG LORS wena e meet aeanstueas 88 O Odometer install date wo cece cecceeceeseeseneeee 106 Odometer piston cycles ayereesssevesnacecsiadeneesnseoiaomnn 106 Operator s Manual for CTC ccceccccccccccceeeeeeeees 100 DU ONS ra E ease 14 98 OSC ALOIS es a E 106 Over voltage protection a0vscivesessdearcenss lecuvehanedeoeennes 63 OV EIVICW at a a E sehen teases 14 Overview schematic c cec cece eccse
76. Parabolic response is the natural behavior of an orifice resistor with turbulent flow Linear response Mixed assumes laminar flow which Parabolic means that flow through the Linear resistor increases relative to the driving pressure in a response applies to strictly proportional fashion R Rt only Figure 4 45 R Types NOTE There are two implementations of the parabolic resistor response a purely parabolic or the mixed case For the latter resistance is calculated in such a way that always the larger of the linear or parabolic resistance values applies For very low flows this means that the linear value is used which in this case has the higher P Flow ratio This approach avoids the value for Resistance being very close to O for small flows enhancing overall system stability 4 2 11 Advanced Model Settings Independent Inspiratory and Expiratory Resistor Settings A second switch related to resistor behavior allows the selection of independent values of resistance during times of expiratory flow in lt gt out a in out Figure 4 46 Independ R 39 40 Operation Modeling Using the Simulation Editor Environment Choosing Rin lt gt Rout implies that all resistor values in the model need to be defined both for inspiratory and expiratory flow conditions The respective parameter controls will appear in the Lung Model Editor screen when the switch is operated Two Compartment Figure 4 4
77. Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN gt button before you can open any other view from the Post Run Analysis Menu window Js FX SS data e path Program Files 86 ASL Software 3 5 ASLdata Figure 5 19 Trigger Analysis Display Trigger Analysis shows breath by breath plots of the critical time period for triggering after a patient breath was initiated by the simulator with parameters flow pressure and volume as well as calculations for trigger response time and other trigger performance characteristics Trigger analysis is performed on a breath by breath basis Individual breaths are selected in the same way as in the breath data screens by clicking on the Fast Forward Reverse buttons until you arrive at the desired breath number position Alternatively you may click on the up or down arrow next to the breath number to go to a specific breath of f1s9 G LOZ PI JeoIpew sewsul O ZAY S E MS 000S ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 You can also see the current breath highlighted in the graph representing the full length of the simulation at the bottom of the window To obtain meaningful results it is important to verify that the breath to be considered for analysis has been properly identified see page 73 In particular it i
78. Presentation 2 0 eee eeeeeeees 89 Screen Charl UPAATES spiieeipeoceeeis astatace neue setedexced 105 Screen Multi Parameter Display 0eeeeeees 74 Screens analysis trend display ccceeeeeeeeeeeeeeees 79 Screens Continuous Time Based Data IL Screens Post Run Analysis Loop Display 76 Screens servo control performance display 84 Screens Trigger Analysis Display csseeeeeeeeee 82 Screens WOB Analysis Display eseseeeeeeeeees 81 Selections analysis data display ceeseeeeeeeeeee 70 Sidestream measurement OXYGEN ceeeeeeeeeeeeees 100 Simulation Editor Module cc eeeeeeeeneeeeeeeetees 31 Simulation pausing s s 4say coacaneySuvenasieunceenecteoneswacevan 45 Simulation STOPPING wo 2 54 iiweactesteseontis dead actinaneees 49 Simulations running eee eeeeeeneeeeeeeeteeeeeeeeeeeeeeees 43 SIMMUNAHONS Saved Seccunchi ie nttin Gels eid Saleh 64 Simulator Bypass and Leak Valve Module 15 98 Sinusoidal breath profile as chest wall activity 122 SMart UMP MOTE x oceicenescacacnnicantaniaesae etree an 15 SmatP ump MOOS sasina a tances tat gts 126 SW UO NO OG nre erasa ean Ena 126 Specifications jena ve 0610 EE tote neers E erate Aa ere E 141 CIOCINIGAY gera tanta eee tant alta 144 SNVINOMMICM CA eeii 144 DAVSIGAN araro E E 144 SON aE ei e aa 144 SPUS reana NA 13 Stp 3 OL modelih sranuecne ee
79. S 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 5 3 2 Breath by Breath Display C Program Files x86 ASL Software 3 5 8 ASLdata 24_breaths Ppeak cmH20 2 5 O m Ppause cmH20 o o Volumes Vt mL PatinspVt 712 1 ooo 72 1 Pat Vt right 1356 0 indo correction for tubing effects as defined by aux compensations PatExp t 711 9 Vent ExpVt 1711 9 PatVt left 1356 0 Figure 5 11 Analysis Breath by Breath Display In this view data is displayed one breath at a time Scrolling through or selecting single breaths is easily performed with the fast forward reverse arrows You can also see the lt gt lal current breath highlighted in the graph at the bottom of the window Parameters displayed are grouped into separate fields for timing inspiratory flow pressure volume You may zoom into a detail area at any time by clicking into the display and dragging open holding mouse button down while moving cursor a detail window To return to the normal view go to the slide rulers for X and Y scaling X and Y in the graph manipulation palettes to the right of the graphic display areas and double click there Data Analysis Display Data Selections Green Buttons 0 00195 0 4 Le fa e A By clicking the X and Y resolution buttons identified as lt X XX gt and lt Y YY gt in the Graph Palettes you may also change
80. S E MS 000S ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Preparation Connections STEP 1 Check that you have all components ASL 5000 Main Unit RS 232 Router RS 232 to USB adapter ser gt 1400 USB type A cable Cables Ethernet 2x Power cable adapter External Options SBLVM AGEC STEP 2 Make all connections Connect PC and ASL to Router with Ethernet patch cables use ports 1 4 NOT the Internet port Connect ASL COM1 host with RS 232 cable and RS 232 to USB adapter to PC for units ser gt 1400 use USB type A cable Figure 3 5 Quick Reference Startup Steps 1 and 2 23 24 Preparation Starting the ASL 5000 3 3 Starting the ASL 5000 Green power switch in the back of unit ON lit IMPORTANT Make sure motor is enabled disable switch in the depressed position red light in the switch will be OFF 20 s after power up Riwencng fesp story temedetion INGMAR MEDICAI Figure 3 6 Quick Reference Startup Steps 3 and 4 G LOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 Operation 4 1 Getting Started Launching the software on your host PC after all connections have been made and the simulator has been turned on will allow you to edit simulation models to run them and to analyze the results Below you will find an o
81. Serial Cal Ae prener ee 21 Definitions nomenclature ssssseeeessseeesssssssssssssssssssserererene 12 DACP ECNE anna A 20 Digital filter DrESSUG aaro IEE memo nen eases tareesueeas 60 IDISCASE SIALES orae Avene a weet densoetasteesees 119 120 DLG sees eeteete cnt peace eee loc beeen tet ie cect 17 E Electrical sSUppI ainis a a 13 ENCIOSUTE sidre endu E 14 E guation OF MONON seein a 119 Enor CoOmMmMO Darrena a aan aT 105 Ethernet COMMUNICATION SCIP paisa ea tenes sc 20 Event GDI serrare a a 87 EXC E A E E E A E EN 69 EX ICME SOWAT aia R 64 Explosion Nazar erama a O tienenesea es 13 F Fast Oxygen Measurement FOM senserce 100 Features VSE ennnen ear a 15 Flow pattern generator tiie merit utin aiden aeiteanecetees 15 OIA eB acest ert e e a E 14 Cae eee ree ree ee ore een er ener ere 36 G Gans ad USNE suave cee oe eR 75 78 79 Gas temperat Ure areira a E T 47 H Hard drive required space eseese 16 ibe VENI ON ceana AR E 105 ROSC PC TeOQUIPEMICIIIS rreren et osmasaaneanae 16 I ICP gt see Interactive Control Panel 00 0 51 Identification instrument cee eee eeeeeeceeeceeeeee ees 106 Installation software sesessessesesecsscsersersessersesersees 18 Instructor Dashboard sseecesceccrccseescererenee 87 89 Instructor Scenario Guide eee eeeeeeeeeeeeeeeeeeeeeeeeees 89 INSHUCIONMDEIVEN scat a a ten a onan 89 Interactive Control Panel seese 51 L Lung Model Parameters in Interactive Control
82. UY dreathing Siinukitor Post Run Analysis Utilities Titerieriys Control Hual Lung Model Param Spont Breath Param Trends ClosedLoop Vt ClosedLoopMV ClosedLoop cozy Patient Library active patient Revert to Original Model r Sett CO2Y Directory a Files x86 ASL Software 3 5 vars Scenarios Sl Directory Contents Double dick to change VR3 file Adolescent_Normal vr3 Adult_Asthma vr3 Adult_CF vr3 Adult_ChBronchitis vr3 Adult_COPD vr3 Adult_COPD_unassisted vr3 Adult_Emphysema vr3 No Loop Adult_Normal vr3 Const Vt Adult_Normal_unassisted vr3 Const MV Adult_Normal_unassisted_variable Adult_Normal_variable vr3 Adult_Passive vr3 Adult_Pneumonia vr3 Adult_Right_Pneumothorax vr3 Anesthetized_Adult vr3 Improved_Compliance_Adult_1 vr3 Improved_Compliance_Adult_2 vr3 Improved_Resistance_Adult_1 vr3 Improved_Resistance_Adult_2 vr3 Infant_Bronchiolitis vr3 s Kussmauls_1 vr3 ave Waveform Kussmauls_2 vr3 Data Kussmauls_3 vr3 Save Current Model Settings Keansate Meera se Figure 4 79 Interactive Control Panel Patient Library Tab From the Patient Library tab pre configured patient parameter sets can be invoked at any time by selecting a file name and clicking the lt Change Patient Parameter vr3 File gt button or double clicking the file name in the list This is particularly useful in situations where certain disease states scenarios a
83. VM and PC The simulator is housed in a desktop enclosure similar to that of a tower style personal computer Its functions are controlled via a host PC that is connected to the simulator by a Local Area Network LAN physically removed from the host PC Alternatively the simulator may be operated via a USB connection older models use RS 232 with a serial to USB converter A laptop computer or touchscreen all in one PC when the system is mounted on a cart is included with pre installed software to support all functions of the system 2 2 Available Options Options that can be added to the base system include Simulator Bypass and Leak Valve Module SBLVM Fast Oxygen Measurement FOM Cylinder Temperature Controller CTC Auxiliary Gas Exchange Cylinder AGEC The ASL 5000 also forms the basis for IngMar Medical s RespiSim Mechanical Ventilation Training workstation which adds software and hardware to the base unit RespiSim software option the framework for multi stage scenario simulations RespiSim Ventilator Interface Kit VIK for capturing ventilator information modes alarms etc Optical Oxygen Saturation Simulator 0282 and RespiPatient a high fidelity respiratory torso manikin including CO2 production and scenario based aus cultation sounds optional GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Please
84. Ventilator 4 4 1 Concept of the Virtual Ventilator The Virtual Ventilator VV is a newer feature introduced with software 3 3 With it realistic simulations may be performed that include positive pressure traces in waveform graphs as they would be generated by an actual ventilator This makes the ASL 5000 software an even better tool for classroom instruction long distance learning and learning management systems LMS The Virtual Ventilator feature is included in the license for software accompanying ASL 5000 simulators It can be made available separately as a purchase of the stand alone version of the ASL software 3 5 The VV is invoked from the Run Time Home tab of the Window Manager and is only available in demo mode no ASL 5000 Be ASL Virtual Ventilator Both VC and PC can be either operated as patient triggered or as machine triggered which means that the patient s breathing pattern has no influence on the timing of positive pressure from the ventilator WARNING Intensive care ventilators are complex therapy devices with many features and modes The Virtual Ventilator is not intended to be an exact rendering of an actual ventilator and its behavior The user should use care when interpreting results from the Virtual Ventilator and always take into account that the modes implemented are a significant simplification c ES INGMAR MEDICAL 15 20 40 79 6 0 4 0 79 6 0 1 xv wh a 1 i 3 0 _
85. WILL EVEN IF INGMAR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN ANY EVENT INGMAR S MAXIMUM LIABILITY SHALL BE LIMITED TO THE AMOUNT OF THE PURCHASE PRICE U S GOVERNMENT RESTRICTED RIGHTS LEGEND The Software and Documentation have been developed exclusively at private expense and are provided with RESTRICTED RIGHTS Use duplication or disclosure by the Government is subject to restrictions as set forth in subparagraph c of the Rights in Technical Data and Computer Software clause at DFARS 252 227 7013 or subparagraphs c 1 and 2 of the Commercial Computer Software Restricted Rights at 48 CFR 52 227 19 as applicable IngMar is the Contractor and is located at 5940 Baum Blvd Pittsburgh PA 15206 EXPORT RESTRICTIONS The program or underlying information or technology may not be installed or otherwise exported or re exported where prohibited by law MISCELLANEOUS This Agreement shall be considered severable and if for any reason any term or condition is determined to be invalid illegal or unenforceable under current or future law such invalidity shall not impair the operation of or otherwise effect the valid terms and conditions of this Agreement so long as the intent of this Agreement is maintained This Agreement shall be governed by construed and enforced in accordance with the laws of the Commonwealth of Pennsylvania with the exception of its conflict of law provisions The parties consent to the personal
86. Wyene I an Ovent PEEP Ty 19 For the respiratory muscles E muse IW musel I F Wruse 2 0 The total expiratory energy is Foote TWyente T Wruse 1 ale Wentel Wruse r Oven PEEP T 21 For the complete breath cycle as Bae Foote 22 Many of these terms are zero during most breathing patterns Equations 19 22 can be evaluated in a straightforward manner in a simulation in which Ap is available Even though it is more complicated calculation of the various work terms can be obtained by substituting equation 3 for APmu Again a simulation can calculate and plot Pe Pgs versus v with a superimposed chest wall compliance curve if a Campbell type diagram is desired or if intrinsic PEEP is to be visualized S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 13 2 Introduction to Modeling 13 2 1 Model Background Based on the ventilatory mechanics i e the lungs airways diaphragmatic muscle activity and chest wall recoil forces discussed in the previous chapter a model of passive and active breathing of a lung simulator was developed meeting the challenge of appropriate simplification and approximation A more technical translation of the Equation of Motion for the model as described in the previous section Normal Lungs page 109 and Non uniform Lungs page 116 is shown below
87. al curve representative of actual patients For adjusting compliance in this fashion please refer to Advanced Model Settings Non Linear Compliances page 40 NOTE For use of the non linear compliance feature a two compartment model has to be selected The user may choose to have both compartements modeled identically by simply checking the C1 C2 checkbox S LOZ PI yeoIpew sewsul O ZAY FE MS 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 13 4 Patient Effort Model The different spontaneous patterns Ap profiles are pre defined through the Patient Effort Model pop up menu as passive simple pressure trigger simple flow trigger sinusoidal pressure profile trapezoidal pressure profile user defined pressure profile external analog input 13 4 1 Passive Model Cycle Time 700 44 Passive no activity _ Figure 13 16 Patient Effort Model Passive The passive setting will not add any spontaneous breathing to the Lung Model defined in step 2 A passive model will respond just like a spring loaded conventional lung model with orifice resistors and one or two compartments However you set a passive cycle rate which will be used to indicate the length of the passive interval similar to a spontaneously breathing model The repeat rate of this pattern as in all other types of profiles generated from wit
88. ar Medical Ltd 2015 IngMar Medical Ltd IS09001 2008 certified www ingmarmed com
89. arameter File el A Patient Work parameter Resistive Pat Total Res Work Pat Insp Res Work Pat Exp Res Work mJ Pat Trig Work to Pmus dV from SoE to Trigger A Patient Work parameter Trigger Work Time during Trigger Response _ see also its components Time Work between SoE and Pmin and Work between Pmin and PEEP PEEP Pause Pause Time z Pause time expressed as Time counted from the point of Algorithm uses peak pressure instead of peak maximum pressure to StartExp volume E Parameter calculation changed in sw 3 5 Pairway PEEP dt from SoE to prior to sw 3 4 labeled Pressure Time Product also End of Inspiration in drop downs Pairway PEEP dt from SoE to May be used as a substitute for Trigger WOB Time to PEEP after Pmin Added parameter in sw 3 5 Pairway PEEP dt from SoE to 300 ms Added parameter in sw 3 5 cmH20 Pairway PEEP dt from SoE to 500 ms Added parameter in sw 3 5 Barometric pressure Reading from a dedicated pressure sensor Added parameter in sw 3 4 Peak Flow L min Maximum flow highest positive value of flow cmH20 Minimum pressure maintained at PEEP Positive EndExpiratory Pressure the end of the breath cycle cmH2O Average pressure over the full Includes any offset due to PEEP CPAP breath cycle definition has been restored to previous was averaged over the inspiratory cycle in sw 3 3 only c
90. arameter graph a simultaneous display of A different variables versus time breath by breath Two parameter loops Y versus X plots breath by breath Multiple breath view a timeline graph of 4 parameters and Trend graph of breath parameters from a breath parameter brb file Figure 5 4 Display Data Selections GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 5 3 1 Advanced Graph Analysis Tools The Graph and Cursor Palettes The ASL5000 software offers considerable flexibility in terms of the appearance of the graphs displayed in both the simulation model set up and the post run analysis In all graph displays except the 1 2 Run Time Home screen you should notice one or two small grids depending on which graph is being displayed They are called the Scale Legend 1 and Graph Palette 2 Figure 5 5 Legends Palettes In the Run Time Home graphs you can make the Graph Palette and Scale Legend visible by right clicking in each of the three plot areas themselves and selecing Graph Palette from Visible Items see Figure 5 6 below The Cursor Legend 3 is already visible by default aF 1724 Copy Data Description and Tip Visible Items t Scale Legend Clear Graph if ee keno Graph Palette a nna n P EEA X Scrollbar AutoScale X x AutoScale J XScale AutoScale Y w Smooth Up
91. art of Time stamp for the beginning of Software uses Point B to discriminate breaths Inspiration an inspiration the minimum and takes minimum volume before Point B as volume in a breath Sol Time when the Breath Start Volume threshold default value is 5 mL suitable Volume Threshold has been for adult size models 0 5 mL is recommended exceeded for neonatal models The time mark for the maximum This marks the begin of expiration However volume when a flat volume maximum is encountered the end of that line is used as Start of Expiration G LOZ PI JeoIpew sewsul O ZAY S E MS 000S ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Parameter Definitions Parameters in the brb Breath Parameter File Start Expiration Start Exp The time stamp for the beginning of expiration Point F Time when the Exp Start Volume Threshold has been exceeded Time to Pmin after SoE The time interval to the largest Paw depression below baseline pressure occurs calculated from SoE Trigger Time Ttrig Point in time at which airway pressure has returned to baseline after a downward deflection i e the pressure level before the start of inspiratory effort 14 2 Parameters in the brb Breath Parameter File NOTE Parameters appear in alphabetical order of names in the drop down menus in the analysis windows Parameter names are given as they are used i
92. ata files contain a data stream of up to 512 data points per second may be scaled down for pressure and piston position volume flow as well as parameters calculated from the model in use Lower frequency data on oxygen concentration if option is installed barometric pressure gas and wall temperature will also be saved to the captured breath parameter file Gas Temperature Measurement is a standard feature installed independent of the Cylinder Temperature Controller CTC It provides a way for added accuracy in gas volume calculations Volume corrections for gas temperature are made automatically in the data analysis package Automatic Barometric Correction employs a second pressure transducer for the added convenience of having barometric pressure entered automatically into the host analysis software for volume corrections Test Automation Interface TAI Beginning with software 3 4 IngMar Medical has created an API application programming interface that allows remote control commands to be embedded in third party software applications for testing and validation of respiratory care devices For a pdf version of the specification document of this interface please consult the documentation subdirectory in the sopftware installation on the PC 2 4 Host Computer Requirements The controlling host PC should be at least a 1 5 GHz dual core or i3 class computer running Windows XP or Windows 7 or Windows 8 operating system s
93. ations From the Run Time Home Display The parameters O2 concentration wall temperature AUX1 and AUX2 will be visible only after the respective check box to the left of the digital displays has been checked Data Oxygen vol 9 0 P baro kPa 101 3 Gas Temp C 25 0 Wall Temp c 0 Optionally the analog channels may be recorded see Working With the Analog Inputs page 63 dii i Record Aux1 Aux2 Auxi 0 00 Aux 19 00 Figure 4 59 Analog Parameters NOTE TCP IP data broadcast for both breath parameters and waveforms is also supported with the ASL software acting as a server For details see TCP Data Broadcast page 97 4 3 7 Modifying Waveform Displays The ASL5000 software allows you to modify the appearance of waveform displays By default each trace in a waveform plot is labeled with a name To the right of the plot label is the plot sample Each plot sample has its own pop up menu to change the plot line color and point styles of the plot From among all the possibilities to alter the appearance the color and line style selections are the most relevant selections for the ASL waveform plots Pressures cmH20 Airway Fagin Muscle Tracheal Pg Alveolar 1 Fa Alveolar 2 a Figure 4 60 Trace Colors First right click the sample that you want to modify The Color item displays the palette for selecting the plot color Common Plots Color Th
94. atory Mechanics The so called pressure time product ApT has been used by various authors as an index of effort or interchangeably with work of breathing The ApT is analogous to the impulse in mechanics It is not a work term per se However in as much as it provides a basis for comparing ventilators and ventilatory systems we will use it as a measure of energy provided it is scaled using an appropriate factor to provide it with an appropriate magnitude and units of energy The scaling must also account for the different rates of energy expenditure by the various components i e the ventilator and the respiratory muscles Thus the energy expended during inspiration is For the ventilator Ei Wyentt t T TWyena I Olyent Pro Ty Pas en lin 16 For the respiratory muscles Esai ae Wrust Omu A Pms Lm 17 where a is a factor that relates the pressure time product to energy for the different components The total inspiratory energy is Eou W ult T TWrenu I T vent Pao Pes gt AmusAPmusr Tur 18 During expiration the ventilator and or the respiratory muscles may be silent zero work done they may retard exhalation negative work or they may aid exhalation positive work The pressure time product can be used to estimate the energy required to maintain an expiratory hold e g zero volume change at PEEP The energy expended during expiration is For the ventilator Eent Wene
95. atory system on the components producing the pressure differences The negative area in the initial portion of Figure 13 3 a represents work done by the respiratory muscles on the ventilator to cause it to trigger The work under the total driving pressure difference volume curve is divided into two regions elastic work to the left of the total compliance curve and resistive work to the right of it Elastic work is stored and can be used by the system to compress the volume back to end expiratory volume Resistive work is dissipated as heat and cannot be reclaimed or reused by the system It should be noted that although Figure 13 3 is reminiscent of a Campbell diagram it is not a Campbell diagram In a Campbell diagram esophageal pressure change minus body surface pressure change Pe Pgs IS plotted against lung volume change v along with the static Ap characteristic of the chest wall the chest wall compliance Cy curve These two curves are then used to graphically solve equation 3 for APmus and depict the components of work given in equation 10 111 112 Theory of Operation Introduction to Ventilatory Mechanics Vol Vei Vee VT Work done by the ventilator on the lungs chest wall and or resp muscles positive a Work done by the lungs chest wall and or resp muscles on the ventilator K negative PEEP PAO PBs Vol Vei Vee VT Work done by the resp muscles on
96. ave Waveform Data Real Time Analysis Conditions as measured AOE SUN rsating Simukiter Post Run Analysis Utilities Breath Datacion RT Analysis Pressure Filter E Moving Ave a Auxiliary Compensation Parameters Inspiratory Circuit Resistance cm H20 L s o oo Expiratory Circuit Resistance cm H20 L s Afo o0 Circuit Compliance mL cm H20 f0 00 3 Preath Rate BPM cls Patient Exp Vt mL ar _ peak cmH20 Breath by Breath Volume Plot mL Lalela Display Uncompensated Volume _ ia Figure 4 80 Real Time Analysis Tab The Real Time Analysis RTA tab is accessible from the Window Manager From the RTA tab the user has control over the analysis and capture of data from a simulation run The selection of parameters to be displayed 2 x 4 may be changed at any time Selections made here are stored in the Project File and may also be changed at the start or close of the software from the Project File Tool The four parameters chosen for the left column are shared with the parameter selections in the Trend Graph Display Vice versa changes made there are also reflected in the RTA tab see page 60 In the upper half of the window parameters relevant for the breath detection algorithm and for the ventilator volume related compensations are set You can control the saving of waveform data with the Save Waveform Data checkbox to save disk space or even turn analysis off completely by
97. beling of the X and Y axis to suit your needs Clicking on the symbol in the graph manipulation palettes will allow the pointer to take hold of the green cursor lines and move them about In this view the cursors are by default not locked to a parameter You may lock them however by clicking on the padlock symbol in the graph palette in the upper right corner of the graph A little pop up menu will allow you to check the parameter that you want your cursor to be locked to After doing this the parameter value at the intersection of the X and Y cursors is always displayed in the cursor palette indicators You may change your selection at any time Parameters for each graph can be freely selected from the drop down list of available parameters click on the arrow symbol next to the parameter name Please refer to Parameters in the brb Breath Parameter File page 131 for details on the individual parameters displayed in this data view Volume corrections are performed towards different standard gas conditions BTPS ATPD STPD by clicking on the arrow symbols next to the Conditions label Conditions Ac measured no correction is the xas measured default setting Please also NOTE on page 69 In this view gains for each parameter can be adjusted individually to adjust the view of multiple graphs click on the W symbol next to the gain factors to view drop down menus for available choices Figu
98. c valve in the SBLVM if connected being activated This will switch a connected ventilator back to the auxiliary test lung attached to the SBLVM Simultaneously the green SIM indicator light on the simulator will extinguish and the simulator piston will move back to its home position at the last URC setting With the simulation OFF changes to the simulation parameter script will be accepted for the next simulation run as described in Working with the Simulation Script Editor page 31 After saving the new script the simulator will use this script as its new source for locating parameter sets and assigning numbers of repetitions for the sets Immediate quasi interactive changes of parameters are possible without stopping a simulation by applying the standard method of editing simulation models on the currently running parameter set and saving the set without changing its name The intended method however is to use the Interactive Control Panel described in 4 5 below which gives the user also control over all the patient model parameters NOTE Some parameters such as the URC setting will only be applied as defined in the first vr3 file in a script Changes made to these parameters after a simulation has been started will not be considered for a simulation already running Operation Running Simulations From the Run Time Home Display 49 50 Operation Using the Virtual Ventilator 4 4 Using the Virtual
99. ccescescesceesenseueens 108 OXV SCM CONCEINANON giess a A 47 OXY SEM MUSE WIL oroe a i 13 P Parameter MIC meeer o sodas 44 Parameter eS ouaa a a TANE 31 Patent aioicioveigocuon ist n ee EE EE 12 patient effort reducing wie icnreacsidiedeivareeiiocateaiedes 123 Paent TOOS orea e a a 13 Fe LUIS INNS EET N SA 45 Performance analysis display selections 81 Performance verification ventilator eee eee 12 Pm s modified OW PAW oxssudouveg steadier ssetauels uixtent 123 POCA UIMONS tutte andes E AE 13 Pressure feedback in control loop 06 119 Pressure trigger as chest wall activity oe 121 Procedures ventilator test or calibration 12 PUTT Gessner ed ea ee tat oan 90 R Ramps pressure profile cccccesssesesseeseeeeeeens 123 Resampling pressure profile ccccceceeeeeeeeeeeeees 96 Resistance definition cece cee eecceecceccescesceusceues 14 Re OL MN aie saree act cetasin tes ore eee etree msec usenet 14 RESISTOR Dard DOW ax jsces core ce krn e REE 14 Resistors bronchial widuieceensuctaxstenstiancace nivale deatacesene 36 NGS louie Wg sociale cae ue cat eae aaa 86 Response neural to ventilation 20 0 0 eee 119 Restarting SOftWAFE eein E E 64 RETURN button 67 74 75 76 78 80 82 83 85 S Safety operator csessessssssseesseeeecnneaaaaaanaceaaeees 12 SIVA sprs eet a teat la tats eet ern ete 14 44 98 Scenario Concept
100. ccomplish motion The movement of the piston is governed by the basic equations for gas exchange in a ventilated and or spontaneously breathing patient Figure 2 1 Functional Overview Compliance is simulated by moving the piston according to dV dP e C This relationship between pressure and volume can even be made non linear for the purpose of better representing the S shaped p V response curve of a human patient Resistance is defined by dP R e dV dt so the piston is moved at a speed of dV dt dP R Different values for resistance can be selected during inspiration and expiration Resistor settings for the value of Rt resistance of the trachea or single resistor in the system respectively can additionally be chosen as linear or parabolic Parabolic resistors have been the choice for most physical resistors due to the fact that implementations of linear resistors require flow to be laminar over the whole range of flows in use The simulator avoids those difficulties and allows you to choose either types For more details see Advanced Model Settings Parabolic Linear Resistors page 39 Please note that there are no actual springs or orifices in the system nor is a flow sensor required The simulation is performed very accurately by executing the necessary calculations at a high rate gt 2000 Hz and by moving the piston accordingly to generate the appropriate response Figure 2 2 ASL 5000 with SBL
101. ch the Software is embodied to be free from defects in materials and workmanship under normal use The warranty is personal to you and no warranty is made to your transferees THE FOREGOING WARRANTIES ARE THE SOLE WARRANTIES ON THE DISKETTES AND ARE IN LEIU OF ALL OF WARRANTIES OF ANY KIND SUCH AS WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE 2 NO WARRANTY ON SOFTWARE OR DOCUMENTATION INGMAR LICENSES THE SOFTWARE AND DOCUMENTATION SOLELY ON AN AS IS BASIS WITHOUT WARRANTIES OF ANY KIND SUCH AS WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE THE ENTIRE RISK OF QUALITY AND PERFORMANCE IS WITH YOU IF EITHER THE SOFTWARE DOCUMENTATION OR BOTH PROVE TO BE DEFECTIVE YOU ASSUME THE ENTIRE COST OF ALL SERVICING CORRECTION OR REPAIR REMEDY FOR DEFECTIVE MEDIA Your sole and exclusive remedy in the event of a defect in a warranted item is expressly limited to eolacement of the defective media To receive a replacement USB flash drive you must send the defective flash device with proof of purchase to IngMar at the address indicated below postage pre paid and postmarked within the Warranty Period IN NO EVENT SHALL INGMAR BE LIABLE FOR ANY OTHER OBLIGATIONS OR LIABILITIES INCLUDING WITHOUT LIMITATION LIABILITY FOR DAMAGES WHETHER GENERAL OR SPECIAL DIRECT OR INDIRECT CONSEQUENTIAL INCIDENTAL EXEMPLARY OR FOR ANY CLAIM FOR THE LOSS OF PROFITS BUSINESS OR INFORMATION OR DAMAGE TO GOOD
102. cking the proper data connection of the VIK and ventilator see next page The StudentScan app is a PC version of a ventilator data charting application that can also be installed onto a tablet style mobile device Windows 7 that would be used in a real ICU environment This application also supports annotations by the caregiver that would be expected for proper documentation of patient status 19 Preparation Connections 3 2 Connections 3 2 1 Electrical Connections The ASL 5000 Breathing Simulator must be connected to line power supplying 100 240 V AC 50 60 Hz NOTE The heater of the cylinder temperature controller option CTC should be configured for either 100 120 V or 200 240 V range for best performance Please contact IngMar Medical if your ASL 5000 is equipped with this option and you require a change to its configuration CAUTION Electrical Supply Connect instrument only to a properly grounded wall outlet providing 100 240 V AC 50 60 Hz WARNING Electric Shock Hazard Always disconnect from line power before opening ASL 5000 Connect the SBLVM Simulator Bypass and Leak Module available option to the instrument by plugging its 1 4 audio style plug into the labeled receptacle at the front of the instrument see Figure 3 1 CAUTION Always fully insert plug Do not leave plug in a partially inserted position Figure 3 1 SBLVM Connection 3 2 2 Communication Setup via Etherne
103. cles as they shorten while contracting during expiration Work of the Breathing Cycle Figure 5 shows an alternative way of plotting the Ap v relation for a complete breathing cycle that might help visualize the work involved Inspiration is plotted as in Figure 13 3 However expiration i e negative changes in lung volume is plotted upward from Va the end inspiration point Thus the expiratory curve is the upward reflection of the expiratory portion of Figure 13 5 Vee n 1 lost U Wexp lost Vei Vee n 1 VT Ctot Wel Insp stored Winsp Vee n 1 PEEP AP tot Figure 13 7 Ap v Curve for an entire breath with expi ratory volume change plotted upward from end inspiration on the v axis 114 All area to the right of the v axis in the lower inspiratory curve is positive work done on the system In the upper expiratory curve the opposite holds Area between Ap and the lung volume axis to the right of the lung volume axis is negative and represents work done by the system Area to the left of the v axis is positive and represents work done on the system The same type of plot can be constructed for Pao Pp and Ap Using all three curves we could examine the work done by these pressure difference components for the various segments of the breath Work can be done on the ventilatory system by the respiratory muscles or the ventilator or both and vice versa If the wor
104. cs Vee n 1 VTo Vee n 1 VTN Vee n 1 VTR Veeol n trapped gas volume Vee n APtot Veer n 1 Vee n 1 b Figure 13 9 b The Apor v for the three cases Note that in the time allotted the obstructed system s volume does not return to the same V as the other systems Restrictive diseases such as chest wall paralysis pulmonary fibrosis or pneumonia typically may be represented by a single compartment model with a decreased compliance stiffer system and approximately normal resistance Although the system would be harder to expand the product of R and C would be smaller than normal and the system would be able to empty faster than normal Some obstructive diseases may be characterized by a single compartment model with either an increased resistance e g asthma tracheal tumor and or increased compliance e g early emphysema In these cases inspiration may be harder increased R or easier increased C and the lungs may expand to a larger than normal volume for the same effort increased C Expiration in contrast because the time constant is increased increased R and or increased C can be much longer than normal requiring an extended expiratory time for the lungs to deflate In many cases they do not reach the normal FRC before the next breath begins and gas is trapped in the lungs From it can be appreciated that the intrinsic PEEP that accompanies gas trapping i
105. cursor to the center area of the graph Selecting this item changes the X Y coordinate position of the cursor Figure 5 9 Cursor Legend Options Selecting Go to Cursor moves the displayed region of the graph so the cursor is visible The cursor position remains constant but the scales change to include the cursor selected The size of the displayed region also stays constant This feature is helpful when the cursor is used to mark a point of interest in the graph such as a minimum or a maximum and you want to see that point You can use the last button to lock the cursor onto a particular plot By clicking the lock button you Can see a pop up menu that can be used to lock the cursor to Free Snap bo point i x Lock bo plot a specific plot If you lock the plas Trend 2 cursor onto a plot the button Trend 3 changes to a closed lock Trend 4 Select Free if you want to place or ean move the cursor anywhere on the Mean 2 graph Select Snap to Point if you Mean 3 want the cursor to always attach Mean 4 itself to the nearest point on any plot Figure 5 10 Cursor Lock Select Lock to Plot to attach the cursor to a specific plot The first time you select Lock to Plot the cursor attaches itself to the first point on the plot After freeing the locked cursor and moving it to any new position selecting Lock to Plot moves the cursor to the last location of the locked cursor S LOZ PHT yeoIpew sewsul O ZAY FE M
106. d dragging sections of the graph If you press the Zoom tool the magnifying glass symbol 4 it opens a submenu from which to choose ways to zoom in on a section of the graph by dragging a selection rectangle around that L section Figure 5 7 Zoom Tool The options are as follows Zoom by rectangle Zoom by rectangle with zooming restricted to X data the Y scale remains unchanged Zoom by rectangle with zooming restricted to Y data the X scale remains unchanged Undo last zoom resets the graph to its previous set ting Zoom in about a point if you hold down the mouse on a specific point the graph continuously zooms in until you release the mouse button Zoom out about a point if you hold down the mouse on a specific point the graph continuously zooms out until you release the mouse button NOTE For the last two modes zoom in and zoom out about a point lt Shift gt clicking will zoom in the opposite direction 71 72 Data Analysis Display Data Selections Green Buttons The Cursor Legend Fow 0 650 0 0 Figure 5 8 Cursor Legend As indicated in the above figure each cursor for a graph has the following parts A label X and Y coordinates A button that enables cursor movement with the cur sor movement control pad A button that controls the look of the cursor A button that de
107. d in the regular ASL 5000 software is a comprehensive library of patient models describing adult and neonatal respiratory mechanics of certain disease states The table on the following two pages illustrates the parameters used For questions regarding the rationale for individual choices please contact IngMar Medical s Clinical Education Business Unit a T T T S T T S E E D a S S S a E C O senom une an tout c eon rae Prax ierense Hold Release EA O o oaie S os e e w smaa is o o w o racons os o o so sinusoida 8 O 7 l o l o i o O Aduk tmpinsema os 6 10 iso smsa 7 s w o o noma os e e so fama as O 0 to O Minnat nasie os 3 s s smsa s 7 o o 10 o l raeme os 6 6 o fanaa 1s 0 30 0 10 acu anos os n w w sma s a r 20 p aow os ar a ss foma te a as O Adit coPD amassed os 12 2 o sms 2 s s o a o aaaea os o o o fama 2 a ame o w s a Sisal 2 v o rediasie Premature Neorae o2 iso iso os Simsoel s iss s o a O Neomie Noma o2 40 w a smsa 2 8 w o 10 neonate Fasive 02 0 O 0 we 0 10 O Neomsie Noma o2 40 w a Simul 2 a w o 10 OOO remete o2 o o O a smo a o e f o o neeo o2 69 ay 2 soa o e l o 2 OOo ames l oa os os os sma 0 e o memso o2 an os 12 Smosh a S s a0 C
108. d the adjustment thresholds may be performed by clicking and positioning dragging the blue pointer on the knobs to the desired setting or by entering numerical values into the field below a knob The adjustment is not immediate but rather gradual to give a more realistic representation of patient changes However please keep in mind that there is no underlying physiological model applied here that would make allowances for disease states and other patient conditions NOTE There is no automatic adjustment of the breath rate in this mode Depending on the external conditions ventilator settings etc the model may or may not be able to reach the desired preset Vt Both actual and set values for Vt are displayed in the trend diagram on this tab G LOZ PH JedIpew sewsu O ZAA S E MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Running Simulations Using the Interactive Control Panel ICP 4 5 5 Closed Loop MV Tab File Windows Help Customize INGMAR MEDICAL AOE SUN Breathing Simiukiter Run Time Home Interactive Control INGMAR MEDICAL Lung Model Param Spont Breath Param Trends ClosedLoopvt Closed Loop MV SS h Figure 4 75 Interactive Control Panel Closed Loop MV Tab In this mode both Vt and bpm settings are manipulated automatically with the goal to accomplish a preset level of minute ventilation Upper and lower limi
109. dates Autosize Plot Leoend J T Scale Figure 5 6 Graphs Visible Items If you uncheck autoscale X in the pop up menu click on lt Y YY gt the graph will stop autoscaling the Y data which is sometimes useful for the purpose of comparing different graphs In the legends and palettes different icons represent specialized graphing tools From the graph palette 2 the panning tool and the zoom function are used to get more detail of a specific part of a graph The cursor legend 3 is described with Figure 5 8 page 72 Although these graphing tools appear on all but the Run Time Home graphs the cursor palette is available only in the Display Data and Display Performance screens of the ASL 5000 Post Run Analysis Menu Data Analysis Display Data Selections Green Buttons If you want the graph to autoscale either one of the scales continuously click on the lock switch to lock autoscaling on By using the scale format buttons you can maintain run time control over the format of the X and Y scale markers respectively Use the three buttons on the right side of the Graph Palette to control the operation mode for the graph cursor Normally you are in standard operating mode indicated by the plus or crosshatch appearance of the cursor In standard operating mode you can click in a graph to move cursors around Clicking the panning tool will switch to a mode in which you can scroll the visible data by clicking on an
110. ded parameter in sw 3 4 aluminum cylinder Work between J Pmus dV from Time of Pmin A component of Trigger WOB Pmin and PEEP to Paw PEEP Pmus dV from SoE to Time of A component of Trigger WOB Pmin Work between SoE and Pmin GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Parameter Definitions 14 3 Data File Parameters From the data files in use with SW 2 0 ASCII types can be generated using the File Translation Utility see page 92 These are binary ASCII brb brabreath parameter data file dtb dtahigh resolution breath data file rwb rwahigh resolution raw data file The headers of these files contain information on the different parameters contained in them ASL 3 5 bra ASCII he format of this file is tab delimited text Each entry is 12 characters wide and padded with spaces Breath Type Time Insp Pause lnsp Vt Mean Flow Vent Exp VT Exp Work J Pat Insp Work J Pat Exp Muscle Work J Max Pres Drop During Trig rigger Response Time Insp Res Work J otal Res Work J Pat Exp Res Work ime to Min Pres after Trig s Exp Vt Median Flowl E Vent Insp Vt Exp Res Work Pat Insp Elastic Work J Pat Heat Production Work between flow starts after trig to pmin J Ppeak Ppause Insp Work J Exp Active Work Pat Insp Res Work Pat Total Res Wo
111. dependent on the choice of lt Chart Length gt see Display Options of the Run Time Home Window on page 45 It is intended for general orientation only and not for strict data analysis Looking at the Display Data views accessed from the Post Run Analysis Module with waveform data saving turned on will show any details that might not have been visible in the real time charts of the ASL Run Time Home view Dissynchrony between calculated and piston flows and volumes in Runtime charts Serial communication is not able to download the new pressure profile for a breath in the time it had available This might happen if you switch from a faster to a significantly slower breath rate To prevent time constraints at higher bpm the simulator actually places several breath profiles into one breath see page 123 However when a longer profile needs to be downloaded for an upcoming slow rate while the simulator is still operating at a higher rate dissynchrony is possible Inserting a parameter file segment containing just one breath of an in between rate can be used to prevent this This effect is not to be expected when operating in TCP on a network Ethernet connection SmartPump models result in motor disable red light ON When using SmartPump mode the pressure profile acts as a flow or volume profile calibrated in L min or L respectively For volume pumps numerical values have to be very small compared to regular model
112. depicted sap choices File lt Random Uniform Distribution Random Gaussian Distribution Figure 4 37 TVP Curve Types Depending on the curve type selected different parameters needed to describe a transient lung model are then presented for editing The following choices are possible Linear defined by Slope or by Endpoint e Y Linearly interpolated between Start Value and End Value Figure 4 38 TVP Curve Editing Linear Power Y Start Value Constant exponen a an need meee a o TO TO T ee en ee ee a a ae a a ls a ee Figure 4 39 TVP Curve Editing Power Exponential Y Start Value Constant exponent Figure 4 40 TVP Curve Editing Exponential Sinusoidal Y Start Value Amplitude sin X Period Phase Shift F a MREFA See See Zhi Saas Aa eae es Seer Asa aed Saris TT TT TT Figure 4 41 TVP Curve Editing Sinusoidal User supplied Profile from File Y Values read from text file Fs mca ees es A Ca Oc Figure 4 42 TVP Curve Editing From File NOTE When sequencing parameter curve segments it is the user s responsibility to match up parameter values at intersections between segments if smooth parameter transitions are desired Uniform Random Distribution with Thresholds Random Uniform Distribution Y Uniform Random Distribution About Mean _Hgtls 2 flee fp ot RT IM ath Sh ot SU hele AAY M ont I i WT AU UP er
113. drop down menu If a patient file has been edited but retained its name there is no need to re save since the script itself did not change The editions will be automatically applied when running the script It is important to keep in mind the conceptual difference between a script file scriptname sct and a patient parameter file filename vr3 While the script dictates how parameter sets are applied over the course of a simulation a patient parameter file contains the details of each segment of your simulation You may compare it to the difference between a recipe and the ingredients for a dish to be prepared For moving script files to a different location in your PC s file structure see also Using Tokens page 33 and Manipulating Scripts page 32 S LOZ PHT JeoIpew sewsu O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Running Simulations From the Run Time Home Display 4 3 Running Simulations From the Run Time Home Display aE E EE E Ee Control Display Windows Help Customize INGMAR MEDICAL Central tun Tinie Display Downloading parameters for next breath g C Program Files x86 ASL Software 3 5 vars demo_segment vr3 y Figure 4 52 Waveform Window Clicking the Run Time Home tab on the Window Manager reveals the Central Run Time Display which features a comprehensive user interface to take control of your
114. e 41 Sdent AIS ireren e N 89 Switch motor enable disable 00 0 eee ceee cece ee 105 Symmetrical profiles for SmartPump mode 126 Synchronization problems With seeeeeeee 105 Synchronization with host PC eceeeeeeeeeeeeeeeeees 28 147 148 T TAI Test Automation Interface c ccceeceeeeeeeeess 90 Tee Dl CSS ies i A 84 TOMS NGS cata Ane att ate ale Sat cata Getta catia 88 TECAMIC GNI edanean a EE 141 Terminal connecting PC aS ccra iets ec ieixcnccacee cess 21 Test lung ventilating the ec eeeeeeeeeeeeeeeees 22 Theory Of OPEALION areren e 109 Time varying parameters in chest wall model 41 Training MOdUlCS ceine oa EES 87 Training Modules authoring ceeeeeeeeeeeeeeeeeees 89 Trapezoidal breath profile as chest wall activity 123 Trends in Interactive Control Panel 000 58 IPB CrFESDOMNSC OME siar Hana E 82 Troubleshooting ccceeeeeeeeeeccecceeeeeeeeneeeeeeaaaaaas 105 U UDP DOIICI E cisien o e sere actrees 20 Update SS OTW ANC reiro an hatin etangeettaineci 17 User breath profile maximum length 125 User defined breath profile as chest wall activity 125 V Vane pump for O2 sampling ccceeeeeeeeeeeeeees 100 WENT ALON Sarri T a iacns hare tecmes tut momen steamed 12 Volume corrections 69 73 75 79 82 83 84 Volume threshold for trigger time calculation 83 WE TANS Cl
115. e Line Manifold CAUTION Do not block port of main cylinder while operating the ASL 5000 with the Preemie cylinder attached It would prevent piston motion and could damage the unit 10 6 6 Unmounting the Preemie Cylinder Follow the steps of assembly in reverse order Before unscrewing the cylinder from the ASL 5000 detach all lines and cables Place all components into the protective case provided with the kit Take special care to not damage the piston seal when handling the parts Close the front of the unit with the large aluminum lid that had to be removed when installing the Preemie Cylinder Tighten gently CAUTION Misalignment of the threads could cause damage to both the lid and or the ASL main unit 103 104 Options Mobile Cart Option 10 7 Mobile Cart Option Frequently it is easier to move the simulation to a location where a ventilator is available that students need to be trained on A height adjustable cart for placing the entire ASL 5000 system is available as an option that will create a mobile simulation station The ASL 5000 is mounted to a tray on the cart the notebook computer sits on a shelf with a lockable compartment underneath The cart also facilitates mounting a screen up to a 40 diagonal or 20 Ibs not included with the cart option and is the ideal platform for in situ training where the complete training station is brought right into an ICU or NICU for training staff in small gr
116. e Line Style Line Width and oe gt further down in the menu the De T Point Style items display styles Pss you can use to distinguish a plot Bar Plots b The line width subpalette contains Fill Base Line gt widths thicker than the default 1 Interpolation gt pixel which is helpful for Point5tyle emphasis of plot lines particularly ara in printouts of screenshots rs 5 Figure 4 61 Graph Modifications The Fill Baseline item indicates a fill setting for the baseline Zero fills from your plot to a baseline generated at 0 Infinity fills from your plot to the positive edge of the graph Infinity fills from your plot to the negative edge of the graph By using the bottom portion of this menu you can fill to a specific plot of the graph NOTE It is recommended to carefully experiment with these display options to obtain the optimum view for a particular purpose It is helpul to keep in mind that certain setting combinations especially those for color can render traces invisible which may or may not be intended S LOZ PHT yeoIpew sewsul O ZAY FE MS 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 3 8 Stopping a Simulation A simulation can be stopped by clicking the lt Stop Sim gt elas button in the top right corner poss of the screen the Simulation field Figure 4 62 Simulation ON OFF At that time you will hear the electromagneti
117. e click the checkbox in the Oxygen vol 457 1 lt MENU gt button on the controller until SP1 starts ASL Central Run Time tab blinking to the left of the set temperature display To window to see the value P baro kPa 110 3 enter a new temperature value press the lt MAX gt of O2 readings button for changing digits the lt gt MIN gt button for l proceeding to the next digit After you have finished Figure 10 6 O2 Data at Run Time press lt ENTER gt and the controller will acknowledge that l l the new value has been stored NOTE Please note that no corrections are made in the When decreasing the temperature setting keep in mind breath analysis to adjust for O2 values other than 21 that the CTC unit cannot actively cool and the decrease Ventilators always include that type of correction for in temperature therefore will depend on heat diffusion their flow sensors and should report accurate volumes to the environment For this reason factors such as gas independent from the oxygen concentration exchange of the simulator room temperature etc will D i l determine the lowest possible temperature and the time For specifications of the FOM please see Technical it takes to reach a lower temperature Data page 141 As part of the instrument documentation a separate WARNING Operator s Manual for the temperature PID controller is enclosed for further reference You may also contact IngMar Medical for additional setup docu
118. e from the current non linear selections CLOT PH JedIpew sewsu ZAA GE MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Operation Modeling Using the Simulation Editor Environment 4 2 13 Step 3 Choose a Patient Effort Model The spontaneous breathing pattern of a model is selected as Step 3 in the Patient Effort Model window SE Patient Effort Model m n eee eee E G G o a Active Expiration Pmax cmH20 3 40000 lt Exp Pmax cmH20 Increase p Exp Increase 0 40 Hold 0 a a Exp Hold 0 6t Release d 0a a Exp Release 8 0 Pause 0 10 0 l I I I I I I I I I 0 06 5 LO LS 20 25 30 35 40 45 50 Time Varying Parameters Edit Figure 4 50 Simulation Editor Patient Effort Model For a detailed description of the different pressure profile If time varying parameters have been selected when configurations including the use of profiles from user preparing the lung model Step 2 the Edit button defined files see Patient Effort Model page 121 Please below the pressure profile graph will be visible and note that only the sinusoidal and trapezoidal profiles and Certain parameter selections to the right will be grayed user defined profiles are accessible in the SmartPump out All these selections will then have to be made via mode plus analog input of a profile Only some of the the lt Time Varying Parameter
119. e presented as individual screens STEP 1 through STEP 4 4 2 1 Working with the Simulation Script Editor The ASL 5000 Simulation Script Editor is based on the paradigm of a script file that allows you to use a sequence of parameter sets vr3 files also referred to as segments of a script for a complete simulation run The Script Editor is also the place where different simulation segments are assigned a number of repetitions for which specific parameter files are in effect Figure 4 20 Script File Editor Scenario Scripts Operation Modeling Using the Simulation Editor Environment When the software is first launched the Simulation Script Editor will appear as in Figure 4 20 with its Scenario Scripts tab as the default selection Choosing a specific scenario script allows you to quickly pre load patient parameter files for specific disease states and patient types These scripts are fully editable for further customizing NOTE The factory default location for scenarios is ASL Software 3 5 vars scenarios You can change this Script Editor Working Folder to a different directory as your customized default with the Project File Tool Configured Relative Paths tab Script Editor Working Folder C Program Files x86 ASL Software 3 5Wwars my tests ci C Program Files 86 ASL Software 3 5 Current ASL Project File ini Figure 4 21 Project File Tool Editor Working Folder You may also open a stored sc
120. e you can open any other view from the Post Run Analysis Menu window C Program Files x86 ASL Software 3 54 peel ea ees J25 measured Type Spontaneous 5 3 3 Multi Parameter Graph The multi parameter graph display uses more screen area for the graph and allows the overlay of parameters so that you can view them in a synchronized fashion easily performed with the fast of fisa forward reverse arrows or by entering the desired breath number into the lt Breath gt field You can also see the current breath highlighted in the graph at the bottom of the window Data is displayed breath by breath Scrolling through or selecting single breaths is Breath You may zoom into a detail area at any time by clicking into the display and dragging open a detail window holding mouse button down while moving cursor To return to the normal view go to the slide rulers for X and Y scaling in the graph manipulation palette on the right of the screen just above the graphic display area and double click there Pressure mouth emH20 Pressure musde onH20 bl i ii We eke gaol Figure 5 12 Analysis Multi Parameter Graph GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 By clicking the X and Y resolution buttons identified as lt X XX gt and lt Y YY gt in the Graph Palette you may also change the la
121. eeeeeeeeeeeee 35 Step 2s LUNE MOEI busite si renane ene 35 Lung Model Settings Compensations 36 a AEP VAC TI eoin aa a eubusas aes 37 Time Varying Parameters Editor 37 TVP Curve Segment EQUON versa enrio a enamiat a 37 TAF CUNVE TY DOS repii tena t auc a ene petal teentaonte 38 TV PGurve Editing LINEA cpsccccie snenia 38 TVP Curve Editing POWET secctoctince pacctecauesyencaues 38 TVP Curve Editing Exponential sssis sess csseaaseveaess 38 TVP Curve Editing Sinusoidal seeeeeeeeee 38 TVP Curve Editing From File 38 TVP Curve Editing Uniform Distribution 38 TVP Curve Editing Gaussian Distribution 39 PRY CS an E E oaiast Cota eines 39 TN CL CIS 11 he IN aaie eano ar aO 39 Independent R Settings Rin lt gt Rout eee 40 RONLINE AT Corer ish a AN 40 Non Linear C Editing santeti a 40 Simulation Editor Patient Effort Model 41 Simulation Editor Saving a Parameter Set 42 Waveform Window sessssseserserscssererserserserseseesees 43 Simulator SA rore a tte eee tee 44 SSCL Pause Key oer a eera aa 45 Freeze SWIC pae miner EE eahtundadeesee 45 EOOD MCN ier e E Gaetan a sieuate deuce ien 46 bang EN AMNGIC ALON Ssvunotttinae wets a as tenteeeees 47 Analog PArANIGtONS se saniascuctwseueSenesisan vactan acsnabestnee ened 48 Trace Colo urnan en eke eetace EA 48 Graph Modifications ccccccccccccccceceeececeeeeeee
122. eeeees 48 Simulator ON OFF eccesosticavss oa n a 49 Virtual Ventilator Panel oo cece cece ceeceeeee eens 50 Interactive Control Panel Lung Model Parameters R and tab cccccccececccececescececeees 51 COs TONG Penia a arin case tte atent ia uaate 52 ICP Active Message in Instructor Dashboard 52 View Original Model 2ss26ntiavtieceeapcdieca Aen ncetoe eas 52 ICP CONTO Senienos at hee enee E 52 ICP Lung Model Parameters R and C tab 53 TVP files cannot be used for ICP eeeeeeeeeeeeeeeees 53 ICP Spontaneous Breathing Parameters tab 54 ICP Adjustment Not Yet Applied ee 54 Interactive Control Panel Trends Tab 0000 55 Interactive Control Panel Closed Loop Vt tab 56 Interactive Control Panel Closed Loop MV Tab 57 Interactive Control Panel Closed Loop CO2Y Tab 58 NOTOG reniri naa ier Gaeta aise 58 Interactive Control Panel Patient Library Tab 59 Real Time Analysis Tab seeen 60 Pressure Filter Choices 60 Configure TCP Broadcast Menu Selection 61 Broadcast Configuration Dialog Window 61 Greate Report Key oiin cisternae eased 62 Sample REDON ererat i oa 62 Data Recording Checkboxes ececeeeeeeeeeeeeeeees 63 149 150 Communication Connections Back Panel 63 SOW all CBX Cennin s 64 Project Eile DIOS sites caa i ciudes hah atin loess mansion atest 64 Welcome Window Retur
123. eet might also contain suggestions for debriefing questions As part of the module package included are also files for x rays as well as lung and heart sounds where applicable Also loaded with the each module are compilations of ABG results and lab results for each stage These file can be played presented as part of the Vital Signs Monitor by student request and under instructor control 6 2 4 Authoring Training Modules A special bulletin and other information style guides and templates can be made available for individuals who are interested in authoring RespiSim curriculum modules Please contact IngMar Medical for details For further information on RespiSim please consult the dedicated RespiSim User Manual see our website at www ingmarmed com respisim or contact IngMar Medical directly 89 90 Test Automation Interface TAI Overview 7 Test Automation Interface IngMar Medical Ltd has developed an interface for the ASL5000 Breathing Simulator which will provide the end user with the capacity to incorporate the ASL 5000 into automation testing This server software will run independently from the ASL 5000 software and provides a command based interface for the ASL control The server will run in the background with a visible icon in the Windows task bar notification area It can be accessed remotely or locally by connecting to a TCP IP port and sending ASCII formatted commands For controlling the ASL 5000 s the se
124. eform from fil C Program Files x86 ASL Software 3 5 Browse EDF Example EDF Patient0 in 0019531 Using ASL Utilities Using the Patient Flow Data Processor Dout x To Ei F NOES Alen Yeu rie aoe 3 5 EDF Example SEDF PatientO vrs S EDF ExampleSEDF Patientl S EDF Example EDF Patient2 S EDF Example EDF Patient3 S EDF Example EDF Patient4 S EDF Example EDF Patient5 5 EDF Example EDF Patient 5 EDF Example EDF Patient S EDF Example EDF Patients oNEDF Example EDF Patient9 5 EDF Example EDF Patient10 5 EDF Example SEDF Patient1l S EDF Example EDF Patient12 5 EDF Example EDF Patient13 5 EDF Example EDF Patientl4 5 EDF Example EDF Patient15 S EDF Example EDF Patient16 NOTE It is important to keep in mind that this procedure does not generate a patient model with R and C but is based on a flow pump model Therefore playing back the script will not respond to a ventilatoar in the way a Pmus R C model would Rather the flows the piston movement of the simulator is prescribed at any point in time by the flow rate that was part of the recording pressure feedback is off for pump models Alternatively if data is available that in fact would describe Pmus over time instead of flow the same utility can be used to generate a true patient model for a playback All you need to do is to modify the seed vr3 file to represent a patient model with R and C instead o
125. eline pressure counting from Time to Pmin Time to Pmin after SoE Time to Pmin after SoE Time between Pmin and PEEP Parameter Definitions Parameters in the brb Breath Parameter File Includes any offset due to PEEP CPAP Added parameter in sw 3 5 Includes any offset due to PEEP CPAP Added parameter in sw 3 5 Includes any offset due to PEEP CPAP Added parameter in sw 3 4 Includes any offset due to PEEP CPAP Added parameter in sw 3 5 Includes any offset due to PEEP CPAP Added parameter in sw 3 5 Pmus Pressure Time Product Added parameter in sw 3 3 Calculated as median of pressure between time of peak pressure and StartExp Highest pressure during the breath cycle see also Time to Pmin after Start of Effort and Time to Trigger see also Time between Pmin and PEEP and Time to Trigger With this definition trigger delays are measured as the total time it takes for a ventilator to supply pressure sufficient to restore baseline pressure counting from the very beginning of patient effort see also Time to Pmin after Start of Effort and Time between Pmin and PEEP 137 Parameter Definitions Parameters in the brb Breath Parameter File cmH20 PEEP PEEP_lauto PEEP PEEP 2auto Total PEEP in Compartment 1 of the lung model Added parameter in sw 3 3 Total PEEP in Compartment 2 of the lung model Added parameter in sw 3 3 Total Res Work m J Insp Res Wor
126. ent see RespiSim on page 86 is in a format called TDMS A special utility is provided to make such data import friendly for spreadsheets and the like It will convert the whole file into a txt file with the same name as the original file From this file portions such as the breath parameters can be imported or marked and pasted easily into other applications Click the lt RespiSim File Conversion gt button on the Utilities tab A file dialog window will open INGMAR MEDICAL RespiSim Simulation File tdms C Program Files 086 ASL Software 3 5 ASLdata test tdms i Figure 8 4 Utilities RespiSim File Conversion Navigate to the desired TDMS file and click lt Convert File gt You can find the converted file in the same directory as the original NOTE Please be aware that the size of TDMS files generated during simulations many minutes long can easily be several hundred Megabytes and may not process quickly or cannot be opened with some text editor programs Baspjsimn File Conversion Utiliey 93 94 Using ASL Utilities Using the Patient Flow Data Processor 8 4 Using the Patient Flow Data Processor 2 C Program Files x86 ASL Software 3 5 EDF Example patient flow data example edf 2 C Program Files x86 ASL Software 3 5 EDF Example EDFPatient Figure 8 5 Patient Flow Data Processor This utility is essentially an expansion of the utility described in the next paragraph Using the Press
127. epresents the pressure drop in this supply tube It has two parts Rino is the coefficient of linear resistance and R is the quadratic or parabolic component so Psupply 7 z 2 Paw Rino L Rint When the flow reverses i e when the ASL 5000 is exhaling the flow does not go back into the supply plenum Instead it goes to atmosphere through a discharge tube The discharge tube has a resistance Paw is higher than P ambient and Rexo and Rex4 are the coefficients that specify it Continuous Mandatory Ventilation WE Vent Compliance Setting Cvent v E 20 Vent Resistance Settings Rind Rini co C Rex Rexi co Go Figure 13 30 Virtual Ventilator Basic Controls CLOT PH JedIpew sewsu ZAA GE MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 This VV model assumes that the choice of flow path is determined by two valves When the VV wants to supply air to the patient it opens the supply valve and closes the exhaust valve Air flows from the supply plenum through the supply tube resistance to the ASL 5000 When the VV holds it closes the supply valve and at the time the VV is programmed to allow the patient to exhale it opens the exhaust valve Because this simple VV has only open close valves the pressure changes suddenly at a transition A more realistic model would have proportional valves The numerical difference equations used
128. er Pas APmus Vi Cw 2 We follow the convention that a positive pressure difference produces expansion of the lungs Likewise expansion of the lungs is positive deflation is negative Changes in esophageal pressure pss that can be measured clinically are considered equivalent to changes in pleural pressure and are substituted for them NOTE The patient effort as used in the ASL software environment plots and pressure profiles is pictured as the negative value of Ap with the intention of creating more clearly distinguishable plots 2 Even in normal lungs these relations may be more a portrayed as non linear However a first approximation as a linear system has been found to be extremely useful clinically 109 Theory of Operation Introduction to Ventilatory Mechanics AP nus Figure 13 1 A one compartment ventilatory system in which Pao is the change in pressure at the airway opening Pss Is the change in pressure on the body surface Dp Is the change in pressure within the intrapleural space APmus is the change in the net force produced by the respiratory muscles expressed as an equivalent pressure difference often called muscle pressure difference v is change in lung volume is rate of change in lung volume interchangeably referred to as flow C Cw is lung compliance and chest wall compliance respectively R is resistance of the pulmonary system sometimes called airway resistance
129. essure at the airway the system sees during a breath measured above baseline pressure PEEP No backoff occurs when PIP above PEEP is greater than the spontaneous effort otherwise the reduction of spontaneous effort is by the specified fraction of PIP above PEEP m a PIP HFa of Para above PEEP Release A 0 expiratory backing off Expir Pehest wall With expiratory k backing off 30 Active Expiration Inspir Figure 13 26 Patient Effort Expiratory Backing Off GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 13 4 6 User defined Breath Profile i EE User File Length User specified freeform from file Praga Fita AA Solt 3 5 EDO Empe EDF Feien Figure 13 27 File based Patient Effort User defined pressure profiles allow breath configurations completely independent from the pre defined patient effort models External data files for defining spontaneous breathing patterns may be synthesized using a spreadsheet application or by taking data from esophageal pressure tracings from actual patients They must contain a column of pressure values at the pre defined sample rate Time increments of the pressure data are expected by the software at the same rate as is used internally by the software i e 512 data points per second The user synthesized pat
130. etea tuin y EUT aa Figure 4 16 Real Time Analysis Tab The Post Run Analysis tab gives access to all data analysis functionalities that are built into the ASL software Detailed coverage on this topic can be found beginning on page 67 Post Run Analysis Main Menu ie e INGMaAR MEDICAL AST AeA sar Be incMar MEDICAL Pueta cial ee Laka Figure 4 17 Post Run Analysis Tab Finally the UtilitiesSelector tab gives access to a number of auxiliary software features regarding data input and output For details on this topic see Using ASL Utilities page 92 BR rege hieden ASL SOO Vair Wiaan I on ie Virdee Hei ugtonor B incMar Manica AST heating eerie tor Fie Timer Horror inerta Cetra Seurtpt Pater Peniel Real Tee Asahin Pelan Pahan itan Be IncMaAR MEMCAL Ui Soc Parameter Sharing Patient Playback File Litilities Data Tie Eeport AIFA hareri Cuat put Frare Figure 4 18 Utilities Selector Tab The RespiSim main interface panel is the last tab on the right Again it is not active by default and needs to be activated with the lt Start RespiSim gt button Please note that only playback of a demo recording is possible without a proper license key The RespiSim option is covered in a general way starting on page 86 more detail is provided in a special addendum to this manual J haghir tection AtA S000 inise Maraga r m Fe ee iie Peai W incMan Menca AAA n
131. eters Breath detection parameters right side of the Post Run Data Re Processing window should only be modified from their default settings if you notice that the volume plot in the bottom half of the window does show improperly identified individual breaths For neonatal applications as already stated for Real Time Analysis threshold values should routinely be changed from their default value of 5 mL to a smaller setting typically 0 5 mL to assure that small tidal volumes are correctly interpreted as individual breaths Volume Start Pat Insp Effort Start Insp Vol Max Airway pressure filtering lt Pressure Filter gt may be applied in the same way as from the Breath Detection Real Time Analysis window see page 60 The setting lt Fraction of Target for Steady State gt determines a range of steadiness for the algorithm to use when determining whether a ventilator breath is a pressure targeted constant pressure or flow targeted constant flow breath see also Servo Control Performance Display page 84 If these targets are known up front they may be entered into the fields lt Inspiratory Target Override gt or lt Expiratory Target Override gt The default value of 1 is used for automatic calculation with the steady state criterium Compensations set in the PRDRP window will allow as in the Breath Detection Real Time Analysis window for properly adjusting calculations with regard to the compressib
132. f the flow pump model That file can be found at C Program Files x86 ASL Software 3 5 vars ASCH_flow vr3 Of course the values of R and C for the patient whose Pmus was recorded for example via an esophageal catheter need to be known or estimated 95 96 Using ASL Utilities Using the Pressure Profile Resampling Utility 8 5 Using the Pressure Profile Resampling Utility The Chest Wall Modeling option of user defined muscle pressure profile or user defined flow profile in SmartPump mode see page 126 often requires a reprocessing of available profiles e g from a patient flow profile Data to be used has to be presented at a 512 Hz sample rate which is typically a higher rate than that used by patient monitors for example The Pressure Profile Resampling Utility allows you to manipulate such data sets in the time domain as well as multiplying them with a gain factor The utility includes a batch processing feature that allows efficient processing of a large number of these files at once OoOO C SE ASL 5000 Pressure Flow Profile Resampling Utili Frequency Hz 5 100 000 Files to Resample Press Shift Click to select multiole files en emda 5_NEG20 in 5_NEG 40 in 5 POS 100 in 5 POS20 in 5 POSSO in current in exerco in exerco tvp in Exp_28_3Lpm in expbr3 in expbr in Insp_30Lpm in multibr 1 in Zero in Figure 8 8 Pressure Flow Resampling Utility First the p
133. flicts The settings from standard gas conditions BTPS ATPD STPD as they are made in the Breath Detection Real Time Analysis window also apply to the broadcasts Thus a convenient way is provided to make these adjusted parameters and waveforms available to other applications 61 62 Operation Run Time Home Report Generation The software installation includes two separate client applications TCP Waveform Client exe and TCP Breath Client exe for demonstrating and monitoring the broadcast They are helpful when developing third party applications that are using the data streams from the ASL application They can also be used as a remote monitoring tool to verify that a simulation is running properly when installed on a separate PC In software 3 5 they are conveniently accessed via the Utilities tab of the Window Manager yellow buttons Parameter Sharing Please refer to TCP Data Broadcast on page 97 for more information 4 8 Run Time Home Report Generation From the Run Time Home window you can directly produce simple simulation reports either formatted for printing or as HTML select Save Report Figure 4 84 Create Report Key The number of breaths repetitions saved as waveforms depends on the setting in the numerical box shown in Figure 4 84 The parameter selection is taken from the parameters displayed in the Breath Detection Real Time Analysis window This selection is also preserved in the
134. ftot BPM Pmin Pmus TP PEEP_1 auto PEEP_2 auto FEP_1 tot PEEP_2 tot Ext Insp Work Ext Insp Elastic Work Ext Insp Res Work Ext Exp Work Ext Exp Vent WorkExt Exp Res Work Ext Exp Heat Production Pmean Insp Pmean Exp Pbaro Ambient Temp Wall Temp PawTP300 cmH20O ms PawIP500 cmH20O ms Interactive Contrtol Panel The Interactive Control Panel has been updated to now allow also the use of pre configured dynamic patient models time varying parametes The scenarios folder has been revamped to include many more patient conditions and types useful to educators in mechanical ventilation management heal Teme deel 5 i m iio TN PESEN eee eer i ie Erica ee a S Ta niunia io a o Ci Papas Fim aa Softee 1 eer ore E Figure 0 2 ICP Patient Library Tab The Script Editor received a greatly simplified user interface for saving and activating scripts The less frequently used Tokens are now separated into a normally hidden column Figure 0 3 Script Editor Saving RespiSim Software for the ASL 5000 is fully prepared for our newest option RespiSim Patient Ventilator Interaction For more information on RespiSim please visit our website at http ingmarmed com RespiSim htm or consult this manual s chapter RespiSim page 86 There is also a separate addendum to this manual covering RespiSim in significant detail RespiSim optionally includes a hardware interface to the most com
135. get is reached I Time expressed as Pressure controlled or Flow controlled Paw at Vmax PEEP Pmus x Vmax Vo Paw PEEP Pmus min x Vo Vmin 2 where Vo is volume at Paw PEEP and Pairway PEEP Pmus min is the smallest value during inspiration Mean squared pressure or flow deviation from Insp Target during inspiratory flow time Pressure or flow overshoot relative to Insp Target Insp Work Insp Elastic Work The time to accomplish 90 of the rise to Insp Target pressure or flow The pressure or flow at steady state during inspiration where steady state is derived from median pressure during the middle part of inspiration Tidal volume measured from Sol to Peak Volume Inspiratory time includes a potential pause time A ventilator performance parameter either a value of pressure or of flow depending on the type of inspiratory breath delivered by the ventilator Between Points A and E or just before F Based on the behavior of pressure and flow an algorithm determines the type of the breath and the target and performance parameters are selected accordingly A Total System Work parameter Inspiratory Elastic A ventilator performance parameter either a value of pressure or of flow depending on the type of inspiratory breath delivered by the ventilator A ventilator performance parameter a value derived of either pressure or flow depending on the type of inspirat
136. gram Files x86 ASL Software 3 5 vars interactive vr3 The name and the settings of the the vr3 file currently being applied and edited in the ICP out of a running script or RespiSim scenario can be accessed by clicking on the lt View Original Model Settings gt button in the left of the ICP window Figure 4 67 View Original Model After editing from within the ICP is complete you may save the resulting parameter set vr3 file either under its old or a new name by clicking the lt Save Current Model Settings gt button FA NOTE Please note that for the reasons illustrated above the name interactive vr3 is reserved and cannot be used when saving parameter files With this approach of using a working copy of the current parameter file you can always return to your running script by clicking lt End Interactive gt if editing was not satisfactory and no changes to the original vr3 file will occur The left side of the Interactive Control Panel is divided into three sections From the middle section of the control strip you can select to call in a Default Patient that has been defined in a parameter set default vr3 This patient setting may be changed in the same way as any other vr3 file to suit a user s special needs The top third of the control strip shows basic information about the currently running simulation which can be expanded with the information about the originating vr3 file
137. h Hypertronics D01 up to 1400 circular 4 pin DO1PB406MST Connector style 4 position ODU mates with used for serial no s ODU S11M07 PO4MJGO 5260 or above 1400 equivalent LEMO plug Data Enabled Oxygen vol 120 9 P baro kPa 101 3 Gas Temp C 125 0 J Wall Temp C 125 0 7 Aux1 5 00 v Aux2 15 00 J Record Aux1 Aux2 Figure 4 86 Data Recording Checkboxes Data from the analog channels is retrieved while the simulator is running A separate data file data aux may be written which contains the readings for both channels as well as vol of oxygen when checked in addition to a time stamp This feature is activated by checking the lt Record AUX gt check box Updates to this file are written approximately 4 to 5 times a second Recorded values of other analog signals retrieved by the ASL 5000 are also provided in the standard data file set as follows Data File Parameter xxx brb xxx bra O2 xxx avb xxx ava Gas temp once per breath xxx avb xxx ava Cyl wall temp once per breath xxx avb xxx ava Barom pressure once per breath Update rate once per breath 1 Analog outputs are not yet supported in the current firmware Operation Working With the Analog Inputs 4 10 Working With the Digital Outputs The digital output connector of the ASL 5000 provides three TTL signals The first channel is used to provide a high low signal switched with the direction of flow high for inspiration low for e
138. he ASL 5000 as a ventilator The capability of moving tidal volumes of gas that is implemented in the ASL 5000 is not intended to be used for any kind of treatment of humans or animals 1 2 1 Intended Use of the RespiSim Option RespiSim is intended to create a fully integrated respiratory simulation experience for training students in the subjects of mechanical ventilation and ventilator S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 management It gives the educator the ability to capture data from a real ventilator as well as from the ASL 5000 Breathing Simulator and to mark and annotate events as well as display patient vital signs on a separate monitor Replay of simulation recordings assists in debriefing sessions or can be used for classroom instruction RespiSim is intended to bring the advantages of medical simulation accelerated immersive learning training with permission to fail to respiratory care education Preconfigured Curriculum Modules form an integral part of this new method of instruction WARNING NOT FOR USE ON A PATIENT The ventilator data acquisition and storage system of RespiSim ts not intended to monitor chart or store data coming from actual patients or for the purpose of assisting in clinical decisions regarding actual patient WARNING Electromagnetic Interference Do NOT use the ASL 5000 in pat
139. he model editing process actu ally represent the negative of muscle pressure Pmus giving you a picture that resembles that from an oesophageal pressure tracing J 0 500 Uncompensated Residual Capacity L gt 5 0 R cmH20 t s F 21 1 C mL cm H20 Two Compartment 13 3 2 Dual compartment Model Click on diagram to select a model 0 500 Uncompensated Residual Capacity L E Rtin cmH20 L s 5 o Rtout cmH20 L s i o Riin cmH20 L s so Rout cmH20 L s LJ 10 0 Rzin cmH20 L s f 200 R2out cmH20 L s Ff soo C1 mL cmH20 F 20 0 C2 mL cmH20 Figure 13 15 Two Compartment Model The two compartmenttwo compartment model consists of a single linear or parabolic tracheal resistor two branch resistors always linear and a dual linear or non linear compliance The icon of this model symbolizes the configuration For the mathematical description please refer to page 116 Equations 14 and 15 13 3 3 Model Enhancements In addition to linear or parabolic response of the respective resistors the modeling environment also allows different settings of resistance during inspiratory and expiratory flows This is intended to give the user added flexibility for generating models representing particular pathologies or disease states e g high expiratory resistance in patients with asthma Compliance may be modeled both as a linear relationship between volume and pressure or as the familiar sigmosoid
140. hese values set to zero Please be aware that it will not be possible for the breath detection algorithm to successfully identify breaths under all circumstances It is therefore recommended to always perform a plausibility check A higher than expected number of breaths for the total time period of recorded data viewed in the Breath Data display for example will normally indicate an improper identification In this case small fluctuations most likely have been incorrectly separated into individual breaths and an increase in the breath detection threshold is indicated An example would be a situation where high frequency oscillations are superimposed on a bi level regular breath pattern In the Post Run Analysis you can further fine tune aspects of the analysis algorithm For example you can introduce a manually selected threshold for start of effort in effect filtering out small artifacts of the patient effort In addition it is possible to manually override the simulator side calculation of a target flow or volume during inspiration or expiration a parameter related to ventilator performance This target is effectively known a priori in many situations for example given as a ventilator setting the peak pressure in a pressure controlled mode lt Insp Waveform SD Threshold gt is a setting to be used by the algorithm for determining the type of the inspiratory waveform pressure or flow as the primary control va
141. hin the Simulation Editor is determined by the bpm parameter The small profiling window always shows the time allowed for one breath unless the rate exceeds 24 bpm see also NOTE on page 125 Theory of Operation Patient Effort Model Pressure Trigger Cycle Time 100 45 Simple Pressure Trigger Figure 13 17 Patient Effort Model Pressure Trigger Selecting Pressure Trigger shapes the pressure waveform as a rectangular pressure drop no ramps defined only by amplitude and duration the set trigger time For the condition of an occluded port this setting will produce a rectangular pressure profile as mouth pressure see Figure 13 18 page 121 The excursion of the piston is reversed by the recoil forces programmed into the system as its compliance C or C1 and C2 in case of the two compartment model NOTE All pressures of the Patient Effort Model are plotted inversed negative trace producing an inspiration See also the footnote on page 120 Inspiration Press Ptrigger inspir Cycle Time 100 Simple Pressure Trigger Figure 13 18 Pressure Trigger Effort Detail 121 122 Theory of Operation Patient Effort Model 13 4 2 Flow Trigger JA Pasion frar Model ki inspir Cycle Time 100 Simple Flow Trigger oo k 4 ai 8 Lo i 1 I a a E E B I F 1 1 DS 0 5 10 15 20 25 20 25 40 45 50 25 60 ryepParameters Ean
142. hnde iaecite te aaaseaserise lia aas 103 Unmounting the Preemie Cylinder 103 Mobile Cart Option e 00000000000000000000 104 Troubleshooting 6 105 Common Errors bsscesssssiunssdseceveseusscatesouseaves 105 Maintenance sesee0 106 Instrument Identification seeeee8 106 Service and Calibration Intervals 106 Firmware Upgrade sssssssssssssseees 107 Schematic Overview ccccssssssccccceeseees 108 10 13 13 1 13 1 1 13 1 2 13 1 3 13 2 13 221 bo 2 13 2 3 13 3 13 3 1 T3332 13 3 3 13 4 13 4 1 13 4 2 13 4 3 13 4 4 13 4 5 13 4 6 13 4 7 13 5 13 6 13 7 14 14 1 14 2 14 3 15 16 16 1 16 2 16 3 16 4 16 5 Theory of Operation 109 Introduction to Ventilatory Mechanics 109 Normal LUNGS cerina 109 ABHOR Mal LUNGS scssesieani na 115 FACIE GUC Siregar n A 117 Introduction to Modeling 119 Model Background eeseeeeeeeeeeeeeeees 119 Limitations of the Model ceeeeeeeees 119 Realization of the Model c0 119 Ventilatory Model Types cccceeeeeees 120 Single compartment Model 08 120 Dual compartment Model 0000 120 Model Enhancements 0 seeeeeeeeees 120 Patient Effort Model sssssssessseeee 121 PASSIVE IMO eiidse testes aceite iien 121 FOW ENC BOM astissti
143. i Chega feet a Powel Tanp erat x eT imiran Phiake j e aad D Fsg ee n Se be ee e Pa OTA O H maiaa forced E avy A Ma 7 an Leet ries Grii Pek Fier Piep e Pimi a See eis Sth pii OT JET ager ere RD eee Che pe i tegen Perlerceces l amp r rie Tapaa ees hija bahea beeps edie pir SOPs OS egy Re tT a Saar j reel iii t 4 RE ee ee a Pale Cte elie ETJ Se imag reed fcc ge er fi ama cia i i f Ene Pert h I ecb O ree maena n b eh hiama Di a peppery p i Figure 6 3 RespiSim Virtual Vital Signs Monitor G LOZ P JeoIpew sewsul O ZA S E MS 000S ISV JenueW s asSN User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 RespiSim RespiSim Screens bs a Patient Fie Simulation Details Current Module ASL Default Module Description This is a demo Figure 6 4 RespiSim Main Interface The RespiSim Debriefing Panel has distinct regions A history plot Event Graph shows significant events on a timeline during the simulation such as alarms or instructor comments An area for Graphical Data may show waveforms loops or trend lines for select breath parameters A field for Numerical Data can be preset with up to 18 different breath by breath readings from the ASL simulator an attached ventilator and the virtual Vital Signs Monitor While the simulation is running under control of RespiSim all va
144. i E 7 a E O 5 50 75 WhO 125 ERO 175 NO 225 250 2S MO 35 Pressure cm H20 9 2 Ci ffor angie mode Figure 4 49 Non Linear C Editing The compliance curve is modeled in three segments with a linear middle segment for volumes between intercept 1 and intercept 2 and lower and upper portions of the curve shaped by a polynomial Inflections points 1 and 2 are the equivalent of what is commonly referred to as the lower and upper inflection point in P V graphs In the red control lines the links indicated by dots in the curve may be grabbed with the cursor click and hold and moved around Similarly the horizontal intercept lines may be moved to increase or decrease the linear middle portion of the compliance response curve In cases where it is difficult to discern the individual curve segments because the red control lines are at the edge of the graph for example it is a good idea to start editing by using the numerical parameter fields first and to begin moving the control lines directly from within the graph only afterwards NOTE It is important to ensure that the compliance response created covers the whole range of pressures expected to occur in a simulation run Otherwise undefined behavior of the simulator may result The straight green line pointing to the middle of the linear portion of the curve indicates the compliance value that would be used if you switched back to linear complianc
145. iSim if no license was purchased Playback Controls e COC Patient rile Simulation Details Current Module 1 i ros tee Figure 6 5 RespiSim Control Field Initially you will need to select a TDMS file for replay Click the folder icon under Recorded Simulation to Load With the demo version of RespiSim you have access to ASL Software 3 5 RespiSim_Modules RespiSim_Demol RespiSim_Demo tdms You will see information about the Curriculum Module to which this data file belongs a brief description and the associated preferences file 1 ATDMS file contains all data to be displayed in RespiSim playback mode It is a file in the set of saved files from each simulation pro vided the simulation was performed while RespiSim was active The regular waveform files are also saved as usual for a more detailed look at pressure volume and flow The function of the end of track beginning of track buttons M D is to allow easy navigation to the first or last use of a specific patient parameter set during a simulation The cursor in the Event Graph will be placed in this location so that waveforms and numeric values can be read off at transitions between different patient states with ease While the Event Graph is expanded using the arrow_L in its left bottom corner hovering with the mouse cursor over the Instructor Events marked in the file will bring up any comments that had been recorded
146. ient rooms or other areas where life supporting equipment is in use 1 2 2 Use of the Smart Pump Mode In addition to the applications of the ASL 5000 as a breathing simulator using R C patient effort it may also be used as a flow or volume waveform generator assisting e g in tests performed in the development of devices for the delivery of pharmaceutical aerosols CAUTION Do not allow aerosols to contaminate the cylinder of the ASL 5000 Equipment malfunction may result For applications requiring the inhalation of substances always use accessory 31 00 600 the Auxiliary Gas Exchange Cylinder AGEC WARNING Explosion Hazard Do NOT use the ASL 5000 in the presence of flammable anesthetics Use of this instrument in such an environment may present an explosion hazard Operator Safety General Precautions 1 3 General Precautions CAUTION Electrical Supply Connect instrument only to a properly grounded wall outlet providing 100 240 V AC 50 60 Hz WARNING Electric Shock Hazard Always disconnect from line power before opening ASL 5000 CAUTION Do not operate ASL 5000 when it is wet due to spills or condensation Never sterilize or immerse the device in liquids CAUTION Always use dry air or oxygen with the ASL 5000 Rainout inside the cylinder may impair its function and may eventually damage the simulator Please contact IngMar Medical for the necessary procedu
147. inear parabolic or mixed depending on the respective switch setting in the lower half of the screen 3 The values for R1 and R2 the respective bronchial resistors leading to compartments 1 and 2 with the additional independent values Rout Rlout and R2out for independent setting of resistance during expiration if the switch in the lower half of the screen has been activated 4 The values for C1 and C2 i e the respective com pound compliances of compartments 1 and 2 NOTE It should be noted that the value of the simulator URC does not need to correspond to a patient s true FRC Functional Residual Capacity for the typical simulations performed Please keep in mind that FRC of adult patients might be larger that what is allowed as the largest setting 1 5 L plus 0 2 L of the safety zone The calculations for model response do not depend on the value of FRC and therefore a value for URC may be chosen that is practical for purposes other than those of matching real FRCs For example a sufficient baseline volume allows the simulator to follow excursions required by negative pressures applied forced exhalation without running into the forward piston position limits Also URC values need to be chosen that allow the expected tidal volumes within the capacity limit of the simulator Vt URC 0 2L lt 3L required As 1 0 2 Lis the value of the home position volume that is always main tained as a safety zone against an
148. invert flow direction multiply with 1 if the recording does not conform to the requirement of the ASL 5000 i e counting inspiratory flow as positive S LOZ PHT JeoIpew sewsu O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 The file naming process assigns to the vr3 files names that use the base file name of the flow data file extended with the number of the segment in the script The resulting script may be inspected using the Script Editor and Simulation Editor ee ee ee eee A I aC OG eee a Gea Oa eo i Program Program Program Program Program Program Program Program Program Program Program Program Program Program Program Program Program x66 NASL x66 SASL x66 SASL x66 ASL x66 SASL x66 SASL x56 SASL x66 SAS5L x66 SAS5L x66 SAS5L x86 NASL z566 NASL x86 NASL zx866 SASL x56 NASL Z66JNAASL x86 NASL Figure 8 6 Script From Recorded Patient Flow Each segment represents a smal original recorded flow 7 Software software software software software software software software software software software software software software software software Software 3 snippet of the Flow Pump Time Varying Parameters edit 4 Figure 8 7 Script From Recorded Patient Flow m User File Length User specified fre
149. ipt path name box in the top of the Script Editor reminding the user of the saving status of a script It will be EE when a new or changed and yet unsaved script is shown After a script has been saved the box background will appear green Saving a script automatically also generates a copy of the script under the name vars current sct which is the work copy used by the simulator NOTE In software versions prior to 3 5 the saving as current sct had to be performed by the user manually using Save as current sct from the lt Script File gt menu This is no longer necessary NOTE Any changes made to a parameter file in use during a simulation will go into effect immediately upon saving the vr3 file providing a second way to operate in an interactive fashion in addition to using the Interactive Control Panel NOTE You cannot save a parameter file under the file names current vr3 interactive vr3 or respisim vr3 These names are reserved internally 4 2 2 Manipulating Scripts Whenever a script is opened the Script Editor will evaluate its content and verify that any parameter files referenced actually exist If that is not the case those segments of a script that cannot be found will be highlighted in red see Figure 4 29 HH ingMar Medical ASL 5000 Window Sopfie Paametefie windows Melp Oustomze INGMAR MEDICAL Interactive Control gt e Du ASONI T Run Time Home Resi Time Analysis Post R
150. ities ASL 5000 Data File Conversion 92 Utilities AUX Resampling cceeeeeeeeeeeeeeeeeeees 93 Utilities RespiSim File Conversion 00s 93 Patient Flow Data Processor cceeeeeeeeeeeeeeeees 94 Script From Recorded Patient Flow ee 95 Script From Recorded Patient Flow ee 95 Pressure Flow Resampling Utility cesses 96 TEP Breata Cuent xyes ie eta ave cers A 97 TCP Waveform Client cccccccccscccnccccccccccsscceseeces 97 Simulator Bypass and Leak Valve Module 98 SBLVM SEMEMIALIC Sass cacnetetsungurre viatncaad antidote seen 98 SBLVM Orifice Characteristics eeeeeeeeeee 99 Cylinder Temp Controller Front Panel 100 Paramagnetic Oxygen Transducer 0000 100 CO Data at RUM TINE zarreta E Ne 100 Auxiliary Gas Exchange Cylinder e 101 Setup withManikin ssessssssesssssssssssssssssssserrrersesees 101 ASL 5000 with Preemie Option Installed 102 Installation of Preemie Cylinder cc ecceeeeeeeees 102 Preemie Cylinder Pressure Line Manifold 103 Tao Bi N46 8 xs Oral teen ter Merc rr Pee rete eee rere 104 ASL 5000 Component Serial Numberts 106 Firmware Upgrade Normal SW Launch 107 Firmware Upgrade Confirm ceeeeee 107 Firmware Upgrade Disconnect Warning 107 Firmware Upgrade Restart Notice 107 Schema
151. ity two stop Hamilton vents Fusion for configuration bits Maguet Serva i 100 240 V AC Power Philips Resplronics Esprit Adapter GE Engstrom Beige GE 15 DB 15 3 pins Beige MIB Cats Jumper Beige LTV RJ12 Jumper ae has ae eae Hamilton G5 Mone Needed Maquet Serve 300 None Needed Maguet Servea i None Needed Philips Respironics Mane Needed Esprit Philips Respironics None Needed GE Engstram with black MDH male 3110631 with black MDH male 31 10631 v g Carefusion Viasys Viasys Pulmonetic LTV on Baud 3600 8 bits Avea Vela PTV neo Parity Nane i arin bit CareFusion Viasys melee pLUtitity 3 AveaVela PTV In aut Output VOXP Set to VOXP Baud 19200 Beige SV300 8 bits Parity None 1233 anay with 6 pins in top row 1 stop bit Maguet Servo 300 Part no 31 10633 Part no 31 10636 Part no 31 10637 Gray V g 25 pin Philips Resplronies V60 Part no 31 10635 Part no 31 10 634 143 144 Technical Data Electrical Specifications Physical Specifications Software Specifications 16 2 Electrical Specifications Supply Voltage Current 120 V 230 V Fuses universal input 100 to 240 V AC CTC option either 220 to 240 V AC or 100 to 120 V AC please specify at time of ordering lt 1 0 A typical 2 0 A max lt 0 5 A typical 1 0 Amax 3 0 A time delayed 2 x size 5 x 20 mm 16 3 Physical Specifications Dimensions ASL 5000 SBLVM Weight ASL 5000 SBLVM
152. jos smo a os os Todler Obsicive o9 as Smal 2a 20 19 oa 06 0 15 04 04 Peditic6 12yo Normal o5 20 05 os 05 05 zs s Ow jsi EEE 5 Sinusoidal 20 Sinusoidal 20 Sinusoidal o 30 si w js 80 80 jt 80 a 50 20 ae 25 30 50 ee 25 30 28 20 Sic a a a0 fs 8 25 40 j ee ee ee ee ee ee ee ee ee ee ee ee Y GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA as 2 Compartment Static Models Rtin 75 Rtout 75 Adult_Right_Pneumothorax 0 5 Riin 15 Riout 3 Rin 3 R2out 1 33 o pes Pos J ps 3 a0 Tapes C1 7 C3 1 gt So Sinusoidal 20 30 30 Figure 13 31 Patient Model Library Parameters Static User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Time Varying Models 1 Compartment Adult_Normal_variable Adult_Normal_unassisted_variable Improved_Compliance_Adult_1 Improved_Compliance_Adult_2 Improved_Resistance_Adult_1 Improved_Resistance_Adult_2 Anesthetized_Adult Adult_Pneumonia 0 5 0 5 0 5 0 5 0 5 0 5 Figure 13 32 Patient Model Library Parameters Time Varying 6 6 3 3 6 6 6 b Endpoints Endpoints Reps 50 Reps 50 Start 30 Start 50 End 13 End 15 Random Random Uniform Uniform Reps 50 Reps 50 Mean 13 Mean 15 Seed 1 Seed 1 Ampl 5 2 Ampl 6 3 3 Random Random Uniform Uniform Reps 1000 Reps 1000 Mean 12 Mean 12 Seed
153. k Exp Res A Total System Work parameter Work Resistive Work Vent Exp Vt mL Expiratory volume as seen by the Ventilators that actually use corrections to take into ventilator taking into account account volume lost in circuits would be compressible gas volumes in expected to report volumes similar to the ASL s circuits as defined in Auxiliary uncompensated parameter Vtin at BTPS Compensation Parameters in the conditions Breath Detection RT Analysis window Vent Insp Vt mL Inspiratory volume as seen by the Ventilators that actually use corrections to take into ventilator taking into account account volume lost in circuits would be compressible gas volumes in expected to report volumes similar to the ASL s circuits as defined in Auxiliary uncompensated parameter Vtex at BTPS Compensation Parameters in the conditions Breath Detection RT Analysis window Vol 1 Peak mL Total Volume Voll peak In a 2 compartment model volume is Vol2peak distributedbased on R amp C values input into the Lung Model Vol 2 Peak mL Total Volume Voll peak In a 2 compartment model volume is Vol2peak distributedbased on R amp C values input into the Lung Model Vol Max Index integer Time stamp for the time of Internally used parameter for marking the times of maximum volume during a specific events during a breath cycle Spacing is breath cycle 1 data rate default at 1 512 Temperature as measured on the Ad
154. k done on or by the respiratory muscles is to be evaluated then the Ap v Curve is used If the work done on or by the ventilator is of interest then the plot of Pao Pri versus v is required If the entire load represented by the ventilatory system is desired then Apv is needed When analyzing the work of the breathing cycle and its subdivisions one must include both the positive work done on the system and the negative work done by the system An alternative way of viewing Figure 13 5 and Figure 13 7 is to consider the fate of the work done on the ventilatory system during inspiration For expiration to occur i e v to decrease from V toward V work energy is required This is supplied by the stretched elastic components of the chest wall and lungs Work was stored in them as potential energy when the system was expanded during inspiration We in Figure 3 This energy is used to compress the ventilatory system during expiration Figure 13 5 c shows that the potential elastic energy i e the area between the C line and the v axis is divided into two regions by the expiratory Ap v Curve The area 1 between the Apv curve and the v axis represents the work done on the ventilator and the respiratory muscles by the ventilatory system s elastic elements as they decrease in length The energy this represents is lost as heat to the atmosphere The area 2 between the Apv Curve and the Ca line is
155. le Tool Output Settings ee 26 Project File Tool Relative Path Tokens 27 Project File Tool Default Analysis Param 27 Project File Tool Virtual Ventilator Settings 27 Quick Launch Menu Options s ssseeeeeeseessssessssssssse 28 Full Choice Menu Connection Options 28 ASI Gen tii aliOM Editer a a o 28 Run Time Home Sync Message ceecee 29 Script Patient Model Tab Scenario Scripts 29 Interactive Control Panel ceceeeeeeeeeeeeeeeeeeeees 29 StartelnteractiVe Control ssrin 29 Real Time Analysis Tab ccceeceeeeeeeeeeeeeeeeeeees 30 Post RUM Analysis Tabernan aa 30 UJTINPEIES Selector TaD areor i ES 30 Respo imi TAO ea EE EE 30 Script File Editor Scenario Scripts sseeeeee 31 Project File Tool Editor Working Folder 31 Script File Editor ScriptFile Menu Items 31 Script File Editor Manual Scripting 00 32 Script File Editor Script Errors cceeeeeeeeeees 32 Script File Editor Editing Techniques 0 32 Script File Editor Tokens 4 3 scs cssesseouteseeercnsaastecense 33 Tokens Relative Path Configuration Tool 33 Tokens Exchange with Configured Token 34 Token Configuration Errors c sscsssccccsceceeeeeeeeeees 34 Script Editor Scenario Scripts ceeeeeeeeeeeeeeees 34 Script Editor Manual Scripting cce
156. le to generate forced expiration e g to mimic a patient fighting a ventilator NOTE All pressures of the Patient Effort Model are plotted inversed negative trace producing an inspiration See also the footnote on page 120 Cycle Time 100 Sinusoidal Half Wave Figure 13 22 Sinusoidal Effort Detail 1 This feature has been available as of SW 3 1 Hering Breuer response has been added with SW 3 4 CLOT PH JedIpew sewsu ZAA GE MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 When designing a spontaneous breathing pattern it is the responsibility of the user to ensure that the patterns do not exceed the range of possible volumes or flow rates A simple calculation is that of URC C Pmus lt 2 5 L ignoring the resistance to arrive at the maximum volume Of course if there is a ventilator connected the external pressure applied will also make a contribution to tidal volume which has to be taken into account Similarly a volume undershoot due to forced expiration programmed into the patient effort profile could lead to a stop at the forward limit switch for the piston Please refer to the Patient Backing Off for a description of the functionality of the Pmus modified by Paw control parameter 13 4 4 Trapezoidal Breath Profile FA Pabent Erot Model o C Cycle Time 100 2 Trapezoidal Half Wave
157. le volume and external resistances which CLOT PH JedIpew sewsu O ZAA GE MS OOOS ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 may be introduced into the system via connectors and external circuits The effect of the compensations will be that volumes indicated as ventilator volumes will more closely match the measurements from a ventilator itself when its calculations do not already include any compensations for these effects Especially when using the simulator in neonatal applications where parasitary effects can be significant careful adjustments will be helpful in eliminating unwanted biases in this regard As an example let us assume that the ventilator delivers a tidal volume of 550 mL to a patient with a very low compliance of 10 mL cmH2O If the circuit compliance is 1 mL cmH2O the overall compliance of the system is now 11 mL cmH20 and only 11 12 of the volume hat leaves the ventilator actually reaches the patient 550 mL the rest is lost in gas compressibility of the ventilator circuit Entering the volume of the circuit into the lt Compensations gt field will result in showing the full volume that left the ventilator instead of just the volume that reached the simulator NOTE If on the other hand compensations of this kind are performed by a ventilator and most ventilators do this for example by calibrating a patient circuit at startup you can leave t
158. lease launch the software and check that it has been installed properly The software as installed will run without applying any license keys in a stand alone Demo Mode without the ability to communicate with an ASL 5000 device or the Virtual Ventilator option These additional capabilities are accessed by placing a license key into the main installation folder NOTE License keys can be purchased separately for the Virtual Ventilator option or are part of the delivery of the RespiSim option When software is updated through a new download it is necessary to replace the key after the installation is complete as the key will be reset during a standard installation From the Welcome tab presented at startup you can make the selection of how to connect to an ASL 5000 simulator either via Ethernet preferred method or via RS 232 serial connection see Starting the ASL 5000 page 24 NOTE If you are upgrading from a 1 n n 2 n n or 3 0 n version of the ASL 5000 software you will need to first upgrade the firmware on the embedded controller of the simulator to a 32 bit version Please follow the instructions in section Firmware Upgrade page 107 in order to ensure a smooth upgrade process As long as the installed firmware in the simulator is a 32 bit version version 3 1 of the ASL host software or higher you may use it with the 3 5 release of the host program to perform a direct upgrade of the firmware no 32 bit pre
159. linder Kit 10 6 1 Intended Use The preemie range cylinder improves volume resolution of the ASL 5000 by approximately a factor 8 to approximately 0 2 uL It can be used when simulations are fully within the range of 200 mL maximum volume and flow rates below 40 L min Figure 10 9 ASL 5000 with Preemie Option Installed 10 6 2 Assembly The piston for the 2 5 cylinder is first attached with its extension rod to the regular 7 adult size piston plate Gently screw the assembly into the threaded adapter on the large piston plate taking care not to damage the seal on the small piston Take the preemie cylinder and slide it over the 2 5 piston plate from a slight angle so that no sharp edge cuts into the seal on the piston Push cylinder gently all the way towards the threaded inlet of the ASL and turn clockwise to engage the threads Be careful that the threads mate as intended When turning the cylinder only the friction from the kapseal should inhibit the motion CAUTION Misalignment of the threads could cause damage to either the Preemie Cylinder or the ASL main unit Fully thread the piston in until the shoulder ring sits directly against the brass receptacle Gently tighten Se i T j Figure 10 10 Installation of Preemie Cylinder Connect 3 pole Hypertronics plug into the receptacle marked External Cylinder Temp on top of the ASL 5000 The short cable connecting the internal temperature se
160. log default value when no source is connected is 5 V Input O 10V Aux 2 Volt V Signal on channel 2 of analog default value when no source is connected is 5 V Input O 10V Breath Num integer The number of the breath starting Only breaths that exceed the inspiratory and from the beginning of the expiratory volume thresholds are counted simulation as determined by the eliminating volume noise The count is a analysis software posteriori independent from ventilator or model settings ss z overall breath rate calculated Combines mechanical and spontaneous breaths from the time between peak Added parameter in sw 3 3 volumes Breath Type flag Spontaneous 1 or Mechanical Based on the presence of spontaneous effort 0 anywhere during the breath Time stamp for End of expiration Internally used index for marking the times of End Exp Index integer Start of a new breath cycle specific events during a breath cycle Spacing is 1 data rate default at 1 512 E Time Expiratory time counted from Between Point E or just before F and G StartExp to EndExp Exp Active Work If Exp Work is lt 0 Exp Active A Total System Work parameter Expiratory Active Work Exp Work zero otherwise 2l Exp Mean Mean squared deviation from A ventilator performance parameter cmH202 Squared Error Exp Target during expiration Exp Overshoot Relative pressure change from A ve
161. ls as well as vol of oxygen when checked in addition to a time stamp For update frequencies for these recordings please see Working With the Analog Inputs page 63 NOTE Beginning with software 3 4 O2 and the primary AUX signal are also included in the waveform files and TCP broadcasts NOTE In the following pages it is mentioned for many of the Analysis views that volume corrections can be applied to display volumes according to the different standards BTPS ATPD etc It is important to note that these corrections are only applied for viewing of the data but that the data itself even the processed data is in now way altered by making different selections in this regard NOTE In sw 3 5 all analysis views will consistently show the volume offset caused by PEEP in the same fashion as this is plotted in the Run Time Home graphs in the past the volume at the begin of a breath was set to zero In some instances 1 FOM Fast Oxygen Measurement 69 70 Data Analysis Display Data Selections Green Buttons NOTE As of software 3 5 it is now possible to have multiple analysis windows open at the same time This facilitates comparison of data using different views 5 3 Display Data Selections Green Buttons The column of options regarding display of breath data is colored in green and offers 5 different views see Figure 5 4 below rusiu Ausly Sis Breath by breath data 3 graphs Multi p
162. lues are updated continuously For debriefing of a simulation session Playback Mode gives convenient access to all data collected during the session In Run Mode an instructor can invoke patient models at will from an inventory that is displayed in the control area of this screen For a true plug and play experience the RespiSim option includes a special Instructor Dashboard from which to load all elements of dedicated RespiSim Curriculum Modules The Instructor Dashboard is automatically opened as a separate window when RespiSim is started Use of RespiSim with Dedicated Educational Modules page 89 6 1 2 RespiSim Modes of Operation RespiSim can be used both for running an actual simulation as well as for playing back such a simulation for purposes of debriefing The latter aspect is of critical importance for enhanced instruction methodology since the debriefing process is where a significant portion of the learning actually occurs RespiSim is therefore designed around the concept of a comprehensive debriefing 87 88 RespiSim RespiSim Screens When the button lt Open Playback Mode gt in the control area of the RespiSim window is clicked the visual appearance of the left portion of the window changes and all the pertinent information for the recorded simulation is displayed together with a play end of track beginning of track set of buttons This is also the mode you can use to invoke a demonstration of Resp
163. mH20 Average pressure for comp 1 Includes any offset due to PEEP CPAP over the full breath cycle Added parameter in sw 3 5 a lt a v 2 cmH2O Average pressure for comp 2 Includes any offset due to PEEP CPAP over the full breath cycle Added parameter in sw 3 5 cmH20 Average pressure over the Includes any offset due to PEEP CPAP inspiratory part of the breath Added parameter in sw 3 4 cycle 136 CLOT PH JedIpew sewsu O ZAA GE MS OOOS TSY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 SD Exp Res Time between Pmin and PEEP Time to Pmin after Start of Effort Time to Trigger cmH20 cmH20 cmH20 cmH20 cmH20 cmH2O cmH20 cmH20 cmH2O cmH20 L s gt VN Average pressure for comp 1 over the inspiratory part of the breath cycle Average pressure for comp 2 over the inspiratory part of the breath cycle Average pressure over the expiratory part of the breath cycle Average pressure for comp 1 over the expiratory part of the breath cycle Average pressure for comp 2 over the expiratory part of the breath cycle Lowest pressure reached during a breath cycle typically during inspiration Pmus dt from SoE to End of Effort Pressure at start of expiration Peak pressure Standard deviation of Pairway dV dt during expiration The time it takes during a patient effort to return to bas
164. ma sct Neonatal_obstruction sct NeonatalINCLD_6 12mo sct NeonatalNorm_6 12mo sct PediatricSyo_asthma sct PediatricSyo_normal sct NOTE For editing scenarios go to Manual i Figure 4 30 Script Editor Scenario Scripts There are three patient types neonatal pediatric and adult and multiple patient conditions to choose from Disease states include ARDS apnea asthmatic obstructive condition COPD obstructive condition pneumothorax bronchiolitis pneumonia WARNING Due to the wide variety of clinical conditions associated with different lung diseases it is not always possible for a specific patient parameter setting to be representative of such disease states Scenarios in the ASL 5000 software are therefore intended as suggestions only The user is advised to apply his or her own clinical expertise to use and edit the scenario scripts After highlighting a script from the list click Choose Scenario Script File or double click the respective script This will open the Manual Scripting tab with the patient model file entries and allow you to further edit the preconfigured script using the methods described below NOTE Most scripts from the Scenarios list consist of just one line entry with a vr3 file describing the specific type of patient CLOT PH JedIpew sewsu ZAA GE MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 20
165. me 00 01 11 4 Figure 9 2 TCP Waveform Client 2 1 00 00 50 0 00 00 55 0 97 98 Options Simulator Bypass and Leak Valve Module SBLVM 10 Options 10 1 Simulator Bypass and Leak Valve Module SBLVM The Simulator Bypass and Leak Valve Module SBLVM is an accessory intended to be used when connecting ventilators to the ASL 5000 Figure 10 1 Simulator Bypass and Leak Valve Module A typical problem of using a simulator with most ventilators is that various alarms are likely to be triggered on the ventilator when no simulation is running With the SBLVM connected see diagram below an electromagnetic valve bypasses the simulator while no simulation is running and allows the ventilator to use the attached breathing bag or test lung At the beginning of a simulation the valve shuts off so that only the ventilator and simulator are connected The SBLVM connections are female 15 mm ISO ports The test lung and the connecting circuit piece are attached with 22 15 mm adapters to the SBLVM Please refer to the diagram below for the proper connections Solenoid valve DA ASL 5000 One way valve a a ELT Tt Figure 10 2 SBLVM Schematics Test lung QuickLung or similar GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Options Simulator Bypass and Leak Valve Module GBLVM The second feature
166. mentation in case the basic settings of the controller become inadvertently changed Fire Hazards related to the use of oxygen When using the ASL 5000 with elevated concen trations of oxygen ventilators set to FiO2 gt 21 observe all precautions applicable to the use of oxygen indoors See also General Precautions page 13 G LOZ PH JedIpew sewsu O ZAA S E MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 10 4 Using the Auxiliary Gas Exchange Cylinder AGEC The Auxiliary Gas Exchange Cylinder AGEC is intended for situations where it is necessary to work with substances aerosols anesthetic agents etc that are incompatible with the simulator It consists of a clear acrylic cylinder with openings at the top and bottom that allow it to be used as a bag in bottle device Figure 10 7 Auxiliary Gas Exchange Cylinder The simulator connects to the female 22mm ISO port at the base of the AGEC a second 22 mm port is located on the top and would normally be routing gas into a bellow or bag placed inside the AGEC Inspiration by the simulator will start to evacuate the space surrounding the bag or bellow and therefore inflate it Expiration will press gas out of the bellow or bag again The additional compressible volume of the AGEC is approximately 3 L therefore adding a parasitary compliance of 3 mL cmH2O This may be compensated by entering the 3 L as a tubi
167. monly used ICU ventilators for capturing their data for the purpose of a true 360 degree view of all interactions between patient and ventilator For a list of compatible ventilator models please see RespiSim Ventilator Interface Kit VIK Compatibility and Communications Settings page 143 A trial version that allows playback of a recorded simulation session sample can be accessed via the RespiSim tab on the Window Manager Please contact sales at 412 441 8228 extension 107 or at sales ingmarmed com for pricing To facilitate multi stage simulation scenarios an Instructor Dashboard has been added in version 3 4 as well as a Virtual Vital Signs Monitor to display patient status to students This display can also be made visible on a remote iPad or other computer INGMAR MEDICAL Simulation Coatrol Initial Settings Change Lvent 1 Change Fvent 2 Change Event 3 Change Event 4 em He lO ior sae ee 2 toatie instrutor seu d 2000NTV ve3 n 2000NIV vr3 B n es d ng ri Show Imtructor Actions Show Instructor Actions Show Inetroctor Actiows Mode oz gt som Hode drag delivery Mede nbtewel Set Vt sat Vt et Vt Peak How Puak Huw Peak How Set Rale Set Rate Set Rate E cers ass Deep Pinap vine gt 15 rv rv rv PEEP PEEP gt 55 ae i noz moa aoso ASL Patent Exp vt mt P T Trigger PIF Trigger P F Trigger P Linnit P Livnit D Lieret CC a eee oe EKG Pattern EKG Pattern EKG Pulter eee o itis nS ie Kx W
168. n Option eeeeeee 64 Post Run Analysis Menu cceeeeeeeeeeeeeeeeeeeeeeeees 67 Post Run Analysis Select Data File 67 Post Run Data Re Processing Window 66 68 Display Data Selections axivas sicnsccheriendasneatenenente tak 70 Legends PaletleS tase scott te i i 71 Gira PhS Visible HEMS ccinpssiisen nein 71 ZOO TOO lmnr E E aaa 71 CURSOR LECEN irune aaa E eae 72 Cursor Legend Options cccseeeeeeeeeeeeeeeeeeeeeees 72 CSOP LOCK oie kets ES 72 Analysis Breath by Breath Display 0008 73 Analysis Multi Parameter Graph eeeeeeeeees 74 Parametr GAIN ea E E 75 Analysis Loop Display sssssssssssseeeseseereerseseseesss 76 Analysis Continuous Time Based Data 77 Parameter GaN reio E tudes ties teres 78 Analysis Trend View Genin corn cas sraaienscusasvacdeptnseneetiecs 79 Analysis Work of Breathing Display 4 81 Trigger Analysis Display ccceceeeeeceeeeeeeeeeeeees 82 Servo Control Performance Display 06 84 RespiSim Mobile Ventilator Management TANNE SUA OM ee A axes N 86 RespiSim Instructor Dashboard 00eeeeee 86 RespiSim Virtual Vital Signs Monitor 86 RespiSim Main Interface eeseeeeeeeeeeeeeeeeees 87 RespiSim Control Field wie aah ichscpiseanapteetiatimeneeiysd 88 Test Automation Interface cccccccccccceceeceeeeeeeeeees 90 UUES SCICCIOR eiai a eee 92 Util
169. n RT Analysis Since tabs on the main Window Manager screen can be torn off and turned into separate windows the terms window and tab are used interchangeably at times in this manual 1 2 Intended Use The IngMar Medical ASL 5000 is a breathing simulator for ventilator demonstrations and evaluations inservices and respiratory staff training It enhances the educational value of patient parameter modeling by employing computer graphics to visualize patient ventilator interaction similar to today s advanced intensive care ventilators With appropriate software test scripts the ASL 5000 may be used for ventilator performance verification see also Test Automation Interface page 90 When using the device for this purpose one has to bear in mind however that the design of modern ventilators is complex and these devices incorporate a great variety of features and performance parameters It is therefore mandatory to always follow ventilator manufacturers instructions and recommendations regarding performance verification procedures IngMar Medical Ltd does not recommend any specific ventilator test or calibration procedures and no portion of these instructions shall be construed as doing so The purpose of the breathing simulator within the context of ventilator performance verification is solely to assist in implementing test procedures mandated or recommended by the ventilator manufacturer WARNING Do not use t
170. n algorithm parameters as needed in real time The breath parameters displayed in the middle of the window 2 x 4 parameters may be selected from a total of more than 90 parameters The parameters selected here will also be used in the Reports generated from the Run Time Home tab see below The selection is also part of the Project File Operation TCP Broadcast Configuration 4 7 TCP Broadcast Configuration While a simulation is running both waveform and breath parameters are being broadcast on the network which allows third party applications to connect via TCP IP and to use the data in real time The configuration for this broadcast can be set from the menu bar of the Real Time Analysis tab elie eo Help Customize TCP Broadcast Configuration Figure 4 82 Configure TCP Broadcast Menu Selection Clicking lt TCP Broadcast Configuration gt brings up this dialog window I TCP Broadcast Configuration INGMAR MEDICAL Broadcast Type Raw Processed Waveform Server Port 1 Raw 6343 Breath Server Port Broadcast Precsion e i5 6342 m t Figure 4 83 Broadcast Configuration Dialog Window You can broadcast either raw waveforms or processed waveforms includes flow which is not part of the raw data set The waveforms use port 6343 as the default and breath parameters are communicated via port 6342 The port settings may be changed as needed in a particular network to avoid con
171. n are needed please go to the Post Run Analysis Menu and select a saved data set by the name you gave it when the simulation was started For further reference see Trend Graph Display page 79 2 sim r T 8 8 a ae ae ac aan p ap ana i a Pee T F INGMAR MEDICAL g 55 56 Operation Running Simulations Using the Interactive Control Panel ICP 4 5 4 Closed Loop Vt Tab SE IngMar Medical ASL 5000 Window Manager File Windows Help Customize INGMAR MEDICAL ASCON breathing Sinukiter Run Time Home Interactive Control Script Patient Model Lung Model Param l Spont Breath Param Set Vt mL 400 0 600 0 Figure 4 73 Closed Loop Vt tab From the Closed Loop Vt tab a target of tidal volume Vt may be set directly in servo control fashion This means that the simulator will try to maintain the desired Vt by making adjustments to the muscle pressure profile specifically by adjusting the maximum negative pressure of the excursion Pmax Before opening this tab please make sure that the slide switch on the left of the ICP window is set to Const Vt otherwise a reminder will show up on the tab stating that Lung is passive or Closed Loop Vt is not active Figure 4 74 Constant Vt Post Run Analysis Utilities titerietiye Control sial Trends Closed Loop vt Closed Loop MV Closed Loop CO2Y l Patient Library l Setting the Vt target for the interactive patient model an
172. n drop down menus in the analysis windows name and unit indicate parameter names and units in brb file where different Points A F refer to Figure 14 1 page 130 Usually the point of maximum volume Point E except in cases of small local volume maxima see comment for Point E above where StartExp is determined as the last of any small volume local maxima less than threshold volume Volume threshold counted down from the volume maximum in a breath default value is 5 mL suitable for adult size models 0 5 mL is recommended for neonatal models From Point A to Point C From Point A to Point D of Peak Flow when exp begins Relative flow at the time 20 ms before Start Expiration Gas temperature inside the cylinder as measured by the ASL 5000 s own gas temp sensor P_compartment_1 Paw at End of Expiration A measure of the rapid opening of an expiratory valve of a ventilator at Point F Parameter definition changed in sw 3 5 20 ms This is always an average temperature Added parameter in sw 3 4 Pcompartment_1 Alveolar Pressure in Compartment 1 of the lung model Added parameter in sw 3 3 131 132 Parameter Definitions Parameters in the brb Breath Parameter File cmH20 P_compartment_2 Paw at End Pcompartment_2 Alveolar Pressure in of Expiration Compartment 2 of the lung model Added parameter in sw 3 3 Aux 1 Volt V Signal on channel 1 of ana
173. nd there are two prime movers that drive the ventilatory system and its components The first are the forces produced by the active contraction of the respiratory muscles in support of ventilation These do not include the forces produced by these muscles in support of posture or mobility etc The second prime mover is the pressure difference between airway opening and the body surface Pao Pgs This can be controlled by a mechanical ventilator The mechanical behavior of the ventilatory system in response to these driving forces can be described mathematically by relations among pressure differences across the system volume changes of the system and their respective rates of change 13 1 1 Normal Lungs Governing Equation Normal lungs together act primarily as a single pneumatic visco elastic compartment This implies their mechanical properties are uniformly distributed across both lungs Figure 13 1 shows a flow resistive airway leading to a single representative elastic lung compartment contained within a distensible shell representing the chest wall The lung and chest wall are separated by a thin intrapleural space The governing equation for this configuration can be developed by considering each component individually 1 This section authored by Frank P Primiano Jr Theory of Operation Introduction to Ventilatory Mechanics For the airway Pao Prt v C Raw Oy 1 For the chest wall P
174. nd Y scaling in the graph manipulation palette on the right of the screen just above the graphic display area and double click there By clicking the X and Y resolution buttons identified as lt X XX gt and lt Y YY gt in the graph palette you may also change the labeling of the X and Y axis to suit your needs Clicking on the symbol in the graph manipulation palette will allow the pointer to take hold of the yellow cursor lines and move them about The parameter value at the intersection of the X and Y cursors is always displayed in the cursor palette indicators in the upper right hand corner of the graph In this view the cursors are locked to trace one of the plots by default You may change this setting by clicking on the padlock symbol in the graph palette and creating a different link 77 78 Data Analysis Display Data Selections Green Buttons A drop down menu will allow you to check the parameter that you want your cursor to be locked to After doing this the parameter value at the intersection of the X and Y cursors is always displayed in the cursor palette indicators You may change your selection at any time Parameters for each trace of the plot can be freely selected from the drop down list of available parameters click on the parameter name next to the arrow symbol in the list displayed above the graph area Please refer to Parameters in the brb Breath Parameter File page 131 for details on the
175. negative work is done on the ventilator as the intrapulmonary gas is expanded by the respiratory muscles at the beginning of the breath The increase in ADmus exceeds the decrease in Dxo Pgs by the amount needed to expand the lungs and chest wall sufficiently to drop the airway pressure to trip the trigger Thus the APV plot shows simultaneous increases in lung volume and Ap that follow the Cia curve as the lung expands prior to triggering The net work shown on the APV plot is just that required to expand the chest wall and lungs even though the respiratory muscles do additional work to trigger the assisted breath This additional work is shown on the Ap V and Pao Pps V plots In some breathing patterns prior to the start of expiration there is a pause during which the lungs remain at end inspiration for a period of time This has been called the inspiratory hold If this hold time T is considered part of inspiration then the energy required to maintain the static tidal volume should be accounted for During an isovolumetric hold no work is done since the volume change is zero If the ventilator maintains the hold depending on its design energy may or may not be used In contrast if the respiratory muscles maintain the static tidal volume then they must do this while contracting isometrically Energy is used by the muscles involved 117 118 Theory of Operation Introduction to Ventil
176. new name for the new data set to be saved the previous data will be overwritten at that time S LOZ PHT JeoIpew sewsu O ZA S E MS 000S ISV JenueW sSNA This page intentionally left blank S LOZ PHT JeoIpew seyysu ZAY GE MS 0005 ISV JenueW sasn 65 66 Data Analysis 5 Data Analysis The ASL 5000 software package contains modules for data analysis both in real time while the simulation is running see Real Time Analysis Tab page 60 and post run The purpose of the data analysis package is to provide the user with the tools for an in depth review of data generated by a simulation run and to supply a host of automatically generated breath parameters that characterize each breath When collecting data at high speed 512 Hz maximum you will have waveforms available for an in depth look at the characteristics of each breath as it develops You may want to scale down the data rate or limit the time data is collected because of the significant amount of data stored However breath parameters may be collected without limitations from simulation runs that may extend over several hours or even days An important tool for this type of data is the Trend View see page 79 where you have an instant overview of a prolonged simulation run Thus it is possible to display a trend of calculated breath parameters that have been obtained using the raw data and the known modeling parameters associated with
177. ng into the display and dragging open holding mouse button down a detail window To return to the normal view go to the slide rulers for X and Y scaling in the graph manipulation palette on the right of the screen just above the graphic display area and double click there By clicking the X and Y resolution buttons identified as lt X XX gt and lt Y YY gt in the graph palette you may also change the labeling of the X and Y axis oy la ta rw e TUA bants i rwb file path Files aay Software 3 5 _ ASLdata 24_breaths Clicking on the symbol in the graph manipulation palette will allow the pointer to take hold of the yellow cursor line and move it about The parameter value at the intersection of the X and Y cursors with a trace is continuously displayed in the cursor palette indicators at the bottom of the graph the default is Inspiration Parameters for displaying loops may be freely selected for each axis from the drop down list of available parameters Click on the parameter name currently displayed next to the symbol on the right hand side of the screen Please refer to Parameters in the brb Breath Parameter File page 131 for details on the individual parameters displayed in this data view You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The
178. ng volume in the simulation editor compensation settings see page 35 Please see also a special Application Note regarding the AGEC for further details Options Using the Auxiliary Gas Exchange Cylinder AGEC Chest Rise Module 10 5 Chest Rise Module The ASL 5000 Breathing Simulator can be combined with Full Scale Patient Simulators improving on the pulmonary mechanics provided by these simulators for use with ventilators and providing them with the ability to truly breathe spontaneously as opposed to simply showing the chest rise Specifically an option for the ASL 5000 has been developed the Chest Rise Module for use with Laerdal s family of SimMan manikins The kit consists of a valve module that can take over the SimMan s chest rise reflecting the amount of volume that has been applied to the ASL 5000 and making the movement synchronous with the inhalation exhalation effort of the patient model Please refer to the special Application Note for details of this setup for both the classic SimMan as well as SimMan 3G It can also be used to give the more basic Laerdal Kelly manikin simulator true high fidelity lungs and respiratory mechanics including the abiltiy to breathe spontaneously 15V DC i Gas Input Cas Outputs Z _ E ami amp SY LS a i Chest Rise pillow TN i Figure 10 8 Setup withManikin 101 102 Options Preemie Lung Cylinder Kit 10 6 Preemie Lung Cy
179. ngMar Medical for details if this configuration is desired Plug in the 5V wall mount power adapter to power the VIK Bridge if used After you have made the required pneumatic connections see Pneumatic Connections on this page you can switch on the ASL 5000 A connected ventilator if applicable should now be ventilating the test lung if such an auxiliary test lung was installed together with the SBLVM module For adjusting the cylinder wall temperature CTC available option please refer to Using the Cylinder Temperature Controller CTC page 100 Ventilator One way valve i i i Solenoid valve i i i l 1 i gt i SBLVM Figure 3 4 Pneumatic Connections Overview 3 2 6 Pneumatic Connections The system is designed to be connected with regular patient circuits using 22mm ISO fittings The Simulator Bypass and Leak Valve Module SBLVM available option connectors are female 15 mm ISO ports The test lung and the connecting circuit piece are attached to the SBLVM with 22 15 mm adapters Please refer to the diagram below for the proper connections NOTE For the individual steps of the routine setup you may also refer to the Quick Reference Startup Guide printed on the next pages A copy of this document is also located in the documentation subdirectory under the installation folder on your PC ASL 5000 lest lung CluickLung or similar S LOZ PHT JedIpew sewsu ZAY
180. nnections Back Panel For pin assignments of the sockets please refer to the Preparation Addendum that is provided with the mating cables for Digital Out and Analog I O in your ASL 5000 Accessory Kit included 2 TTL Transistor Transistor Logic referring to a logic signal that has nominal voltage levels of 5 V high and 0 V low 63 64 Operation Exiting the ASL Software 4 11 Exiting the ASL Software Clicking on the lt EXIT ASL Software gt EXIT ASL Software button on the Run Time Home window or tab will shut down all LabVIEW program modules Figure 4 88 Software Exit Alternatively you can also click the in the top right corner of the Window Manager or select lt Exit ASL Software gt from the Control drop down menu Run Time Home A dialog window will open indicating that the software is about to close and where users are given the opportunity to save their personal default settings in the Project File Figure 4 89 Project File Dialog The next dialog allows for a return to the Welcome window to start a new session with the simulator Figure 4 90 Welcome Window Return Option Data that was written to a raw data file rwb will not be erased Restarting the software you may still analyze data from this last simulation run by loading its data file or of course from other saved simulations even if not running a new simulation NOTE If you start a simulation without assigning a
181. ns semicatarcenoeuseadtebentesinnbers 122 Sinusoidal Breath Profile eeee 122 Trapezoidal Breath Profile eee 123 Patient Backing Off ccecce 123 User defined Breath Profile 125 External Analog Input ceeeeeeeeeeeees 125 SmartPump Mode sssssssssssseees 126 Theory of the Virtual Ventilator 126 Patient Model Library seeee 128 Parameter Definitions 130 Time Stamps and Parameters 130 Parameters in the brb Breath Parameter File 131 Data File Parameters ssssssseeeeeee 139 Support Resources 140 Technical Data 141 Performance Specifications 00 141 Electrical Specifications ssssseeeee 144 Physical Specifications sssseeeseeeee 144 Software Specifications cccccccessees 144 Environmental Specifications 144 INGOX aao eae 146 List of Figures 149 S LOZ PHT yeoIpew sewsul O ZAY FE MS 0005 ISV JenueW sasn This page intentionally left blank S LOZ PHT JeoIpew seyysu ZAY GE MS 0005 ISV JenueW sasn 11 12 Operator Safety Definitions Intended Use 1 Operator Safety For correct and effective use of the product it is mandatory to read and to observe all instructions WARNINGS and CAUTION statements in this manual If the product
182. nsor regular adult neonatal cylinder to the measuring circuit should be removed This will connect the temperature measurement system to the gas temperature sensor of the preemie cylinder instead of the regular sensor on the adult cylinder 10 6 3 Software Adjustments After the initial installation of the ASL software on the host PC the following adjustment need to be made for proper functioning of the unit with a neonatal external cylinder Patient parameter files vr3 files for use with the Pree mie Cylinder should have the value for parasitic dead space adjusted to 25 mL instead of 200 mL Use Notepad or similar text editor to make the change in all vr3 files that are going to be used with the Preemie Cylinder parasitic_constants cylinder_dead_space float cylin der_dead_space liters GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 10 6 4 Firmware Adjustments For the proper functioning of the device it is important to invoke the correct mechanical parameters from an initialization file in the ASL 5000 CPU In the directory c lung of the embedded CPU a file named ASL5000 DOS is responsible for setting those parameters With the two sets of cylinder hardware two different files will be used for this purpose For use with the 2 5 Preemie Cylinder the file c lung ASLNEO25 40 needs to be copied into ASL500
183. ntilator performance parameter Pmax to Exp Target Exp Target Pmin Pmax Exp Target Exp Res Work m Insp Elastic Work Exp Work A Total System Work parameter Expiratory Resistive aii Exp Settling Time Time from Start Exp to the point Will always refer to pressure where fluctuations around target are less than 10 S LOZ PHT JeoIpew sewsul ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Parameter Exp T90 Exp Target Exp Vt Heat Production I Time Parameter Definitions Parameters in the brb Breath Parameter File cmH20 The time to accomplish 90 of the drop from peak pressure to Exp Target PEEP The pressure at steady state during expiration where steady state is derived from median airway pressure during expiration normally equivalent to PEEP Expiratory tidal volume Pairway PEEP Pmus dV from Start Exp to End of Exp Ext Insp Elastic Work External Exp Work If Ext Exp Work is lt 0 Ext Exp Active Work Ext Exp Work zero otherwise Pairway PEEP dV from Start Exp to End of Exp Ext Insp Work Ext Elastic Work Pairway at Vmax PEEP x Vmax Vo Pmin x Vo Vmin 2 where Vo is volume at Paw PEEP and Pmin is the smallest pressure during Inspiration Pairway PEEP dV from Sol to StartExp If Exp Work is gt 0
184. nto the control field labeled lt Display width gt 79 80 Data Analysis Display Data Selections Green Buttons With the Fast Forward Reverse buttons in the left top corner of the screen you may position the viewed breaths window to the range of interest Two vertical cursors may be adjusted to qualify a range of breaths for the calculation of mean and standard deviation These statistics are then immediately updated Click the cursor on one of the green vertical lines and drag it to the desired position in the graph The graph additionally features a second vertical cursor It is used to create a defined range of breaths for the calculations of mean and standard deviation You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The lt RETURN gt button will bring you back to the Main Analysis Menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN3 gt button before you can open any other view from the Post Run Analysis Menu window S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 5 4 Display Performance Analysis Selections Yellow Buttons 5 4 1 WOB Analysis Display XE Post Run Analysis Work
185. nues to deflate driven by its internal elastic forces However before end expiratory volume is reached in this example the patient momentarily contracts his expiratory muscles to increase the expiratory flow Then he fully relaxes again just above end expiratory volume Rewriting equation 7 for expiration we obtain Vee WE Pao Pgs dor AP mV Vr Wiene Wmuseen 11 These integrals represent the area between the expiratory curves and the v axis In the upper portions of Figure 4 just below the end tidal volume the change in v is negative i e the lung volume is decreasing while the Ap is positive Therefore the product Apdbv is negative Negative work indicates work is being done by the system on its surroundings In Figure 13 5 a the work is done on the ventilator since the Pao Pr Component of 113 Theory of Operation Introduction to Ventilatory Mechanics Ap is non zero In Figure 13 5 b the work is done on the inspiratory muscles as they lengthen while actively contracting before they completely relax to APmus 0 However further down the expired volume in this example the expiratory muscles are momentarily activated and APmu becomes negative assisting expiration Since both Ap and v are negative their product is positive and this portion of the expiratory work is positive Thus work in this region of volume change is done on the ventilatory system by the expiratory mus
186. o note that the two compartments do not necessarily correspond to the two lungs Instead they represent the aggregation across both lungs of all regions that have time constants sufficiently different from one another Pri Pes Figure 13 10 Two compartment pulmonary system within the chest wall The parameters and variables are as in Figure 1 except that here a distinction is made between the resistance compliance and volume of the two compartments and R represents the resistance of the larger upper airways leading from the carina tracheal resistance The governing equations for this configuration are Pao Pc Rv a Pe Pet Vp C R Oy b Pco Prt V C R r c 14 Prt Pas APmus Vp Cw d Vp Vy F Vr e Combining these equations and collecting terms yields AP K AP YVL Yi Vi y 15 Equation 15 has the same form as the equation for an isolated two compartment pulmonary system chest wall and common airway not included derived by Otis et al 1956 They showed that in such a relationship the apparent dynamic compliance and the apparent resistance of the system each decrease from their respective low frequency static values as the frequency rate of breathing increases Equation 15 extends Otis et al s work by showing how changes in chest wall compliance and common airway resistance affects the system response 1 Otis AB McKerrow CB Bartlett RA Mead
187. oading and editing project files SE ASL Project File Tool INGMAR MEDICAL Ethernet A Active ASL 5000 Project File J C Program Files x86 ASL Software 3 5 Current ASL Project File ini teaa A sevens cose Figure 4 3 Project File Tool Device Identification The Connection Settings tab lets you default to either Demo mode stand alone no ASL hardware Ethernet or a specific COM port 1 8 on your PC When Ethernet is selected you can also force the software to connect to a specific ASL simulator identified by its serial number in the format ASL_nnnn where nnnn is the four digit serial number of the device This is helpful when working in environments where more than one ASL are in use In the Project File this serial number is stored for reference when starting the software later on NOTE If your ASL 5000 is operated with a fixed IP address see page 20 identification via serial number becomes unnecessary Leaving the entries blank or entering 0000 will cancel selective connecting by serial number From the Appearance General Settings tab color choices for graphs can be pre set as well as descriptive notes entered for the project file BE ASL Project File Tool SS lt lS INGMAR MEDICAL Figure 4 4 Project File Tool Graph Colors Output Data Settings will define the defaults for standard report headers as well as the output data path ASL Project File Tool i INGMAR
188. ocessor load and other factors It can be expected to be around 3 Hz The ASL 5000 software provides a utility which can turn the data stream into an interpolated signal with equidistant points of a user specified sample rate To open the utility click lt AUX Channel Output Resampling gt on the Utilities tab A file setup window will open aux File Path fi C Program Files x86 ASL Software 3 5 ASLdata data aux Sl Resampling Choices Channel 1 Gain a 1 000 Channel 2 Gain a 1 000 Channel 3 Gain Output Sample Frequency I 1 000 5 100 000 Output File Path 4 C Program Files x86 ASL Software 3 5 ASLdata test_AUX_output Sf File Description Recorded by ASL 5000 and resampled to current frequency Value Name Channel 1 isi risse OO Value Name Channel 2 nan fChanne 2 Value Name Channel 3 Nan fChanne 3 Figure 8 3 Utilities AUX Resampling In the utility you can define the output sample frequency as well as gains for all three channels independently The third channel is reserved for the signal of the O2 measurement and reports oxygen concentration in percent when the default gain factor of 1 is applied After defining the output destination and optionally a descriptive text to be inserted into the file you can click lt Resample gt Using ASL Utilities AUX Channel Resampling 8 3 RespiSim File Conversion Data recorded when using the RespiSim training environm
189. of Breathing Data Analysis Display Performance Analysis Selections Yellow Buttons Pe teeme O MELTS aE path Figure 5 18 Analysis Work of Breathing Display The WOB analysis allows for separation between patient i e simulator and ventilator work components WOB analysis is performed on a breath by breath basis To obtain meaningful results it is important to verify that the breath to be considered for analysis has been identified properly see also page 60 Individual breaths are selected in the same way as in the breath data screens by clicking on the Fast Forward Reverse buttons until you arrive at the desired breath number position eeu feeeg eess Alternatively you may click on kedde the up or down arrow next to the breath number to go to a specific breath C Program Files x86 ASL Software 3 S ASLdata 24_breaths Please refer to User s Manual regarding additions and changes of definitions for in SW 3 4 Power m s 40 37 429 65 3289 29 Description Work m7 i i uf insoWork 5192 Insp Elastic Work 871 89 Insp Res Work 1 789 98 Epoki 348 93 122 67 Exp Res Work 622 96 Exp Active Work 0 00 Heat Production 248 931 Total Res Work 167 011 nor E Expir You can also see the current breath highlighted in the graph representing the full length of the simulation at the bottom of the window WOB parameters are displayed either as
190. of a UDP broadcast Accessing a device with a fixed IP address can be made the default via the Project File Tool see page 26 For questions related to assigning IP addresses to networked devices please consult with your network administrator The physical Ethernet connection can be made using the two networking patch cables provided blue no cross over The notebook PC may alternatively connected to the router via WiFi NOTE The Breathing Simulator will always attempt to synchronize using the method specified in your selection in the Welcome screen or the last settings Please make sure that the connection you attempt to use is physically available CLOT PH JedIpew sewsu ZAA GE MS OOOS ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 3 2 3 Communication Setup via serial connec tion RS 232 USB On older devices a serial connection between instrument and host is made via a RS 232 serial cable extension style male female DB9 and a separate serial to USB converter included The cable must be connected to COM1 on the ASL 5000 and the serial port generated by the converter must also be assigned COM1 on the host computer default Please follow the converter manufacturer s instructions regarding installation of driver software when installing on a third party PC the driver is pre installed on the included laptop It is important to assign the correct COM port COM1
191. off Inspir Increase Hold Release 7 Active Inspiration Cycle Time 100 4 Figure 13 25 Patient Effort Inspiratory Backing Off It might require some experimentation to optimize the percentage value for a realistic backing off of the spontaneous breath at the onset of ventilator support A value of 30 or 40 may work well as a starting point Using this feature with larger percentages will reduce the spontaneous breath to a small trigger effort As an added feature for realistic patient behavior beginning with SW 3 4 firmware 4 7 20 or higher a full breath inhibition caused by external ventilation can be modeled into the Patient Effort Model secondary Hering Breuer Effect When a patient model is scheduled to take a breath this spontaneous breath can be fully skipped if a positive pressure breath is delivered by a ventilator The setting lt Cycle Inhibition after positive pressure gt adjusts the time for which after the positive ventilator pressure was present the inhibition will apply This time interval is defined as a fraction of a spontaneous breath cycle A setting of 0 0 default disables the effect no skipping of breaths Expiratory Expiratory backing off acts to limit active expiration to just those cases where a patient would have a need to push against external pressure to accelerate or even accomplish expiration Here the reduction of patient expiratory effort is based on the amount of pr
192. oftware both 32bit and 64bit versions are compatible A higher CPU performance is recommended when handling large data sets TDMS files generated by RespiSim Users should also take into account concurrent applications taking up some of the PC s computing resources The recommended PC operating systems minimum RAM requirements should be met or exceeded Increasing memory to a level beyond the recommended minimum to 4GB or 8GB is typically an inexpensive way to boost performance of a PC as it ensures avoiding time intensive disk operations which could lead to unacceptable time delays in the real time operations The host computer must either feature network connectivity i e an Ethernet network card or a serial port default COM1 If the PC is not equipped with a serial port a USB to serial converter included may be used for legacy ASL 5000 hardware We recommend always using the adapter that was supplied with the original purchase of the system since its performance has been verified Not all USB to serial adapters reliably support the high data throughput required NOTE Settings in the Project File need to be adjusted from the host software when using a COM port different from COM1 A color screen with at least XGA 1024 x 768 pixel resolution is required for the host PC higher screen resolutions are recommended Due to the amount of information to be displayed on screen a smaller screen size would yield unacceptable re
193. oftware either through Ethernet or RS 232 connectivity or in demo mode see the Window Manager will present itself 28 with the tab for the Run Time Home window selected If your installation folder contains a file aslident txt and you are using Ethernet connectivity a reminder will appear that you are attempting to connect to an ASL 5000 with a specific serial no only see also Project File Tool page 26 At that time you can change the content of aslident txt to reflect the serial number of the simulator you actually want to connect to useful when more than one ASL 5000 are on the network or you can opt to delete this filter and to connect simply to the first ASL that is seen on the network This feature allows to specify a particular ASL to be paired with a host software installation on a PC Simulator Identif 3 5 Attempt is made to connect to ASL 5000 identified as ASL_8883 ONLY Please change or eliminate ASLident txt to connect to other simuators Figure 4 11 ASL Identification Edit NOTE Itis not necessary to have the simulator turned on before you launch the software However the runtime module of the software will attempt to synchronize with the instrument and show an error message if synchronization was not possible within 10 seconds You then have the opportunity to make the necessary cable connections or switch the simulator on before proceeding If no communication is occurring after this
194. ol performance window analyzes pressure adjustments made by a ventilator connected to the simulator It attempts to detect both the inspiratory and expiratory target pressures and calculates parameters that describe the transition between these pressure levels Please refer to Parameters in the brb Breath Parameter File page 131 for details on the individual parameters displayed in this data view Servo analysis is performed on a breath by breath basis Individual breaths are selected in the same way as in the breath data screens by clicking on the Fast Forward Reverse buttons until you arrive at the desired breath iene position Alternatively you may click on the up or down arrow next to the breath number to go to a specific breath genera Files ES Software 3 5 ASLdata q 95_parameter tests on SF missed_trigger_COPD Med Exp Resist cm H20 L s SD Exp Resistance cm H20 L s Insp Target cmH20 L min CER a 257 1 S a ___ Sol Soe ms 0 0 450 3 of Peak Flow when exp begins 0 0 Pairway cmH20 poy ij 1x sa Vent Flow L min EE f Ins Target cmH20 1 min Exp Target cmH20 7 To obtain meaningful results it is important to verify that the breath to be considered for analysis has been identified properly see page 73 You may zoom into a detail area at any time by clicking into the display and dragging open holding mouse button down a detail window To retu
195. ompliance in the chamber defined by the closed valve in the supply tube the closed valve in the exhaust tube and the ASL 5000 s inlet The airway pressure and the air mass trapped in this volume are known at the time of the transition from inspiration to hold Subsequently the pressure computation uses this compliance as the air flows out of the volume into the ASL During the expiratory phase the supply valve is still closed but the exhaust valve is open Flow from the ASL to atmosphere or PEEP is resisted by Rex just as it is for pressure control mode How is this theory implemented in detail The physical ASL 5000 measures airway pressure There is no other way for it to know what is attached to its inlet orifice The demo mode virtual ASL 5000 attempts to replicate Theory of Operation Theory of the Virtual Ventilator the physical device The internal modeling equations are identical a measured physical ASL 5000 or specified virtual demo mode ASL 5000 pressure serves as input lung volume is output There is no way to input the specified flow of the conceptually simplest flow control ventilator Instead an error is calculated the difference between the calculated flow into the ASL 5000 and the user specified ventilator flow and a control loop is used to adjust the airway pressure to drive this error toward zero 127 128 Theory of Operation Patient Model Library 13 7 Patient Model Library Include
196. on Script Editor You can shape a parameter s variation over time in individual segments that will apply to a predefined number of breaths see Figure 4 35 page 37 Figure 4 35 Time Varying Parameters Editor The Variable Parameters Editor graphs show the total sequence of parameter segments with the currently selected segment highlighted by bold dots lighter dots for all other segments in the sequence The segment entries show the number of repeats for each segment as well as details of the parameter equation defining the transient behavior Double clicking on a segment will open the Parameter Curve Segment Editor Edit Curve Segment Parameter Being Edited R_Trachea_In Curve Type Random Uniform Distribution Linear Endpoints Power Exponential Sinusoid File lt Random Uniform Distribution Random Gaussian Distribution Equation iv Uniform Random Distribution About Mean LT lela gel tebe el el sol AL V SLANT R RA Te A TM i le ie ES CNN TA BEL BSS RS RES UEESE EEE Random Amp is the max min amplitude limit Seed values are limited to positive integers Figure 4 36 TVP Curve Segment Editor 37 38 Operation Modeling Using the Simulation Editor Environment The curve types for defining P Random Uniform Distribution the time varying characteristics of a lung Endpoints model parameter can be To Exponen a selected from the
197. or Management Training environment created with the ASL 5000 Breathing Simulator at its core It encompasses in its full scope a number of additional hardware components including IngMar Medical s RespiPatient but significantly is also an extension of the ASL 5000 software with greatly expanded functionality It is accessed via the RespiSim tab of the Window Manager NOTE In the scope of this manual only a brief overview of the software screens and windows associated with RespiSim is given Much more detailed instructions for its use are available in a separate RespiSim User s Manual 6 1 RespiSim Screens 6 1 1 RespiSim Interface Overview RespiSim for the ASL 5000 is accessed via its own tab on the Window Manager Clicking on the tab brings forward the RespiSim main screen which provides a unified view of data during a simulation debriefing Since an active RespiSim screen takes precedence over standard script based simulation but not over Interactive Control the RespiSim option first needs to be activated by clicking pe The RespiSim interface consists of three separate windows The Instructor Dashboard ID The virtual Vital Signs Monitor VSM and the RespiSim Debriefing Panel shown on the next page It is a component attached to the Window Manager which also can be made to float Figure 6 1 RespiSim Mobile Ventilator Management Training Station PMB oMa Menge fetal ere 6 hasy Peet
198. or Raw Thus equation 2 can be rearranged and written AP snus Pes Pas Vi Cw 3 Combining equations 1 and 2 we obtain the governing equation for a single compartment ventilatory system AP ot Pao Pas APs V Gor Raw Br 4 in which Ap is the total effective pressure difference driving the ventilatory system and C the total system compliance is given by Ci ChCy C Cy 5 Besides the airway resistance Ray and the total compliance Ci another mechanical property of importance is their product called the time constant Tiot Tot Raw Coot 6 The time constant is a measure of how long it takes the lungs to deflate to FRC after the total effective pressure difference that is maintaining an inspiratory hold is instantaneously reduced to zero The condition is reached after about 3 X T Equation 4 describes a single compartment system with a single degree of freedom The salient characteristic of a single degree of freedom system is that it can be characterized by a single time constant Clinically this implies that both lungs when simultaneously subjected to the same pressure difference will inflate and deflate In unison Normal lungs exhibit age and stature appropriate values for Raw Cio and To For a non apneic patient on a ventilator equation 4 shows that the pressure difference driving the system has two components as previously described the physical pres
199. or Window Clicking the check box for the lt Fill Bar gt indicator next to the lt Freeze Run gt switch see Figure 4 53 page 44 opens an additional window indicating delivered volume as a colored bar graph This window will stay on top as long as the lt FillBar gt checkbox is checked Figure 4 57 To close the Lung Fill Indicator window use the lt Close Window gt button 3E ASL 5000 Lung Fill Indicator High 4700 mL Thresholds Low 300 mL Figure 4 58 Lung Fill Indicator The purpose of this display is to assist users who are using the ASL 5000 for educational purposes The boldly colored bar graph allows to see the filling condition of the simulated patient lung from a good distance for example when having a resuscitation trainer head attached to the breathing simulator A student practicing with a manual resuscitator or manipulating the controls of a ventilator can judge at a glance the success of his or her treatment of the patient Operation Running Simulations From the Run Time Home Display Threshold settings control the coloring of the Lung Fill Indicator For volumes less than Low the bar will appear black above High they will show as red In between the thresholds oreen is used to indicate that the desired range of volumes is applied These settings can be edited by the user in the Lung Fill Indicator window The overall volume scale adjusts automatically with the u
200. ort Detail 0000000000 121 Patient Effort Model Flow Trigger 06068 122 Flow Trigger Effort Detail ssseeeseeseeeeeeees 122 Patient Effort Model Sinusoidal 0086 122 Sinusoidal Effort Detail 0 0 0 0 ccsscccccccccecceeeseeeeees 122 Trapezoidal Breath Profile cc eeeeseeeseeeeeees 123 Trapezoidal Effort Detall d isrieeder adsense 123 Patient Effort Inspiratory Backing Off 124 Patient Effort Expiratory Backing Off 124 File based Patient Effort sccsscsssseesseeeeeens 125 Effort Model Analog Input eeeeeeeeeee 125 Effort Model Flow PUMD eeeeeeeeeeeeeeeeeeees 126 Virtual Ventilator Basic Controls eeeeeee 126 Patient Model Library Parameters Static 128 Patient Model Library Parameters TECN QIAN E eee T 129 Timing of Pressure Flow and Volume 130 S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Breath Parameter Data File brb bra 139 Processed Waveform Data File dtb dta 139 Raw Data File rwh rwa c ceccee cece eeeeeseeceeeeee 139 Video Tutorial ACCESS aunan a 140 Online Support SESSIONS siqscis cat voiatet uctnnmdersweleenss 140 151 User s Manual ASL 5000 SW 3 5 Rev 2 IngM
201. ory breath delivered by the ventilator A Total System Work parameter Inspiratory Resistive A ventilator performance parameter either a value of pressure or of flow depending on the type of inspiratory breath delivered by the ventilator If known in advance for example because it is a ventilator setting this parameter may be set via an override in the Post Analysis Data Re Processing window Note that threshold size does not affect reported tidal volumes S LOZ PI yesIpew sewsul O ZAY GE MS 0005 ISV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 Parameter Definitions Parameters in the brb Breath Parameter File Pairway PEEP Pmus dV A Total System Work parameter Maximum change of slope of the Parameter may be used as a measure of a Insp flow curve ventilator s flow ramp setting P ee from Sol to StartExp Definition changed with sw 3 3 Max Flow Acc we Max Pres Drop cmH2O Deflection of airway pressure A parameter that can be used to evaluate the During Trig from baseline PEEP to Pmin quality of CPAP or the adequacy of flow settings Mean Flow L min Mean value of flow taken from Value derived from flow taken over inspiratory part Sol to Ppeak of a cycle excluding a flow pause if it exists Median Exp Res cmH20 Median of Pairway Median of hese a hie less than 2 L min are excluded L s Pairway dV dt du
202. ou can save this file with the lt Save As gt button on the bottom of the Project File Tool window NOTE You will need to close the Project File Tool in order to proceed with launching the ASL software g Ereath Rate GPM NOTE As a convenience introduced in SW 3 5 the poan ee Project File Tool can always be accessed from the menu z P peak m20 ooo y O bar above the Window Manager tabs z Ereath Number ooo l Patient Insp Vt mL af 1 Patient Exp Vt mL E i Wall Temp C Trig Resp Time ms xi Figure 4 7 Project File Tool Default Analysis Param 27 Operation Getting Started ASL QOUY sresitning Sinulcor Quick Launch Menu Figure 4 9 Quick Launch Menu Options After making the selection the Welcome window will either disappear or you will see more options if lt Full Choice gt had been selected 4 1 5 Full Choice Welcome Window Respiratory Simulation Specialists ASL SUUY Srezening Sinwleicor Maintenance Please note You can always invoke Context Help real time help showing explanations depending on cursor location on the screen by typing Ctrl H or by selecting this feature from the drop down menu _ oe _ m Figure 4 10 Full Choice Menu Connection Options Here you can pick the method of connectivity as well as opting for customization and other maintenance links When opting for launch of the ASL Host S
203. oups or one on one There is also a version of this cart as part of the RespiSim RespiPatient system Please refer to the RespiSim Addendum to this manual as well as to the RespiPatient Manual for a description A screen can be mounted using a standard VESA mount 100 x 100 mm adapter that is supplied with the cart For larger screens an additional adapter may be used also included that provides the VESA 200 x 100 mm pattern NOTE Before purchasing a screen make sure the model you are selecting supports one of these commonly used wall mount standards WARNING Always observe the load limit of 20 Ibs 9 kg for a monitor mounted on the cart An overly top heavy assembly would present a risk of tipping and bodily injury The height adjustability allows for a sitting position with the appropriate height for the notebook keyboard or a standing position The adjustment is operated with a foot pedal at the front of the base of the cart releasing the column lock A surge protected 6 outlet power strip for powering all items on the cart is included in the package The two front casters are lockable to prevent inadvertent roll away CAUTION Always secure all loose items when moving the loaded cart Make sure simulator is clamped tightly in its tray Always lower height adjustable column before mov Ing unit Use special care when rolling over bumps or uneven surfaces such as going through elevator doors Figure 1
204. out the solutions to all problems that arise in the course of the simulation Particularly in what is called multi stage simulations a mostly successful completion of each individual stage is necessary for moving on to the next stage in a meaningful way RespiSim modules therefore are structured in such a way as to strike a balance between the flexibility of conducting the simulation and this need for controlled outcomes at each stage 6 2 2 Role of the Instructor Specifically RespiSim modules are instructor driven The educator stays in control of the unfolding events at all times Each stage of a simulation labeled Change Event in the Instructor Dashboard is divided into a set of possible scenarios which are based on likely choices made by the student Associated with these choices of ventilatory treatment are patient vital signs that could be expected given the ventilation that this patient now receives manifest in the columns on an Instructor Dashboard page The instructor has the responsibility to classify the student choices and to adjust when needed a patient parameter to perhaps emphasize a particular effect that might be critical to get across as a significant learning objective The patient responses are thus not based on physiological modeling but rather expose the medical expertise of the instructor and the authors of the training modules As far as the progression of a simulation is concerned the instructor i
205. ow of 18 78 L min and a frequency of 12 the following parameters are entered b Spontaneous Breathing Rate BPM 18 78 Peak Flow L min 25 Inspiratory Yo O Hold 25 Expiratory o This model will yield a tidal volume of 500 mL which is a result of the chosen peak flow and breath rate Similarly a waveform model entered as a volume waveform will have a peak flow that is a result of the volume and breath rate chosen 13 6 Theory of the Virtual Ventilator The following paragraphs describe the simple ventilator model that is used in the code driving the VV The ASL 5000 continuously measures the pressure at its orifice computes the lung volume s from the patient model parameters and moves the piston to match the calculated volume s The VV code provides a pressure at the orifice that replaces the measured pressure Without the VV and with no ASL 5000 no pressure transducer demo mode will just have to assume that orifice pressure is always zero The simplest ventilator is a supply plenum just a big box with specified pressure connected by a zero resistance circuit to the ASL 5000 s orifice the pressure in the box doesn t depend on how much flow is going to or coming from the ASL 5000 A more realistic ventilator has some resistance in the supply circuit When there is flow into the ASL 5000 the pressure at the orifice will be less than the pressure in the big box s supply The resistance Rin in the VV control panel r
206. p necessary For details please consult the documentation files that are part of the installation package See also the NOTE on page 17 3 1 1 RespiSim This software for the ASL 5000 SW 3 5 is fully compatible with the RespiSim Patient Ventilator Interaction option For more information on RespiSim please visit our website at http ingmarmed com and navigate to RespiSim System under the Products tab A trial version that allows playback of a recorded simulation session sample can be accessed via the RespiSim tab or the Instructor Dashboard on the WindowManager window The operation of RespiSim is detailed in a separate chapter in this manual RespiSim page 86 Please contact sales at 1 800 583 9910 or 412 441 8228 sales ingmarmed com for pricing if you would like to use RespiSim functionality S LOZ PHT yeoIpew sewsul O ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 NOTE If you purchased the PC together with the RespiSim option for the ASL 5000 the installation of the database for the RespiSim VIK Bridgetech database has already been performed and the system is ready to go If you need to perform an installation on a new PC or if the option was purchased at a later time set the Bridgetech database up on the same PC that is running the ASL 5000 host software Use the USB storage device supplied with the RespiSim software component
207. ph palette you may also change the labeling of the X and Y axis to suit your needs Clicking on the symbol in the Graph Palette will allow the pointer to take hold of the yellow cursor lines and move them about Volume corrections are performed for different standard gas conditions BTPS ATPD STPD by clicking inside the control labeled Conditions As measured no correction is the default setting Please also see NOTE on page 69 1 Please note that this definition has changed from sw versions prior to 3 0 where trigger time was determined as the time to the vol ume threshold default 5 mL Data Analysis Display Performance Analysis Selections Yellow Buttons You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The lt RETURN gt button will bring you back to the main analysis menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN gt button before you can open any other view from the Post Run Analysis Menu window 83 84 Data Analysis Display Performance Analysis Selections Yellow Buttons 5 4 3 Servo Control Performance Display 44 Post Run Analysis Ventilator Performance Figure 5 20 Servo Control Performance Display The ventilator servo contr
208. ping CONVENTIONS areais Intended Use s sessssssssssssssesssssssssssssssseses Intended Use of the RespiSim Option Use of the Smart Pump Mode General Precautions ccccccsesecscscees Introduction 0e008 OV GR VIGW esisin iatna Available Options 00000000000000000000000 Syst m FEQtures iccccsciesesccscsssasevececaseseosens Host Computer Requirements Simulator Software sccccccscsccsseees Software Component cccccceeeeeeeeees Software StruCture ce eeeceeeceeeeeeeceeees Remote Control of the Host Software Preparation ccccccccsses Software Installation on the CONNECIIONS ise ee eee Electrical CONNECTIONS ecececeeeeeees Communication Setup via Ethernet Communication Setup via serial connection RS 232 USB ce eee eens Changing the Default Communications oy aes 32 0 3 3 4 1 4 1 1 4 1 2 4 1 3 4 1 4 4 1 5 4 1 6 4 2 4 2 1 4 2 2 4 2 3 4 2 4 4 2 5 4 2 6 4 2 7 4 2 8 4 2 9 4 2 10 4 2 11 4 2 12 4 2 13 4 2 14 4 3 4 3 1 4 3 2 4 3 3 4 3 4 4 3 5 4 3 6 4 3 7 4 3 8 4 4 4 4 1 Communication Setup for the RESDI SIT COOUON cianda tote letamanentens 21 Pheumatie CONNCCUONS vn ccntssrartaessehs cee 22 Starting the ASL 5000 eeeeeeee 0000000000000 24 Operation ccccccccceees 25 Getting Started
209. pper threshold 4 3 6 Auxiliary Parameter Displays In addition to the data plots additional analog parameters are collected from the simulator as follows Barometric pressure Barometric pressure is displayed in units of kPa Gas temperature Gas temperature is displayed in degrees Celsius Please note that the gas temperature sensor with its time constant of several seconds measures an aver aged temperature for the purpose of normalizing to standardized conditions of volume measurement Oxygen concentration default setting numerical display off O2 concentration is displayed as vol O2 Values are from partial O2 pressure oxygen transducer available option corrected for barometric pressure Wall temperature default setting numerical display off Wall temperature is displayed in degrees Celsius The wall temperature is read from the RTD of the op tional Cylinder Temperature Controller CTC Auxiliary data default setting numerical display off AUX1 and AUX2 may be used for displaying external ly collected analog data via the 2 channel analog port located on the back of the simulator See also Working With the Analog Inputs page 63 The dis play indicates the input voltage to these channels range of 0 to 10 V 1 Temperature fluctuations induced by the pressure changes in the cylinder are not considered 2 RID Resistive Thermistor Device 47 48 Operation Running Simul
210. proach with multiple windows for model parameter settings the ICP uses a number of tabs across the top of the window to access its different functions The left side of the window is reserved for general controls and settings The typical use of the ICP would be for adjusting a parameter set in a running script While the ICP is active a parameter set called interactive vr3 is inserted into the running script This parameter set is a duplicate work copy of the vr3 file currently processed from the script at the time the ICP was activated ICP settings take precedence over any other settings that might otherwise be active including RespiSim patient settings 51 52 Operation Running Simulations Using the Interactive Control Panel ICP To enter Interactive Control click the GoTo button in the top left of the Run Time Home tab or the RespiSim Instructor Dashboard and click the button on the ICP itself INGMAR MEDICA ar F Figure 4 65 Go To ICP Alternatively from the RespiSim tab you can activate the ICP by simply clicking the a a button NOTE In the Instructor Dashboard you have an indication that ICP is active via a blinking message i the top right corner of the window es E _ el GUOY ReSpiSim Gistructur Dashboard Figure 4 66 ICP Active Message in Instructor Dashboard In the Run Time Home tab an active ICP is indicated in the parameter file path box Status Line by the entry C Pro
211. program files x86 ASL 5000 SW 3 5 has changed from previous versions Existing parameter files moved from older installations require their static scripts to be adjusted to reflect the correct subdirectories They can either be adjusted manually using NotePad or be converted to use tokens See Using Tokens page 33 NOTE Throughout this manual it is assumed that installation has been to the default location Wherever file paths are indicated your installation directory may be substituted for the directory name ASL Software 3 5 Please read the Software License Agreement carefully Installation of the software indicates your acceptance of the terms of the IngMar Medical and National Instruments End User License Agreements EULAs as displayed during the installation of the software NOTE If you intend to launch the software from the Windows Start Menu you must first specify the directory from which Windows is to start the program as the installation directory by default C Program Files ASL Software 3 5 or C Program Files x86 in 64 bit Win7 or Win8 To do this right click the shortcut that the installation created in the program list under the program group IngMar Medical Click on Properties On the Shortcut tab enter the file path C Program Files ASL Software 3 5 or C Program Files x86 in 64 bit Win7or Win8 or the actual installation directory for the Start in item After installation p
212. r data the content of the brb file to a listening client on the network A demonstration application TCP Breath Client exe is included with the host software as a separate executable accessible from the Utility tab of the Window Manager The default port used to connect to the server i e the PC running the ASL host software is port 6342 In order to establish a connection from a separate PC you need to launch this application after copying it to the PC you want to act as a client or listener and then enter the correct server identification the network IP address of the PC running the ASL host software The port to listen to is still the same 6342 If a change to the server port is necessary to avoid conflicts on a network it can be done from the TCP Configuration option in the Control drop down menu of the Window Manager see TCP Broadcast Configuration page 61 9 2 Waveform Broadcast Similarly waveforms are made available on the network via port 6343 for all raw or processed volume and pressure data as shown in the plots see Figure 9 2 The demonstration application for a listening client TCP Waveform Client exe is also included in the ASL host software installation and conveniently accessed via the Utility tab of the Window Manager Copy this executable to a PC on which you plan to observe the waveforms and then enter the correct server identification the network IP address of the PC running the
213. re 5 13 Parameter Gains You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen When you are done with data analysis in this view the lt RETURN gt button will bring you back to the Main Analysis Menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN3 gt button before you can open any other view from the Post Run Analysis Menu window Data Analysis Display Data Selections Green Buttons 75 76 Data Analysis Display Data Selections Green Buttons 5 3 4 Loop Display zren moren Pees F F SA Pr e I AL iilo i 3 Metisse SREY Lo Saat Figure 5 14 Analysis Loop Display The Loop Display allows you to freely define X versus Y plots for each breath in order to generate the familiar pressure volume and flow volume loops A dividing line separates the inspiratory and expiratory portions of each loop Data is displayed breath by breath HAA Scrolling through or selecting e single breaths is easily Breath f of 159 performed with the fast forward reverse arrows or by entering the desired breath number into the lt Breath gt field You can also see the current breath highlighted in the graph at the bottom of the window You may zoom into a detail area at any time by clicki
214. re being simulated and transitions from one to the other state would require changing multiple parameters at once Using a preconfigured set of patient parameters makes all changes occur simultaneously Time varying patient models may also be invoked to create transitions or patterns for purposes such as simulating the induction of anesthesia For this reason this is the tab that is shown first when entering Interactive Control The default directory for such scenario related parameter files is vars scenarios Patient files saved in this directory will show up in the listing on this tab Neonate_BPD vr3 x Alternatively you can also browse to a different directory where a user has stored special scenarios NOTE The directory selected for this purpose will also become part of the Project File NOTE Please note the difference between scenario scripts and creating flexible scenarios via the Patient Library tab in the Interactive Control Panel In the case of scenario scripts from the Simulation Script Editor Scenario Script tab you not only invoke a particular patient parameter file In this case the sequencing and duration is also part of the scenario and no longer instructor driven 59 60 Operation Breath Detection Real Time Analysis Window 4 6 Breath Detection Real Time Analysis Window INGMAR MEDICAL Run Time Home Interactive Control Script Patient Model ES INGMAR MEDICAL Enable Analysis S
215. res if operation with humidified gas is intended requires heater CTC option or filter CAUTION Do not operate the ASL 5000 if it appears to have been dropped or damaged WARNING Fire Hazards related to the use of oxygen When using the ASL 5000 with elevated concen trations of oxygen ventilators set to FiO2 gt 21 observe all precautions applicable to the use of oxygen indoors Always use extreme caution when using oxygen Oxygen intensely supports any burning No smoking no open fire in areas where oxygen is in use Always provide adequate ventilation in order to maintain ambient O2 concentrations lt 24 Always secure O2 cylinders against tipping do not expose to extreme heat Do not use oil or grease on O2 equipment such as tank valves or pressure regulators Do not touch with oily hands Risk of fire Open and close valves slowly with smooth turns Do not use any tools 13 14 Introduction Overview Available Options 2 Introduction 2 1 Overview The IngMar Medical ASL 5000 Active Servo Lung is the first and most advanced representation of a novel concept in lung analogs Whereas traditional lung simulators are either passive or require an external device to provide the functionality of spontaneous breathing it is an integral part of the ASL 5000 s representation of respiratory mechanics The device is based on a piston moving inside a cylinder that is computer controlled to a
216. riable It is the fraction of the mean below Data Analysis Process Data Blue Button which the standard deviation of pressure must fall to consider it the primary control variable This setting does normally not require adjustment When clicking lt Start gt new brb and dtb data files are produced Whereas the brb file contains the updated breath parameters the dtb file is a real time data format waveforms that contains the processed raw data with additional calculations for flow etc The already existing files in the data set of the same name will be overwritten However the raw data in the set remains unchanged which means that further reprocessing may be performed for example with changed threshold parameters if needed The data file sets are written in binary file format with column headers but they can easily be converted into tab delimited ASCII files using the File Translation Utility enclosed with the ASL 5000 software package see page 92 After conversion files are ready for direct import into Excel MATLAB or any other data analysis graphics program Lower frequency analog data such as O2 concentration if the FOM option is installed AUX1 and AUX2 signals are saved in the brb file at a rate of one value per breath A separate waveform data file data aux is written when the lt Record AUX gt box is checked on the Central Run Time display This file then contains readings for both analog channe
217. ring ponte ARE expiration Median Flow Median value of flow taken from Value derived from flow taken over inspiratory part Sol to Ppeak of a cycle excluding a flow pause if it exists Min Flow Acc Maximum initial negative A measure for the level of a patient cough forced change of slope for the Exp flow exhalation Oxygen Oxygen concentration measured Value will be assumed to be 20 9 vol if no in the ASL cylinder oxygen sensor is connected If Pat Exp Work is lt 0 Pat Exp A Patient Work parameter Muscle Work Pat Exp Work zero otherwise Pat Exp Res Work Pat Insp Elastic Work Pat Exp A Patient Work parameter Expiratory Resistive Pat Exp Muscle Work Work Pat Exp Work Pmus dV from Start Exp to A Patient Work parameter Expiratory End of Exp Pat Heat mJ If Pat Exp Work is gt 0 Pat A Patient Work parameter Expiratory Production Heat Production Pat Exp Work zero otherwise Pat Insp Elastic Work Pmusmax x V at EndPatEffort A Patient Work parameter Inspiratory Elastic V at StartPatEffort 2 where maxima and minima are taken during the time between Sol and Start Exp Pat Insp Res Work Pat Insp Work JPmus dV from Sol to StartExp A Patient Work parameter Inspiratory Elastic Pat Insp Work Pat Insp Elastic A Patient Work parameter Inspiratory Resistive 135 Parameter Definitions Parameters in the brb Breath P
218. ript file by using the lt Open Script gt selection from the lt Script File gt menu see Figure 4 22 and selecting a sct file by browsing the Open File Dialog window NOTE To familiarize yourself with the Simulation Editor you may want to open a ready made script such as example sct provided in the ASL Software 3 5 vars subdirectory Bt Sno Mor EE ca z Saige Parameterrile Windows Help Customize New Script N Open Script Open Current sct Ctrl Shift O Save Script Ctri Save Script as Save Script As Current sct Ctrl Shitt S Print Window Ctri P Exit ASL Software Ctri Figure 4 22 Script File Editor ScriptFile Menu Items 31 32 Operation Modeling Using the Simulation Editor Environment Alternatively a brand new script can be generated by using New Script from the lt Script File gt menu and selecting a name for the new script to be created The default parameter file pause vr3 will be inserted as a first script segment entry assigned one repetition only Se ScriptFile ParameterFile Windows Help Customize INGMAR MEDICAL Real Time Anah Run Time Home Interactive Control INGMAR MEDICAL Figure 4 23 Script File Editor Manual Scripting You may then edit this parameter file and store the resulting vr3 file under a different name as well as further add more segments to the new script The software uses a color scheme for the scr
219. rk J SD Exp Res cmH20 I s Exp Mean Squared Error Exp Overshoot Exp T90 ms Exp Target Insp Breath Type Insp T90 ms Vol 1 Peak Vol 2 Peak Start Exp Index End Exp Index Aux 1 V Aux 2 V ftot BPM Pmin PEEP_1 tot PEEP_2 tot Ext Exp Work Ext Exp Vent Work Pmean Exp cmH20 Pbaro kPa PawTP500 cmH2O ms PawTPt CcmH2O0 ms Pmean Ch2 cmH20 Pmean Ch2 Insp cmH20 Ins Settling Time ms Insp Mean Sq d Error tart Insp Index Vol Max Index in Flow Acc mL s 2 Oxygen OB betw Pmin and PEEP mJ PawTP PEEP_1 auto PEEP_2 auto Ext Insp Elastic Work Ext Insp Res Work Ext Exp Heat Production mJ Pmean Insp cmH20O all Temp C PawTP300 cmH20 ms Pmean Ch1 Insp cmH20 Pmean Ch1 Exp cmH20 Insp Overshoot Exp Settling Time ms Figure 14 2 Breath Parameter Data File brb bra ASL 3 4 dta ASCII he format of this file is tab delimited text Each entry is 12 characters wide and padded with spaces Breath Num Vol Comp In FRCP airwayP chest wallTotal Vol mL Total Flow L s P ch1P ch2 Voll mL ol2 mL Flow1 L s Flow2 L s P trachVol Vent Flow Vent Press Vent Figure 14 3 Processed Waveform Data File dtb dta ASL 3 4 rwa ASCII Tracheal Model Model Piston Airway Esophageal Right vol Volume Pressure Pressure Pressure Left vol L Breath AUX1 O2conc File Figure 14 4 Raw Data File rwb rwa Data File Parameters E Time Pmean PEEP Insp Elastic Work Heat P
220. rmware in the ASL simulator firmware 4 6 xx or higher which requires a special preparation as part of the upgrade process when applied to an older system with 16 bit firmware See Firmware Upgrade page 107 We recommend contacting IngMar Medical for details on how to perform this upgrade before attempting this on your own 2 5 3 Remote Control of the Host Software The Virtual Instrumentation Software is a stand alone LabVIEW application For users who would like to use the device under the control of other test instrumentation software LabVIEW based or otherwise we include the Test Automation Interface API as part of this package It is automatically installed as a separate executable in a folder ASL Test Automation Interface 1 0 under the Program Files x86 directory Please refer to the command definitions in the TAI specifications or contact IngMar Medical for details 17 18 Preparation Software Installation on the Host PC 3 Preparation 3 1 Software Installation on the Host PC Installation is performed by simply running the installer program setup exe from your USB flash drive on which the software was delivered or from the unzipped file that was downloaded from the cloud By default your applications will be created in a folder C Program Files ASL Software 3 5 in the Program Files subdirectory on your C drive C Program Files x86 in 64 bit Win7 or Win8 NOTE The default installation location c
221. rn to the normal view go to the slide rulers for X and Y scaling in the graph manipulation palette on the right of the screen just above the graphic display area and double click there Occasionally the target values for pressure or flow might be known independently pressure limited ventilation or flow limited ventilation In this case the target override may be entered in the Data Re Processing window when re processing waveform data see page 69 Volume corrections are performed for different standard gas conditions BTPS ATPD STPD by clicking inside the control labeled Conditions As measured no correction is the default setting GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The lt RETURN gt button will bring you back to the main analysis menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN3 gt button before you can open any other view from the Post Run Analysis Menu window Data Analysis Display Performance Analysis Selections Yellow Buttons 85 86 RespiSim RespiSim Screens 6 RespiSim RespiSim is the Ventilat
222. roduction Pat Exp Work Pat Trig Work J Median Exp Res cm H2O s Percent of Peak Flow when exp begins Insp Target Start Insp Effort Index Max Flow Acc mL s 2 Time betw Pmin and PEEP ms PmusTP Ext Insp Work Ext Exp Res Work Ambient Temp C Pmean Ch1 cmH20 Pmean Ch2 Exp cmH20 L Model R Model L Pressure Pressure 139 140 Support Resources Data File Parameters 15 Support Resources Recognizing that the ASL 5000 is a versatile instrument with users in a large number of fields and applications IngMar Medical is dedicated to support its users in many different ways We encourage you to visit our website at www ingmarmed com as the entry point for up to date information on support options While the primary source of user information is the Operating Manual there are a number of other resources to receive additional support Updated editions of this Operating Manual can be downloaded from the IngMar Medical website A video tutorial is available online and can be accessed directly through the Help menu item Tutorial C PerforceDepot ASL5000_depot LabVIEW main 4 documentation Figure 15 1 Video Tutorial Access Answers to Frequently Asked Questions FAQs are accessible via our website In addition we can offer live support Virtual Visit for users who have an internet connection for the PC that is being used as host for the ASL 5000 Breathing Simulator On the IngMar
223. rofile s to be processed is are selected from an input directory to which you can navigate from a standard browse dialog window There assumed original and desired new sample rates are entered 512 Hz as default Data sample rates of flow measuring devices typically sample at much lower rates and entering the actual value of sampling as Original Sample Frequency will preserve the time domain characteristics of the data by interpolating up to the 512 Hz needed for operating the simulator at its highest fidelity Additionally a gain factor other than 1 may be chosen 4 C Program Files x86 ASL Software 3 5 breath Text to append to input file name to form output file name _resampled This allows for scaling of patient efforts or tuning of flow profiles to meet a specific tidal volume requirement If for example data for a patient flow profile was collected in L s then a gain factor of 60 must be used to obtain the correct flow rate from the simulator L min If data needs to be inverted a negative gain factor may also be used The new profile may then be saved under a new name via the dialog box that opens once the Resample button has been clicked S LOZ PI JeoIpew sewsu ZAY S E MS OOOS ISV JenueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 9 TCP Data Broadcast 9 1 Breath Parameter Broadcast It is possible to broadcast or stream the breath paramete
224. rranty provided by IngMar Medical Ltd No other warranty expressed or implied is intended Representatives of IngMar Medical are not authorized to modify the terms of this warranty For factory repair service call Toll free 1 800 583 9910 International 412 441 8228 Facsimile 412 441 8404 or contact us via e mail at service ingmarmed com Our shipping address IngMar Medical Ltd 5940 Baum Blvd Pittsburgh PA 15206 USA Please note that a valid return merchandise authorization RMA no is always required before sending in any products for repair calibrations or updates Limitation of Liability IngMar Medical Ltd s liability whether arising out of or related to manufacture and sale of the goods their installation demonstration sales representation use performance or otherwise including any liability based upon above defined product warranty is subject to and limited to the exclusive terms and conditions as set forth whether based upon breach of warranty or any other cause of action whatsoever regardless of any fault attributable to IngMar Medical and regardless of the form of action including without limitation breach of warranty negligence strict liability or otherwise THE STATED EXPRESSED WARRANTIES ARE IN LIEU OF ALL OTHER WARRANTIES EXPRESSED OR IMPLIED INCLUDING WITHOUT LIMITATION WARRANTIES OF MERCHANTABILITY FITNESS FOR ANY PARTICULAR PURPOSE OR NONINFRINGEMENT IngMar Medical Ltd
225. rver Thus data generated from the ASL 5000 s Analysis package can be merged with other signals from separate devices in a convenient fashion see also TAI Overview page 90 S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 5 1 Post Run Analysis Main Menu Data Analysis Post Run Analysis Main Menu ae IngMar Medical ASL 5000 Window Manager eco Fie Process Preview Display Performance Windows Help Customize Pe INGMAR MEDICAL ASL SU vrsacthing Siubiter Run Time Home Interactive Control Script Patient Model Real Time Analysis Post Run Analysis Utilities Respisim S INGMAR MEDICAL Select Files Process Preview Data lasi sus lysis Woe Display Raw Data Please note To allow for data display analysis other than trend of breath parameters data must have been saved with waveforms during simulation run Waiting for menu choice Selected raw Data File Figure 5 1 Post Run Analysis Menu As a first step in the standard procedure a data file rwb needs to be loaded for analysis By graying all other menu selections in the window except for the lt Select a Simulation gt button the user is guided automatically to perform this step You can also open a data file from the lt File gt drop down menu F HE IngMar Medical ASL 5000 Window Manager Process Preview Display Performance Window
226. rver will open the ASL software in hidden mode which prevents unwanted user interference through the graphical interface GUI of the ASL 5000 software 7 1 TAI Overview TAI Server Application Terminal Script Editor LabVIEW VI Server Ethernet or RS 232 s gt 5 Figure 7 1 Test Automation Interface TCP socket The GUI can still be made visible if needed The TAI server also has the capacity to run multiple instances of ASL systems through additional copies of the ASL Software package on the same CPU running the server The remote interface will directly communicate with the ASL software Third party users can create external applications in any independent language C C VB LabVIEW etc to communicate with the server protocol via TCP connection It is also possible to use an existing Telnet client e g PUTTY to connect to the server Furthermore a server internal terminal with script editor will be developed future for the creation and execution of predefined command scripts For more information or the full specification of this API please contact IngMar Medical Telnet similar protocol CLIENT APPLICATION TCP Waveform Breath Broadcast GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA This page intentionally left blank S LOZ PHT JeoIpew seyysu ZAY GE MS 0005 ISV JenueW sasn 91 92 Using ASL Utilities
227. s Excessive volumes will exceed the physical capabilities of the simulator and therefore might cause a motor disable Use values lt 2 1 L when operating with a residual volume of 0 5 L the default setting for URC In this case the piston was not able to follow the required movement fast enough and maintained a higher speed for a longer time to compensate for the effect In such situations it will be necessary to return to model parameters and or conditions that are within the performance range of the simulator system 105 106 Maintenance Instrument Identification 12 Maintenance 12 1 Instrument Identification Please refer to the separate maintenance manual for details about maintenance for the ASL 5000 When inquiring about maintenance please have the following reference information available This label can also be found on the bottom of the instrument as well as in the maintenance manual ASL 5000 Part No 31 00 100 Serial No 1087 Component IngMarPart Manuf Serial PS250 PS48 3110441 FOS1 4023 PSA4531 3110 442 Pas 90083941 PIC 5 60 3110410 PICS125297 EPM CPL 3f 3110439 655082 DMM 16 AT 3110431 wW333776 DMC1411 31 10 421 UU 1922 ICN 77000 31 10 504 0i1iiE000 31 10 300 KO9EX 0 25 3110101 21408 Ball screw 31 10 235 4mm Hiwin Figure 12 1 ASL 5000 Component Serial Numbers Newer versions of firmware in the ASL 5000 instrument 4 6 n and higher also keep track of spindle revolu
228. s important to recognize that the lowest point in the volume excursion is used to determine the begin of a breath Depending on the circumstances this might not always be appropriate In both the Real Time and the Post Run Analysis windows the user should visually inspect the placement of the markers at the beginning of breaths Figure 4 80 page 60 and page 68 to verify that the trigger analysis will be able to yield meaningful results There is also a vertical cursor in order to manually determine the point of trigger Simply drag click and hold mouse button during cursor movement to the desired position Clicking on the Recalculate Work Parameters button will perform a recalculation of trigger related work parameters for the updated trigger point Trigger time is calculated as the time from the beginning of the inspiratory effort i e start of the patient effort pressure profile to the time of return of pressure to baseline See also Parameters in the brb Breath Parameter File page 131 You may zoom into a detail area at any time by clicking into the display and dragging open holding mouse button down a detail window To return to the normal view go to the slide rulers for X and Y scaling in the graph manipulation palette on the right of the screen just above the graphic display area and double click there By clicking the X and Y resolution buttons identified as lt X XX gt and lt Y YY gt in the gra
229. s Help Customize Select Data File Ctrl I L Exit ASL Software Cirl j Figure 5 2 Post Run Analysis Select Data File Loading a data file set with the rwb extension raw binary type will also automatically load the breath parameter file belonging to the same simulation run that was generated by the Real Time analysis Performance Display Data Analysis z Breath by Breath Work hers Data Calculations and 2 Graphs PW Loops Multi Parameter Graph Trigger Analysis 4 Traces Response Data Breath by Breath and Graph Ventilator Performance Loops Y ws X Servo Control Analysis Waveforms Multi Paraneter 4 Traces Continuous Multi Parameter Trend Breath Parameters from brb File Therefore you do not necessarily have to go to the Process Data step if you do not intend to re process data for the purpose of optimizing breath detection performed by the software You may however perform that step at any time for data sets that included waveforms and in this way check the breath detection performed by the ASL 5000 Post Run data analysis processing Once a raw data file has been loaded all analysis menu options become accessible and you can freely pick and choose between them provided that the data set contained waveform high resolution information Very large data files may require you to allocate more memory
230. s Menu gt button from the patient effort model parameters can be turned into time Time Varying Parameters Editor window In this fashion a varying parameters as described in Step 2 varying spontaneous breath rate may be set or the depth of the breath Pmax can be varied over time 41 42 Operation Modeling Using the Simulation Editor Environment 4 2 14 Step 4 Save Simulation Parameter Set After all parameter selections have been made you are ready to save the parameter set for the current segment either retaining the name the set had already been given lt Save gt button or using lt Save As gt for a new name The use of the vr3 file extension which identifies ASL 5000 patient parameter files is automatically appended Path to parameter file C Program Files x86 ASL Software 3 5 4 vars scenarios Adult_normal vr3 Figure 4 51 Simulation Editor Saving a Parameter Set After Saving the parameter set you will be returned to the Script Editor from where you can edit other segments or directly run your assembled script using the sense button NOTE Before running a script that has modifications in its structure different number of repetitions or patient files vr3 files it will need to be saved green highlighting in the Script Editor s Script File Name field either using the lt Save gt or lt Save As gt buttons or the Save Script or Save Script As options from the lt Script File gt
231. s not relegated to a passive role leaving everything to physiological models that work out the patient s response Rather he or she has an active role as educator at all times with the ability to make changes to patient response on the fly RespiSim Use of RespiSim with Dedicated Educational Modules 6 2 3 Instructor and Student Aids In order to facilitate this type of simulation philosophy RespiSim offers a number of tools for instructors and students The introductory cognitive learning component of each RespiSim module is intended to provide educators with a ready made learning management system compatible presentation of basic concepts It is called the Scenario Concept Presentation The presentation can take the form of a PowerPoint presentation an animation enhanced lecture or similar forms that can be enhanced by instructors to include specific quizzes or the like It is expected that students are exposed to the material before being admitted to the simulation class itself This material is provided to optimize the efficacy of the valuable time spent in the simulation lab There is with each RespiSim module also an Instructor Scenario Guide a pdf worksheet outlining the learning objectives a case description the rationale for the separate stages and details on the settings for ventilator and patient model similar to what is found in the software module itself Instructor Dashboard This instructor worksh
232. s not seen on a plot of Ap versus v However this residual pressure would appear on the plot of Pe pss Versus Vy 115 Theory of Operation Introduction to Ventilatory Mechanics In some disease processes even for tidal volumes and breathing rates in the quiet range the ventilatory system while still acting as a single compartment exhibits nonlinear relations for the terms in the right hand side of equation 4 Thus AP it Dao Pes T AP mus f v f 0 13 where f v and f 6 are functions of lung volume change and flow These functions can exhibit a variety of nonlinearities including hysteresis power curves directional sensitivities and time variation In such cases the time constant may not be a mathematically appropriate mechanical parameter However in some situations an average time constant with its concomitant average resistance and average compliance are used not necessarily correctly to approximate the system behavior Non uniform Lungs In some disease states e g advanced COPD tissue loss and airway obstruction can be distributed in multiple locations throughout the lungs Consequently a single compartment model does not describe the system s behavior very well The minimum number of compartments that will exhibit the essential responses of such systems is two Figure 13 10 shows a two compartment pulmonary system within a chest wall compartment It is important t
233. s well as editors for time varying parameters Interactive Control Panel ICP Real Time Breath Analysis Interface Post Run Data Analysis Interface Utilities Selector for the following components Data File Translation utility Pressure Profile Resampling utility Patient Flow Data Processing utility XML Breath Parameter Client example XML Waveform Parameter Client example Examples for remote control RespiSim Main debriefing Panel RespiSim Instructor Dashboard Embedded service software and parameter files per forming tests and verification procedures as well as troubleshooting on the Embedded Controller PC Software license keys supplied separately required for accessing full functionality of the software beyond demo mode NOTE For firmware upgrades on the ASL 5000 Embedded Controller please refer to the specific instructions that are delivered with any upgrade and the instructions in section Firmware Upgrade page 107 This will assure that the correct procedure is followed for the different versions of firmware currently installed in a unit NOTE Serial no s up to and including 0799 cannot be upgraded to the current firmware level and should first receive a hardware upgrade to the most current CPU NOTE Units with serial numbers above 1500 are already equipped with all connectivity needed for use with IngMar Medical s RespiPatient Units with serial numbers beginning with but below 1500 can be
234. sesesees 64 Data Analysis cceeeee 66 Post Run Analysis Main Menu 000 67 Process Data Blue Button s00088 68 Display Data Selections Green BUILONS oscine a 70 Advanced Graph Analysis Tools The Graph and Cursor Palettes 006 71 Breath by Breath Display ceeeeees 73 Multi Parameter Graph ee eeeeeeeee eens 74 Loop Displays sereen a 76 Continuous Time Based Data 00 77 Trend Graph Display ceeeeeeeeeeeeeeeeees 79 Display Performance Analysis Selections Yellow KeyS cccccocsrsosssssecssesesssssesseseseess 81 WOB Analysis Display seeeeeeeeeeees 81 Trigger Analysis Display ceeeeeeeeeeeees 82 Servo Control Performance Display 84 Res piSim 00000000000000000000000 86 RespiSim Screens cccccrrrrrrsssscsssssseseees 86 RespiSim Interface Overview sses 86 RespiSim Modes of Operation 66 87 Role of Training Modules Within the RespiSim Simulation Environment 88 Use of RespiSim with Dedicated Educational Modules 89 Philosophy of Instructor Driven Multi stage Clinical Simulations 89 Role of the Instructor eceeeeeeeee 89 Instructor and Student Aids eeeee 89 Authoring Training Modules seen 89 8 1 8 2 8 3 8 4 8 5 9 1 9 2 10 10 1 10 2 10 3 10 4
235. sible It is quite feasible depending on the level of detail and accuracy desired to use the graphs of the Run Time Home window for quantitative evaluations The purpose of the graphs however is to check in a general fashion selected model parameters to obtain an understanding of the parameter ranges and to judge the overall interaction of a simulation with external devices such as ventilators True breath by breath data waveform analysis should be performed off line with the ASL 5000 s comprehensive Post Run Analysis software see Data Analysis page 66 From the Run Time Home screen you may control the chart length entered in seconds with the respective control in the Display field Chart Length 20 5 Figure 4 55 Freeze Switch The selector button lt Waveform View Loop View gt may be operated at any time to toggle between these views Screen plots may be frozen at any time for better viewing using the lt Freeze gt button in the Display section The number of breaths displayed in the status line will continue to update as will the lt Script Time Remaining gt display in this case The plot itself will stop updating at the time of the Freeze It is helpful in this case to closely observe the status line displaying the currently active model parameter file vr3 file or to go to the Script Progress window Script Time 45 46 Operation Running Simulations From the Run Time Home Di
236. situation plug in the serial USB or Ethernet cable into the correct port etc Only then click the lt Retry gt button again NOTE It is still possible to use the modeling environment of the software after canceling a failed connection attempt When closing the software simply select Yes to the question of whether you want to return to the Welcome window and allow the software to open in demo mode again NOTE After successful synchronization default files are transmitted and you will hear the simulator move the piston to its home position At the completion of the initialization procedure on the Central Run Time screen s status line you will see the message Ready Use the Simulation switch to begin or the Exit button to stop You are now ready to run a simulation 4 3 2 Starting a Simulation With the Run Time Home screen active clicking the lt Start Sim gt button will start a simulation This push button switch is also duplicated on the Script Editor and the Interactive Control Panel as well as on the RespiSim main panel and Instructor Dashboard Simula Figure 4 53 Simulation Start If the Central Run Time screen is not the active window when floating windows you can also start a simulation from one of these other locations or using the lt Control gt drop down menu on the top of the Window Manager The simulator will be now be loaded sequentially with parameter sets stored in
237. splay B IngMar Medical ASL 5000 Window Manager Control Display Windows Help Customize INGMAR MEDICAL Interactive Control Run Time Home Be INGMAR MEDICAL Caniral un f mel Disukay s Running simulation Total of breaths detected 14 q C Program Files x86 ASL Software 3 5 vars demo_segment vr3 Figure 4 56 Loop View In the Loop View two separate plot areas show the flow volume loop and the pressure volume loop for the chart length selected i e several loops may be seen superimposed at any given time The flow volume loops are displayed for calculated model volume for compartment 1 and 2 versus calculated model flows for these compartments or just the total model flow versus volume in case of the single compartment model The pressure volume loops are plotted for airway pressure versus the respective volumes compartment 1 and 2 or total calculated model volume NOTE Please note that autoscaling is now also the default in the loop view If you prefer to have autoscaling turned off right click on the graph and uncheck Autoscale X and Autoscale Y in the pop up menu as needed Loops also may be frozen at any time for better viewing using the lt Freeze gt button in the Display field GLOZ PHT JeoIpew sewsul O ZA S E MS 000S ISV JenueW sSNA User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 3 5 Lung Fill Indicat
238. sults and is therefore not supported Approximately 250 MB of free hard drive space is required for installation of all software components Data file sets take up approximately 3 5 to 4 MB per minute of simulation at highest resolution waveform capture TDM files generated with the RespiSim option use about 15 MB per minute As with most software applications a disk that has ample space for recording files will improve application speed and avoid delays that might not be acceptable for real time calculations by the software NOTE LabVIEW allows you to not use the localized operating system s setting for decimal points and to override the PC s settings always using a decimal point This setting is used for our compiled host software S LOZ PHT yeoIpew sewsul ZAY FE MS 0005 1SV JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 2 5 Simulator Software 2 5 1 Software Components The complete software package including optional components for the ASL 5000 host computer contains System software Windows DLL Virtual instrumentation software host software for controlling the simulation defining its parameters as well as analyzing the results comprising a main screen with detachable tabs for Run Time Controller the simulation controller inter face with Virtual Ventilator capabilities if licensed Simulation Editor including the Script Editor and non linear C editor a
239. sure difference across the system that can be manipulated by the ventilator and the equivalent pressure difference produced by active contraction of the respiratory muscles Figure 13 2 shows example wave shapes that could result from a normal ventilatory system driven by a ventilator assisted breaths and the respiratory muscles The Work of Breathing The work done on a pneumatic system as its components are moved relative to one another is the product of the pressure difference driving the movements and the change of volume resulting from the movements This can be written as Was a JAP mus dv 7 where Wag is the work done going from volume A to volume B Ap is the pressure difference across the system dv is the differential volume and the integral along the path from A to B on the Ap v plane For the ventilatory system for an entire breath numbered N this can be written Vee N Wer Z AP ior dr 8 Vee N 1 S LOZ PHT yeoIpew sewsul O ZAY GE MS 000S ISY JenueW sasn User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 where Vee N and Vee N 7 are the end expiratory volumes for breaths N and N 1 respectively g AD Pro Paal APs Figure 13 2 Normal ventilatory system responses during assisted inspiration with expiratory muscular forcing Va and V are end inspiratory and end expiratory volumes respectively V is tidal volume Inspiratory Work
240. t Ethernet networking has the advantage to allow for flexibility as to the relative locations of PC and Breathing Simulator It also provides the option to connect the system wirelessly via a 802 11b g n WiFi equipped PC The communication protocol is the ubiquitous TCP IP and given a high speed internet connection a PC connected via a VPN virtual private network may even host an ASL 5000 from a remote location The system is set up for DHCP server issued IP addresses For creating an ad hoc network we recommend using the included wireless router as a DHCP server to assign IP addresses to both the PC and the ASL 5000 Fixed IP addresses are supported as well A specific routine in the Maintenance section of the Full Choice Welcome menu helps to assign a fixed IP address to the ASL 5000 NOTE The host PC and the ASL 5000 Breathing Simulator must have compatible IP addresses in order to establish a proper connection via UDP broadcast the method normally used by the ASL 5000 This means that the first three sets of digits in the IP address have to match both devices on the same subnet For a network where your PC is typically assigned its address by a DHCP server verify that the range from which it receives its address is compatible with the address that is assigned to the ASL 5000 With more recent firmware versions 4 7 nn it is now possible to use fixed IP addresses beyond subnet boundaries without the services
241. t Py re hee eee Figure 12 3 Firmware Upgrade Confirm Select the Upload option and confirm the next window Please make sure NOT TO DISCONNECT while uploading software After 32 bit prep run sw upload one more time without prep Figure 12 4 Firmware Upgrade Disconnect Warning The upload process is completed after a few seconds using Ethernet It might take up to one minute using RS 232 Confirm the final message Firmware upload was successful Restart both simulator and ASL host software Figure 12 5 Firmware Upgrade Restart Notice The software will close automatically Switch power to simulator off and after waiting a few seconds back on Verify that the red motor enable disable switch on the front of the ASL will now go off again after 20 seconds as usual 107 Maintenance Schematic Overview 12 4 Schematic Overview SBLVM Simulator Bypass and Leak Valve Module One way valve i _ gt i Test lung ALAND SN NNN Solenoid N7 valve xX CT Se eS Se O 2 i pre re ASL 5000 main unit __ leak valve ol r Optical limit switches p Brushless DC Motor w encoder PWM power F TZZZ ZII NS s A Hall signals IIl Press cal Brushless motor amplifier 5 10 A 55V SIM switch valve Motor Control Signal press transducer 40 110 cm H2O 7 Differential A Barometric press transducer vD
242. t of the compensations will be that volumes indicated as ventilator volumes will more closely match the measurements made by a ventilator Especially when using the simulator in neonatal applications careful adjustments will be helpful in eliminating unwanted biases in this regard if a ventilator itself does not correct for these factors volume lost in circuits NOTE The tidal volumes displayed as Insp Vt and Exp Vt already take into account volume compressibility in the cylinder URC and deadspace which is why you will see small deviations of these numbers from the volume tracings in the Run Time Home display By checking the pigpayuneompensated volumes Checkbox you can match the volume graph to the one seen in the Run Time Home window If it is left unchecked the standard compensations performed when processing data see NOTE above are applied Volumes with corrections towards different standard gas conditions BTPS ATPD STPD may be viewed by clicking on the lt Conditions gt indicator As measured no correction is the default setting Please keep in mind that data written to file is not affected by this choice Real Time Analysis operates with the same core software modules as does the Post Run Analysis see page 67 but performs data analysis concurrently By observing the breath identification markers start of breath begin of expiration etc you can make adjustments to the breath detectio
243. termines if the cursor is locked to a plot or able to be moved freely To label the cursor click on the highlighted word in the Cursor Legend Flow in the example in Figure 5 8 Replace the word with any label of your choice To assign coordinates to the cursor highlight and replace the numbers currently showing in the two boxes to the right of the cursor label The first immediately to the right of the label identifies the X coordinate The second box contains the value for the Y coordinate You can move a cursor on a graph by dragging it with the mouse or by using the cursor movement control pad To drag a cursor make sure the graph does not have the panning or zooming tool selected Click and drag the cursor to the desired location Alternatively to enable the cursor movement control pad click on the cursor movement select button Clicking the arrows on the cursor movement control causes the cursor to move in the specified direction i e up down right left B Snap To d K Attributes H Color Clicking on the cursor display control displays a pop up menu to control the look of the Visible Items cursor and the visibility Cursor Style Bring to Center of the cursor name on Point Style Go to Cursor ape ce the plot Select Line Style Attributes gt Show Name Create Cursor gt Line Width to make the cursor Delete Cursor Show Name name visible on the plot Selecting Bring to Center moves the
244. tern should describe one or more complete breath cycles which will be repetitively used during a simulator run until the simulation is stopped A Pressure Flow Resampling utility is available from the Utilities tab of the Window Manager There you can set the old sample rate to the value that represents the time increments of the file you are using for your pressure profile After clicking on lt Resample gt a file dialog will ask for a new file name to be used for the resampled data and the new file is generated The new sample frequency is by default 512 Hz For details see Using the Pressure Profile Resampling Utility page 96 NOTE Please note that the maximum length of breath profiles allowed is 20 seconds or 10240 data points equivalent to a breath rate of 3 Theory of Operation Patient Effort Model 13 4 7 External Analog Input As an alternative to breath profiles from files to determine the muscle pressure of a patient model the analog inputs of the ASL may be used for this purpose The input range of 0 to 10 V is used with a bias of 5V in order to allow both positive and negative excursions forced exhalation or flow pump with both negative and positive flows BM Patient ifort Model I so l i a i 4 i O00 85 L LS 0 25 10 4S d 45 Figure 13 28 Effort Model Analog Input A gain factor setting makes it convenient to adapt a given voltage source to the exact
245. the labeling of the X and Y axis to suit your needs The Cursor Palettes below each graph may be used to change the visual appearance of the cursor and to position the cursor lines see also page 71 Parameters for each graph can be freely selected from the drop down list of available parameters click on the VW symbol next to the parameter name to the right of each waveform graph Please refer to Parameters in the brb Breath Parameter File page 131 for details on the individual parameters displayed in this data view Volume corrections may be performed towards different standard gas conditions BTPS ATPD STPD by clicking on the W symbol next to the Conditions of 73 74 Data Analysis Display Data Selections Green Buttons Volume Measurement label As measured no correction is the default setting Please also see NOTE on page 69 Breath Type refers to the distinction between mechanical breaths no patient contribution and spontaneous breaths patient makes effort You may change the background color of the graphs using Graph Colors from the lt Help Customize gt menu in the menu bar of each of the analysis windows Use a light color when printing the screen The lt RETURN gt button will bring you back to the Post Run Analysis Menu screen NOTE Please note that in software 3 5 it is no longer necessary to close dedicated analysis windows using the lt RETURN gt button befor
246. the segments of the current script on a breath by breath basis to perform the programmed simulation script The script is also at this time evaluated again for errors for example script segments that cannot be located on disk Before the simulation starts the user has the choice of naming a data file and path for storing breath parameters file brb as well as optionally waveform data No file name extensions need to be used for the destination since these are assigned automatically as yourname rwb for the raw data file yourname dtb for the processed waveform data file and yourname brb for the breath parameter file for data saving options see chapter Data Analysis page 66 NOTE The default filename is data in the ASLdata subdirectory Files in this default location will be overwritten by the next simulation unless you save them under a different name A personalized default location for the data files can be assigned with the Project File Tool see page 26 After closing the data file selection dialog the first breath profile is generated and loaded and the simulation will begin At this time the simulator bypass valve in the SBLVM if this option is connected will audibly close and a ventilator connected to the system will now be ventilating the simulator instead of the auxiliary test lung attached to the SBLVM S LOZ PHT yeoIpew sewsul O ZAY FE MS 000S ISY JenueW sasn User s Manual ASL 5000
247. these values of Vt are therefore not just a reflection of the piston excursion 4 2 9 Advanced Model Settings Time Varying Parameters TVP Time Varying Parameter Menu s ll ail i For editing parameters when time varying parameters TVP is switched on click on the lt Edit gt button below the switch it will be Double Click visible only when TVP A Parameter to Edit has been switched on c1 R_Trachea_In This opens a dialog box Time Varying Parameter Menu from which to choose parameters to edit Figure 4 34 TVP Menu The concept of time varying parameters means that within each parameter segment in your script parameters can be made to change gradually from breath to breath providing a much more realistic rendering of a patient s behavior over time Besides the passive lung model parameters R and C including the optional Rin lt gt Rout and non linear C the parameters of the spontaneous breathing effort i e the muscle pressure profile may also vary over time Operation Modeling Using the Simulation Editor Environment NOTE Switching on Time Varying Parameters TVP requires that all applicable parameters are now set via the Time Varying Parameters Editor Parameters that are meant to remain static can easily be made so by using appropriate selections Double clicking a parameter opens the Variable Parameters Editor window The concept is similar to the Simulati
248. tic Overview ASL 5000 System 108 A one compartment ventilatory system 0 110 Normal ventilatory system responses during assisted inspiration with expiratory muscular TONG ING aaa deter rarest uamtot eteeeam tenn cae 111 Ap v plots for c total driving pressure difference 006 112 Ap v plots for data in Figure 13 2 with expiration included 113 Ap v plots for data in Figure 13 2 with expiration included ssseeeeeeeeeeeeeeeees 113 Aptot v curve for an entire breath with expiratory volume change plotted upward from end inspiration on the v aXiS eceeeeeeeeeeeeeeeees 114 a Volume and flow responses to the same Aptot forcing function for ventilatory systems with different time Constants cccceeeeeeceesceeseeeceeees 115 b The Aptot v for the three Cases ee 115 Two compartment pulmonary system within the chest wall c cece eee cscceeceeeeeeeeees 116 Aptot v relation for a two compartment ventilatory system as breathing frequency is a st a 6 NNE E E renee a revere ere 117 Simulation Model Electrical Analog 06 119 Simulator COME CD 255 8 sarees Gaahecies waa teceltnnotetinens 119 Single Compartment Model eeeeeeeeeeceeeeeees 120 Two Compartment Model 120 Patient Effort Model Passive cceeeeeeeee 121 Patient Effort Model Pressure Trigger 06 121 Pressure Trigger Eff
249. tions accumulated time of simulation runs and breath cycles like the odometer in a car From the file e_log txt to be found in the main installation directory as well as via the lt Maintenance gt button on the Full Choice Welcome window the user can check the status between service intervals Example odometer install_date 09 09 11 odometer leadscrew_revs 170749 odometer simulation_secs 101807 odometer piston_cycles 12520 As a reference 250 000 revolutions of the spindle equal 1 km of piston travel relevant for the life of the piston seal 1000 hrs of operation equals 3 6 x 10 seconds Ventilation at a rate of 15 bpm with 500 mL tidal volume that is a MV of 7 5 L min generates approximately 18 km of piston travel in 1000 hours or 4 5 x 108 leadscrew revolutions 12 2 Service and Calibration Intervals While it is not always necessary depending on the type of use of the instrument to mandate specific calibration intervals users in research and development facilities especially those operating under some regulatory framework will find the following guidelines helpful Interval Jevery monte yearly Service Leak Test Calibration Check if Calibration Check determines that sensor is out of spec festoaton Seal Exchange based on leakage rate determined by Leak Test more frequently if indicated by continuous use of the instrument or by good scientific practice NOTE In software 3
250. to compute flow at each time step do not react well to such sudden pressure changes wherefore a model compliance was introduced The physical justification for such a compliance is that there is a finite volume of air trapped in the tubing between the supply valve and the exhaust valve The trapped air and the elasticity of the tubing have compressibility that prevents a fast acting valve from generating a huge pressure spike The Cvent parameter in the control panel is the user s control over this bit of the model lower its value to get sharper edges at breath state transitions raise it to soften the pressure curve Volume control mode in the VV is intended to drive a constant flow into the ASL 5000 during the inspiratory phase The desired constant flow is specified by the user with the lt Continuous Mandatory Ventilation gt control of the VV control panel as VC CMV Because the flow is specified by the setting s of the two controls lt Inspiratory Flow Time gt and lt Set Tidal Volume gt the VV does not need to know upstream conditions and there is no need for Rin Its value in the VV control panel is ignored During the hold phase of the vent cycle set via the lt Insp Pause Time gt control the model is the same as it is in the hold phase of the pressure control mode A valve in the supply tube is closed instantaneously a simplifying assumption which stops the flow in the supply circuit Cyent describes the combined c
251. to the LabVIEW application depending on the Windows OS version Do so if you receive the respective message from LabVIEW Alternatively for very long runs you may want to reduce the waveform data sample rate see page 35 Pressing the lt RETURN gt button provided on each analysis screen will return the user to the Post Run Analysis Menu screen for further selections 67 68 Data Analysis Process Data Blue Button 5 2 Process Data Blue Button zE Post Run Analysis Data Re Processing File Help Customize SS Effort Start Threshold cm H20 Insp Waveform SD Threshold Fraction of Target for Steady State Insp Gircuit Resistance cm H20 L s j 0 00 Exp Grrcuit Resistance cm H20 L s 2 09 Circuit Compliance mL cm H20 fho 00 Insp Breath Type Override Breath Start Volume Threshold mL Exp Start Volume Threshold mL Inspiratory Target Override Expiratory Target Override eae Pressure Filter Moving Ave i b i a dals Clee cee ele Ln in a PA PY ial in ala dalada aa m e of o E i Breath Number 38 Figure 5 3 Post Run Data Re Processing Window The functionality of the Post Run Data Re Processing window PRDRP window is as mentioned before very similar to that of the Breath Detection Real Time Analysis window This interface is used to check and re perform breath detection and the associated calculation of breath param
252. try fields for Pmus modified by Paw in the sinusoidal and trapezoidal breath profile editor windows provide a way to let patient efforts be reduced in real time as external ventilator pressure is applied This is helpful for added realism in the model behavior when a ventilator is used with a spontaneously breathing patient model It provides a modeling somewhat analogous to the Hering Breuer effect which releases muscle pressure once the stretch receptors of a patient s respiratory system have responded to a significant tidal volume The ASL 5000 s backing off feature is based not on volume but on pressure However the two parameters are of course directly connected via V P x C Inspiratory The amount of ventilator pressure multiplied with the percentage that has been entered into the lt Inspiratory backing off gt field is subtracted from the programmed patient effort profile at any point during inspiration Theory of Operation Patient Effort Model As an example assume that the ventilator after being triggered develops a positive pressure of 10 cmH20O to support the patient effort If the patient effort had been set to 13 cmH20O Pmax it would now be reduced to a maximum of just 3 cmH2O if the backoff parameter was set to 100 and to 8 cmH20O if the backing off was 50 50 of 10 cmH20 5 13 5 8 Pvent t Pehest 7 With patient wall backing off 30 lt patient backing
253. ts may be set for both parameters to keep adjustments within a physiologically relevant range The algorithm used adjusts both parameters Vt and breath rate simultaneously i e larger tidal volumes are associated with faster breath rate and vice versa Before opening this tab please make sure that the slide switch on the left of the ICP window is set to Const MV otherwise a reminder will show up on the tab stating that Lung is passive or Closed Loop MV is not active Figure 4 76 Constant Vt Post Run Analysis Utilities Ditaraetiya Control Sulial Closed Loop CO2Y l Patient Library l Breath Rate Also in this mode a trend window is displayed that shows the approximation towards the set value MV As in Vt Loop mode external conditions such as ventilator support will cause adjustments automatically Setting the MV target for the interactive patient model and the adjustment thresholds may be performed by clicking and positioning dragging the blue pointer on the knobs to the desired setting or by entering numerical values into the field below a knob Please note that the algorithm does not represent a model of respiratory control based for example on CO2 elimination It is furthermore important to keep in mind that depending on the restrictions imposed by limit thresholds as well as by external conditions it will not always be possible to actually reach the set value of minute ventilation
254. ts to different locations The buttons for Token operations are accessed via the lt Work with Tokens gt button on the Script Editor window Figure 4 26 Script File Editor Tokens NOTE Access to the Relative Path Configuration Tool is also available from the Project File Tool Script Editor Preferences tab A token is a friendly name given to a file path in Figure 4 26 it is lt ASLDefaultInstallDir gt With the lt Configure Token Paths gt button you can assign actual file paths or elements of file paths to tokens The other buttons on the left of the Script Editor window are used to switch between tokens and original file paths either individually for the highlighted script segment or as a whole The purpose of tokens is to allow convenient changes of file paths when for example a script with its inventory of patient parameter files vr3 files is relocated to a drive or directory different from where it was originally created In this case configuring the new path as a token and replacing the existing token or file path will avoid having to recreate the whole script Operation Modeling Using the Simulation Editor Environment Configuring tokens is easily done with the Relative Path Configuration Tool that opens after clicking the lt Configure Token Paths gt button BE Relative Path Configuration Tool Configured Relative Paths lt ASLVarsDirectory gt C Program Files x86 ASL Software 3
255. un Analysis INGMAR MEDICAL mulation CASLVarsDirectory examples normal vr3 CASLVarsDirectory examplessnormal vr3 Figure 4 24 Script File Editor Script Errors Segments in a script can be highlighted copied and pasted by right clicking and selecting from the pop up menu or using the lt ParameterFile gt menu There are two additional script saving options on the lt ParameterFile gt menu Save Selected as NewScript allows users to directly create a new script from a highlighted selection and to give it a unique name You may also import highlighted segments from another script via Merge Scripts with a simple drag and drop operation INGMAR MEDICAL ASLVarsDirectory gt exonples normal vr3 ASLVarsDi rec tory Nexamples trigger chal lenge vra gt examplessnormal vr3 s lt ASLVarsDirecto Figure 4 25 Script File Editor Editing Techniques For this you must first identify the script to paste from via the blue lt Select Script gt button in the Script Merge window NOTE Non contiguous selections will be dropped into the script under construction as contiguous sequences S LOZ PI JeoIpew sewsul O ZA S E MS 000S ISV enueW sas User s Manual ASL 5000 SW 3 5 Rev 2 IngMar Medical Ltd 2015 4 2 3 Using Tokens A system of relative path designations is available based on the use of tokens representing file path names or file path segments This facilitates moving scrip
256. ure Profile Resampling Utility page 96 Whenever a long patient flow data set needs to be played back in SmartPump mode this utility can automatically create a script of vr3 patient files using segments of the flow data each of which is a few seconds in length The utility allows to extract the flow data from ASCII files as well as files saved as EDF European Data Format EDF files typically will contain several parameter traces as well as headers column labels It is the user s responsibility to properly select the column of data representing flow The user must also determine the number of rows to be skipped at the beginning of an ASCII data file for the purpose of excluding headers included with the file Offset is used to compensate for bias in the original data Flow sensors typically will not produce a signal that when integrated over a longer period of time would produce a perfectly neutral volume Over time this would lead to an unacceptable out of bounds volume drift for the simulator Testing a script in Demo Mode no physical simulator attached will allow to determine the amount of that bias as L min With the proper offset in place simulation runs over extended periods of time should show a volume that returns to baseline The Gain setting can be used to convert data that is reporting flow in L s or mL s to the required L min multiply by 60 or 0 6 respectively You might also have to
257. verview on the software how it is structured and how to get started using the ASL 5000 More detailed information on individual aspects of operation can be found in separate chapters later in this manual 4 1 1 License Keys Beginning with version 3 3 the operation of the ASL host software is controlled by license keys that are coded into the initialization file of the software ASL5000_SW3 5 ini see also page 18 The default demo installation will not have access to the Virtual Ventilator or connect to the ASL simulator RespiSim is restricted to playback of a demonstration data file RespiSim_Demo tdms located in RespiSim_Modules RespiSim_Demo To gain access to additional features a new file ASL5000_SW3 5 ini a new license key needs to be copied into the main installation folder after the original demo software installation NOTE When an update is made available to your ASL host software it will also be necessary to copy the existing file ASL5000_SW3 5 ini with the licensing information into your updated installation folder in order to have again access to the full licensed functionality of the software A new license key file will only be necessary and supplied for upgrades to a newer version of the software 3 5 or higher 4 1 2 Screen Navigation Beginning with software version 3 4 navigation is now structured into panels that are accessed from tabs on the Window Manager They can also be detached dragged off
258. with the specific event The Event Graph shows a bright yellow vertical cursor line that is used to navigate inside of a selected recording This is the primary method of accessing a particular point in time of a recording The play button on the top left also has a step back forward feature Clicking on these elements forwards the starting point of the playback to the next or previous change of patient parameter file Clicking the play button starts a playback of recorded data from the point of the cursor The numeric parameters in the field on the bottom right change as the recording moves along and so do the waveforms loops in the Graphics field The cursor position represents the right edge of the waveform display On the left the currently playing patient parameter file is indicated as well as the Preferences file associated with the recording Playback provides a superb way for viewing data for the purpose of debriefing after a a simulation session or to demonstrate effects in the context of e learning as a stand alone 6 1 3 Role of Training Modules Within the RespiSim Simulation Environment The RespiSim system is capable of providing training in many aspects of tasks related to patients treated with ventilator support The mechanical ventilation curriculum in respiratory care programs has of course the most tasks with a need for such training On the other hand however other caregivers such as nurses also have
259. x Needle decompression with familiar hiss sound Chest tube insertion Recognition of correct position in the 5th intercostal space Blunt surgical skills Cricothyrotomy Tracheotomy CO2 production for capnography RespiPatient and ASL 5000 can be placed together on a dedicated cart that then creates a fully mobile platform for ventilator management training called the RespiSim Pro see Figure 0 6 on the next page Test Automation Interface TAI The TAI enables users to integrate the ASL 5000 Breathing Simulator into their proprietary systems for automated device testing The TAI makes programmatic remote control of the ASL 5000 a reality The TAI specifications for programmers are available upon request A functional diagram for TAI can be found on page 90 Figure 0 7 RespiSim Pro System Contents Wh No VE BSS NN 2 2 2 3 2 4 2 5 2 5 1 252 2 5 3 3 1 3 1 1 3 2 3 2 1 Cae D2 3 2 4 Legal Information Product Warranty sccasectecnmnersdenmmnenrexrenaees Limitation of Liability ios hieeieespieeomveuenesdanes PEAT na A Trademark S aautuedassanavesanasaateadainnsoncedersanses COP eN eoe hate eeatanaraet eames oa as Software License Agreements 66 What is New in Software 3 4 3 5 we Operator Safety 22 Definitions csn Warnings and Caution Statements NOMONGCIAtUIe cus soceta enoutadancuierns meadesce Ty
260. xpiration A second channel provides a pulse width modulated signal PWM proportional to the inspiratory flow This signal type is used for controlling the chest rise of an attached Laerdal SimMan Chest Rise Module accessory part no 31 00 730 see Chest Rise Module page 101 In ASL 5000 devices below serial no 1400 both signals share a line and the output for this channel is by default set to generate the PWM signal In order to change the behavior the file L bat in the firmware s c batch directory will need to be replaced with the file L_no_PWM bat In newer devices above serial no 1400 that have the new configuration of communication sockets as shown in Figure 4 87 below each of the signals has its own line The third signal provides a 50 ms TTL pulse at the time of the beginning of a pressure profile excursion start of the spontaneous effort This signals provides an easy means of triggering synchronizing external instruments with breaths from the ASL Output TTL Short circuit pro yes outputs not opto isolated tection Signal delay 2 ms Connector style Hypertronics used for serial no s mates with Hypertronics D01 up to 1400 circular 3 pin DO1PB306MST Connector style 8 position ODU mates with used for serial no s ODU S11M07 PO8MFGO 6550 or above 1400 equivalent LEMO plug On ASL 5000 Simulators beginning with serial no 1401 the configuraion in the back looks like this Figure 4 87 Communication Co
261. y defined waveform e g using tracings of a patient s esophageal pressure or patient flow typi cally used in conjunction with the flow waveform generator capability of the ASL 5000 see below In the alternative SmartPump mode of operation the simulator operates as a flow waveform generator where no R and C are simulated but system input directly defines flow or volume output Sinusoidal trapezoidal and user defined flow waveforms are possible see above 15 16 Introduction Host Computer Requirements Parameter sets for simulations are defined using a convenient graphical user interface GUI and may be sequenced together as a script of consecutive models to be run for a predefined number of breaths chosen at will within the context of patient and disease state scenarios or modified by a user in real time interactive control Simulation runs performed using these parameter sets can be analyzed in real time generating more than 90 breath parameters that may be displayed during the simulation see Parameters in the brb Breath Parameter File page 131 Alternatively the raw data collected may be re analyzed off line using the ASL 5000 Post Run Analysis software component described in more detail in the chapter Data Analysis page 66 of this manual Using a binary ASCII file translation routine included the files can also be viewed with a general spreadsheet application such as Microsoft Excel Raw d
262. y module switch must light green Power cycle simulator turn power off then back on again wait until simulator has initialized approxi mately 20 seconds after power up red light OFF then re try synchronizing the LabVIEW software Check serial cable connection DB9 connector must be connected to the COM port labeled host on the ASL 5000 Check that the serial port of the host computer is not engaged by another application for example PuTTY You may also try disabling and re enabling the serial port of the PC in the Windows Device Manager Re start the LabVIEW application ASL5000_SW3 5 exe Restart computer if necessary to free up a locked se rial port Verify network connection Ethernet cable connected to a live network outlet Troubleshooting Common Errors Discrepancies between traces for Lung Model and Piston in Runtime Flow and Volume charts Situations that exceed the dynamic capabilities of the simulator can be identified by the fact that noticeable differences exist between the two traces for Piston and Lung Model in a one compartment model for flow and volume charts Charts do not seem representative of the simulator behavior e g during HF ventilation The screen updating of the chart in the ASL Run Time module is considerably less detailed than the data collection rate for the raw data file Only every 10th to 60th data point is actually displayed
263. y piston overruns at the forward position This value is 0 025 L when using the Preemie Cyllinder Add On option long as lt Compensations gt the switch in the lower half of the window has not been set to ON the compressibility of this volume will add parasitary compliance See also Advanced Model Settings Compensations below For additional information on the single and two compartment lung model please refer to Introduction to Modeling page 119 The alternative to setting a lung model i e flow or volume waveform generation in SmartPump mode is described in a separate chapter of this manual See page 126 Parameter values may either directly be entered into their respective control fields or may be increased or decreased by using the scroll controls next to the number entries 5 900 4 2 8 Advanced Model Settings Compensations Compensations for parasitary volumes i e compliances and resistances may be selected for lung models single or two compartment and are disabled when using SmartPump mode Reonn omH20 L s 0 5 Rtubing cmH20 L s i 0 0 viubing L 0 00 EE Cylinder deadspace L Total parasitary C mLjcmH20 10 63 URC Deadspace Vtubing E Barometric pressure used kPa 101 3 Figure 4 33 Lung Model Settings Compensations The purpose of entering values into the compensations fields is to allow the Simulation Editor to consider the effect of

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