A Model for Educational Simulation of Neonatal Cardiovascular Pathophysiology

Sá-Couto, Carla; Meurs, Willem L. van; Goodwin, Justin A.; Andriessen, Peter

doi:10.1097/01266021-200600010-00003

Cited by 21 publications

(18 citation statements)

References 15 publications

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“…Another illustrative example is the use of the ventricular time-variant elastances to simulate myocardial depression. We refer to a previous article from our group, where several congenital heart defects are modeled using the same methodology (2).…”

Section: Discussionmentioning

confidence: 99%

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A Model for Educational Simulation of Hemodynamic Transitions at Birth

et al. 2010

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Birth is characterized by swift and complex transitions in hemodynamic and respiratory variables. Unrecognized pathologies or incidents may quickly become fatal or cause permanent damage. This article introduces an essential component of an acute perinatal care simulator, namely a model for educational simulation of normal hemodynamic transitions seen during and shortly after birth. We explicitly formulate educational objectives and adapt a preexisting model for the simulation of neonatal cardiovascular physiology to include essential aspects of fetal hemodynamics. From the scientific literature, we obtain model parameters that characterize these aspects quantitatively. The fetal model is controlled by a time-and event-based script of changes occurring at birth, such as onset of breathing and cord clamping, and the transitory phase up to 24 h after birth. Comparison of simulation results with published target data confirms that realistic simulated hemodynamic vital signs are achieved. (Pediatr Res 67: 158-165, 2010) P erinatal acute care is associated with specific clinical demands and challenges. The relatively small number of acute care cases occurring in many institutions, together with the presence of senior staff assuming the responsibility for their management, may hinder the establishment of adequate training for less experienced individuals. In other areas of acute care medicine, realistic simulators contribute to training of healthcare professionals and to patient safety.Clinically relevant learning objectives for medical staff in Neonatology include the recognition of cardiovascular signs and symptoms occurring in pathologies that manifest shortly after birth, such as persistent pulmonary hypertension, left ventricular overload by a patent ductus arteriosus (DA), myocardial depression, and hemorrhage.This article introduces a fundamental component of a perinatal acute care simulator, namely a simulation engine, for normal hemodynamic transitions from the fetal to the early neonatal period. A simulation engine can contribute to a life-like training environment by providing real-time, automatic evolution of clinical signs and monitored signals and of their response to therapeutic interventions. To be able to simulate normal physiology and provide a platform for future simulation of the above-mentioned incidents and pathologies, it is necessary that the engine reflect essential aspects of fetal hemodynamics and its subsequent transition to the neonate. Among others, structures such as lungs, placenta, heart, systemic arterial circulation, and the various fetal shunts need to be included. The simulation engine should be able to simulate realistic blood pressures and flow rates in these structures during fetal, transitional, and neonatal periods. METHODSThe proposed simulation engine for normal hemodynamic transitions from the fetal to the early neonatal period consists of a fetal hemodynamic model controlled by a time-and event-based script (1). The script triggers events occurring at birth such ...

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Section: Discussionmentioning

confidence: 99%

“…We refer to previous studies by our group for a detailed description of the mathematics associated with implementation of the model and similar extensions (2)(3)(4).…”

Section: Methodsmentioning

confidence: 99%

A Model for Educational Simulation of Hemodynamic Transitions at Birth

et al. 2010

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“…The proposed model of the cardiac electrical activity, is based on a set of coupled automata developed by our group [5]. The cardiac mechanical activity is represented by means of a classical elastance-based approach [6]. Finally, the circulation is divided into the pulmonary circulation and the systemic circulation as presented by [7].…”

Section: Cardiovascular System Modelmentioning

confidence: 99%

“…This submodel is based on previous work of our laboratory [6]. The baroreceptors dynamical properties are represented by a first-order filter.…”

Section: 14b Baroreflex and Pulmonary Stretch Receptorsmentioning

confidence: 99%

Sensitivity Analysis of a Cardiorespiratory Model for the Study of Sleep Apnea

Guerrero

Rolle

Hernández

2018

2018 Computing in Cardiology Conference (CinC)

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A novel integrated model of cardio-respiratory interactions is presented in this paper with the objective of understanding the acute physiological response due to events of sleep apneas and hypopneas in adults. A formal sensitivity analysis is proposed, focused on the chemoreflex and metabolism gas exchange components of this model, during the simulation of a 20-seconds obstructive apnea episode. During apnea, the most influent parameters were those related to metabolic rates. After the apnea, the most relevant parameters were the one related with the the amplitude gains of the central and peripheral chemoreflex. A first qualitative comparison has shown a close behaviour between experimental and simulated cardiorespiratory responses to apnea. These results highlight the influent components of chemoreflex control and the metabolic rates and provides key information towards the definition of patient-specific parameters.

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“…Mathematical models have historically been used to quantify characteristics of experimental results from various sources and combine them in a single entity with the goal to improve our understanding of biological systems. Many models simulating the cardiovascular and respiratory systems have been published for adults [4]- [7], and a few for infants and neonates [8]- [10]. However, in the existing newborn models, distinction between organ systems does not exist and the baroreceptor control of autonomic activity has not been modeled.…”

Section: Introductionmentioning

confidence: 99%

Modeling of neonatal hemodynamics during PDA closure

Soleymani

Khoo

Noori

et al. 2015

2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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The transition of the fetus at birth to extrauterine life is an extremely complex process. As part of the hemodynamic transition, the closure of ductus arteriosus, a fetal shunt, is among the key steps to achieve normal postnatal cardiovascular function. However, significant gaps remain in our knowledge pertaining to the hemodynamics of normal ductal closure, and in case of failure of closure, to the hemodynamic consequences and treatment of the patent ductus arteriosus (PDA) in preterm infants. This paper presents a mathematical model of a newborn's cardiovascular system with five peripheral organ systems, the ductus arteriosus, and the baroreceptor reflex. We present the hemodynamic findings during simulation of sudden ductal closure, an event seen in real life when the PDA is closed surgically. The results of our model match the clinical data.

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A Model for Educational Simulation of Neonatal Cardiovascular Pathophysiology

Cited by 21 publications

References 15 publications

A Model for Educational Simulation of Hemodynamic Transitions at Birth

A Model for Educational Simulation of Hemodynamic Transitions at Birth

Sensitivity Analysis of a Cardiorespiratory Model for the Study of Sleep Apnea

Modeling of neonatal hemodynamics during PDA closure

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