Evaluation of the SIMULRESP: A simulation software of child and teenager cardiorespiratory physiology

Abstract

BackgroundMathematical models based on the physiology when programmed as a software can be used to teach cardiorespiratory physiology and to forecast the effect of various ventilatory support strategies. We developed a cardiorespiratory simulator for children called “SimulResp.” The purpose of this study was to evaluate the quality of SimulResp.MethodsSimulResp quality was evaluated on accuracy, robustness, repeatability, and reproducibility. Blood gas values (pH, PaCO2, PaO2, and SaO2) were simulated for several subjects with different characteristics and in different situations and compared to expected values available as reference. The correlation between reference and simulated data was evaluated by the coefficient of determination and Intraclass correlation coefficient. The agreement was evaluated with the Bland & Altman analysis.ResultsSimulResp produced healthy child physiological values within normal range (pH 7.40 ± 0.5; PaCO2 40 ± 5 mmHg; PaO2 90 ± 10 mmHg; SaO2 97 ± 3%) starting from a weight of 25−35 kg, regardless of ventilator support. SimulResp failed to simulate accurate values for subjects under 25 kg and/or affected with pulmonary disease and mechanically ventilated. Based on the repeatability was considered as excellent and the reproducibility as mild to good. SimulResp's prediction remains stable within time.ConclusionsThe cardiorespiratory simulator SimulResp requires further development before future integration into a clinical decision support system.

Using the Past to Inform the Future: How a Classic Respiratory Physiology Equation Informs Computer-Based Simulators and Clinical Decision Support Systems*

“…anaging mechanical ventilation is a core component of an intensivist's daily work, and optimizing ventilator management continues to be a major focus of pediatric critical care research (1). Physiologic models of human respiration help illustrate core principles and can guide clinicians in titrating ventilator parameters (2). Such physiologic models, when implemented in software with graphical user interfaces, can give rise to virtual patient simulators, allowing clinicians to test the impact of potential ventilator changes, to suggest ventilator changes, or even to make ventilator changes autonomously (3).…”

“…Such physiologic models, when implemented in software with graphical user interfaces, can give rise to virtual patient simulators, allowing clinicians to test the impact of potential ventilator changes, to suggest ventilator changes, or even to make ventilator changes autonomously (3). However, accurate implementation of such models, particularly for children, has proven challenging (2). Are the models reliable?…”

“…Recently, there has been a push to shift back to holistic, person-focused care. Most regulatory bodies in medicine have made statements in the last 40 years to urge clinicians to focus on whole-person care (2). This type of care addresses patients' goals and values in shared medical decision-making.…”