80-31-760-ASL-5000-Users-Manualpv1-1 3.6 PDF

USA Toll Free: 1 (800) 583-‐9910 | International: +1 (412) 441-‐8228 | service@ingmarmed.com

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User’s Manual ASL 5000, SW 3 .6, Rev. 1, © IngMar Medical, Ltd. 2016
2

LEGAL INFORMATION
Product Warranty
Educational tools and test instruments manufactured or distributed by IngMar Medical come
with a limited warranty, 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. Software,
fuses and batteries are excluded from this warranty. System components such as computers
are supplied with the factory warranty of the original manufacturer. IngMar Medical reserves
the right to perform warranty service(s) at its factory, at an authorized repair center, 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 the purchased equipment, 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 warranty 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: +1 (412) 441-‐8228
Facsimile: +1 (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 service repair order (SRO) 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. 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 IngMar Medical, Ltd. uses under
exclusive license.

Trademarks
RespiSim® and RespiPatient® are registered trademarks of IngMar Medical, Ltd.
RespiScope™ is a trademark of IngMar Medical, Ltd.
SimMan® is a registered trademark of Laerdal Medical Corporation.
OxSim™ is a trademark of Pronk Technologies.
SimScope™ is a trademark of Cardionics Corporation.

Windows®, MS-‐DOS®, and Excel® are registered trademarks of Microsoft Corporation.
LabVIEW™ is a trademark of National Instruments Corporation.
All other trademarks or registered trademarks are property of their respective owners.

Copyright
© 1998 -‐ 2016, 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

4

Software License Agreements

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 (“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, and shall 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, reverse engineer, sublicense,
transfer or translate in any way the 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 of such 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 flash memory
device on which the Software is embodied (if Software was delivered to you on a USB flash drive) 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 MEDIA AND ARE IN LIEU

OF ALL 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 replacement 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 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 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 ASL 5000 CPU is distributed in accordance with
the provisions of the GNU GPL (General Public License) granted by the FreeDOS Project
(www.freedos.org).

6

Table of Contents

Legal Information ................................................................................................................... 3
1 About the User Manual ............................................................................................... 12
1.1 CONVENTIONS USED IN THIS MANUAL ............................................................................... 12
2 Safety Considerations ................................................................................................. 12
2.1 OPERATOR SAFETY ........................................................................................................ 12
2.1.1 Intended Use .......................................................................................................................... 13
2.1.2 Smart Pump™ Mode ............................................................................................................... 14
2.1.3 RespiSim® Option ................................................................................................................... 14
2.2 SUMMARY OF GENERAL PRECAUTIONS ............................................................................... 15
3 An Introduction to the ASL 5000 .................................................................................. 16
3.1 SYSTEM OVERVIEW ....................................................................................................... 16
3.2 SOFTWARE OVERVIEW ................................................................................................... 17
3.3 SYSTEM FEATURES AND OPTIONS ..................................................................................... 18
4 ASL 5000 Setup ........................................................................................................... 20
4.1 ELECTRICAL CONNECTIONS .............................................................................................. 20
5 Running a Simulation ................................................................................................. 23
5.1 RUNNING A SIMULATION FROM THE STANDARD WINDOW MANAGER ....................................... 25
5.2 RUNNING A SIMULATION FROM THE RESPISIM® WINDOW MANAGER ....................................... 30
6 Understanding The Patient Modeling Process ............................................................. 35
6.1 STRUCTURE OF AN ASL 5000 PATIENT MODEL .................................................................... 35
6.1.1 True Patient Models ............................................................................................................... 35
6.1.2 Smart Pump Models ............................................................................................................... 36
6.2 PATIENT MODEL LIBRARY ............................................................................................... 37
6.3 SCRIPTED MODELING ..................................................................................................... 38
6.4 INTERACTIVE MODELING ................................................................................................ 39
6.5 QUICKCHOICE MODELING IN THE RESPISIM® ENVIRONMENT ................................................... 39
6.6 RESPISIM® PATIENT MODELS IN CURRICULUM TEACHING MODULES ......................................... 40
7 Features and Functions of the Standard User Environment ......................................... 41
7.1 RUN TIME HOME ......................................................................................................... 41
7.2 INTERACTIVE SIMULATIONS ............................................................................................. 47
7.2.1 Lung Model Parameters Tab .................................................................................................. 49
7.2.2 Spontaneous Breathing Parameters Tab ................................................................................ 50

7.2.3 Trends ..................................................................................................................................... 51

7.2.4 Closed Loop Vt Tab ................................................................................................................. 52
7.2.5 Closed Loop MV Tab ............................................................................................................... 53
7.2.6 Closed Loop CO2 Tab .............................................................................................................. 54
7.3 SCRIPTED SIMULATIONS ................................................................................................. 55
7.3.1 Scenario Scripts ...................................................................................................................... 55
7.4 DATA VIEW AND ANALYSIS ............................................................................................. 65
7.4.1 Run Time Home Screen .......................................................................................................... 65
7.4.2 Real Time Analysis .................................................................................................................. 68
7.4.3 Post-‐Run Analysis ................................................................................................................... 71
7.4.3.1 Data Re-‐Processing ........................................................................................................................................ 73
7.4.3.2 Raw Data Preview ......................................................................................................................................... 75
7.4.3.3 Breath by Breath Data ................................................................................................................................... 76
7.4.3.4 Multi-‐Parameter Graph (Breath-‐by-‐Breath) .................................................................................................. 78
7.4.3.5 Loops ............................................................................................................................................................. 79
7.4.3.6 Multi-‐Parameter Waveforms ........................................................................................................................ 80
7.4.3.7 Multi-‐Parameter Trend (Breath Parameters) ................................................................................................ 80
7.4.3.8 Work Calculations and PV Loops ................................................................................................................... 82
7.4.3.9 Trigger Analysis ............................................................................................................................................. 83
7.4.3.10 Ventilator Performance Analysis ................................................................................................................... 85
7.4.4 Parameter Definitions ............................................................................................................ 88
7.4.4.1 Parameters in the *.brb-‐(Breath Parameter) File .......................................................................................... 89
7.4.5 Data File Types ....................................................................................................................... 99
8 The Virtual Ventilator ............................................................................................... 101

9 The RespiSim® User Environment .............................................................................. 107

9.1 CONCEPT OF RESPISIM ................................................................................................. 107
9.2 QUICKCHOICE/INTERACTIVE .......................................................................................... 108

9.3 INSTRUCTOR DASHBOARD ............................................................................................. 113
9.4 VITAL SIGNS MONITOR ................................................................................................ 117
9.5 DEBRIEFING ENVIRONMENT .......................................................................................... 120
9.6 EVENT MARKERS ........................................................................................................ 122
9.7 RESPISIM® PREFERENCES ............................................................................................. 123
9.8 RESPISIM® TEACHING WITH CURRICULUM MODULES .......................................................... 126
9.8.1 Using Pre-‐Scripted Modules ................................................................................................. 126
9.8.2 Debriefing the Simulation ..................................................................................................... 135
9.9 AUTHORING CUSTOM MODULES .................................................................................... 136
9.9.1 Instructor Guide ................................................................................................................... 137
9.9.2 Instructor Settings Columns ................................................................................................. 137
9.9.3 Populating Instructor Setting Columns ................................................................................. 139
9.9.4 Instructor Actions ................................................................................................................. 140
9.9.5 Patient Models ..................................................................................................................... 141
8

9.9.6 Lung and Heart Sounds ......................................................................................................... 142

9.9.7 Chest X-‐ray ........................................................................................................................... 144
9.9.8 Lab Results ............................................................................................................................ 146
9.9.9 Arterial Blood Gas Values ..................................................................................................... 148
9.9.10 Instructor Dashboard Real Time Parameters ....................................................................... 149
9.9.11 Saving RespiSim™ Modules .................................................................................................. 150
10 Customizing the User Environment ........................................................................... 152

10.1 USER PROFILES .......................................................................................................... 152
10.2 CONNECTION SETTINGS ................................................................................................ 154
10.2.1 Ethernet Connection ............................................................................................................ 154
10.2.2 Serial (USB) Connection ........................................................................................................ 156
10.3 OUTPUT DATA SETTINGS .............................................................................................. 157
10.4 APPEARANCE/GENERAL SETTINGS .................................................................................. 158
10.5 SCRIPT EDITOR PREFERENCES ......................................................................................... 160
10.6 TRANSITION SETTINGS ................................................................................................. 163
10.7 DEFAULT ANALYSIS PARAMETERS ................................................................................... 165
10.8 VIRTUAL VENTILATOR .................................................................................................. 166
11 Working with Advanced Features .............................................................................. 167
11.1 ADVANCED PATIENT MODELING ..................................................................................... 167
11.1.1 Advanced Features for the Lung Model ............................................................................... 167
11.1.1.1 Non-‐Linear Compliance ............................................................................................................................... 172
11.1.1.2 Time-‐Varying Parameters for the Patient Model ........................................................................................ 173
11.1.2 Advanced Features for the Patient Effort Model ................................................................. 178
11.1.2.1 Technical Trigger Effort Model .................................................................................................................... 178
11.1.2.2 Sinusoidal Patient Effort .............................................................................................................................. 178
11.1.2.3 File-‐Based Patient Effort .............................................................................................................................. 182
11.1.2.4 Patient Effort from Analog Input ................................................................................................................. 183
11.1.2.5 SmartPump™ Mode .................................................................................................................................... 184
11.2 ASL 5000 SOFTWARE UTILITIES ..................................................................................... 187
11.2.1 Exporting Data Files .............................................................................................................. 187
11.2.1.1 AUX Channel Output Resampling ................................................................................................................ 189
11.2.1.2 RespiSim® File Conversion ........................................................................................................................... 191
11.2.1.3 Processing Patient Flow Recordings ............................................................................................................ 191
11.2.1.4 Pressure/Flow Profile Resampling ............................................................................................................... 194
11.2.1.5 TCP Breath Parameter Broadcast ................................................................................................................ 196
11.2.1.6 TCP Waveform Broadcast ............................................................................................................................ 197
11.2.1.7 TCP Broadcast Configuration ....................................................................................................................... 198
11.3 ANALOG INPUTS AND OUTPUTS ..................................................................................... 199
11.3.1 Analog Output Configuration ............................................................................................... 200
11.4 DIGITAL OUTPUTS ...................................................................................................... 202

11.5 TEST AUTOMATION INTERFACE ...................................................................................... 203

11.5.1 TAI Overview ........................................................................................................................ 204
12 Advanced Hardware Options .................................................................................... 205

12.1 CYLINDER TEMPERATURE CONTROLLER (CTC) .................................................................... 205
12.2 FAST OXYGEN MEASUREMENT (FOM) ............................................................................ 206
12.3 PREEMIELUNG™ OPTION ............................................................................................. 207
12.3.1 Intended Use ........................................................................................................................ 207
12.3.1.1 Assembly ..................................................................................................................................................... 207
12.3.1.2 Software Adjustments ................................................................................................................................. 209
12.3.1.3 Firmware Adjustments ................................................................................................................................ 209
12.3.1.4 Operation with Attached Preemie Cylinder ................................................................................................ 209
12.3.1.5 Unmounting the Preemie Cylinder .............................................................................................................. 210
12.4 AUXILIARY GAS EXCHANGE CYLINDER (AGEC) ................................................................... 211
12.5 CHEST RISE MODULE FOR LAERDAL SIMMAN™ MANIKINS ................................................... 212
12.6 SIMULATOR BYPASS AND LEAK VALVE MODULE (SBLVM) ................................................... 213
12.7 VENTILATOR INTERFACE KIT (FOR RESPISIM) ..................................................................... 215
12.7.1 Software Installation for Users with existing VIK (Fusion Bridge ALFA or BETA) interface. . 216
12.7.2 Ventilator Interface Connections ......................................................................................... 223
12.7.3 Capturing Ventilator Parameters in RespiSim® .................................................................... 224
12.7.4 Training Students in Patient Charting ................................................................................... 226
12.7.4.1 Adding Notes ............................................................................................................................................... 233
12.8 MOBILE CART OPTION (PLUS PACKAGE) ........................................................................... 234
13 Theory of Operation .................................................................................................. 236

13.1 AN INTRODUCTION TO VENTILATORY MECHANICS ............................................................... 236
13.1.1 Normal Lungs ........................................................................................................................ 236

13.1.1.1 Governing Equation ..................................................................................................................................... 236
13.1.1.2 The Work of Breathing ................................................................................................................................ 239
13.1.1.3 Inspiratory Work ......................................................................................................................................... 240
13.1.1.4 Expiratory Work .......................................................................................................................................... 243
13.1.1.5 Work of the Breathing Cycle ....................................................................................................................... 245
13.1.2 Abnormal Lungs .................................................................................................................... 247
13.1.2.1 Uniform Lungs ............................................................................................................................................. 247
13.1.2.2 Non-‐uniform Lungs ...................................................................................................................................... 250
13.1.2.3 Energetics .................................................................................................................................................... 252
13.2 MODELING BASED ON VENTILATORY MECHANICS ............................................................... 255
13.2.1 Limitations of the Model ...................................................................................................... 256
13.3 HOW IT WORKS ......................................................................................................... 257
13.4 SCHEMATIC OVERVIEW ................................................................................................ 258
13.5 PATIENT MODEL LIBRARIES ........................................................................................... 259
13.5.1 Interactive Control Panel Patient Model Library .................................................................. 259
13.5.2 QuickChoice Patient Model Library ...................................................................................... 261
10

13.6 BACKGROUND TO INSTRUCTOR-‐DRIVEN MULTI-‐STAGE CLINICAL SIMULATIONS .......................... 264

13.6.1 Role of the Instructor ........................................................................................................... 264
13.6.2 Instructor and Student Aids .................................................................................................. 264
14 Support ..................................................................................................................... 266

14.1 SUPPORT RESOURCES .................................................................................................. 266
14.2 FREQUENTLY ASKED QUESTIONS (FAQS) .......................................................................... 266
14.3 TROUBLESHOOTING ..................................................................................................... 267
15 Maintenance ............................................................................................................. 269
15.1 ISSUING A FIXED IP ADDRESS ......................................................................................... 271
15.2 MANUAL SOFTWARE INSTALLATION / SOFTWARE UPGRADE .................................................. 272
15.3 FIRMWARE UPGRADE .................................................................................................. 272
15.4 RECOMMENDATIONS FOR CALIBRATION ........................................................................... 274
16 Technical Data .......................................................................................................... 275
16.1 PERFORMANCE SPECIFICATIONS ...................................................................................... 275
16.2 RESPISIM® VENTILATOR INTERFACE KIT (VIK) COMPATIBILITY AND CONFIGURATION ........ 278
16.3 ELECTRICAL SPECIFICATIONS .......................................................................................... 279
16.4 PHYSICAL SPECIFICATIONS ............................................................................................. 279
16.5 SOFTWARE SPECIFICATIONS ........................................................................................... 280
16.6 ENVIRONMENTAL SPECIFICATIONS ................................................................................... 280
17 Index ......................................................................................................................... 281
18 List of Figures ............................................................................................................ 285

1 ABOUT THE USER MANUAL

This User’s Manual is for IngMar Medical’s ASL 5000 or Active Servo Lung, a High Fidelity Breathing
Simulator. It is recommended that you read this instruction manual carefully before using the
ASL 5000.
This manual is divided into several main sections to help you easily access information and instructions
you need.
\.\ Conventions Used in This Manual

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.

New Feature

Significant new features introduced with software 3.6 will be indicated in this way.

Use of the word “Patient”

Throughout this manual and in the software, the word “patient“ is used to describe a simulated patient
with specific lung model settings. This reference corresponds to the use of “patient” in a clinical setting
who receives ventilatory assistance.

Definitions of breath parameters, as calculated in the ASL 5000 Analysis Software, can be found in
Table 7-‐2: brb-‐File Parameters, page 89.

2 SAFETY CONSIDERATIONS
`.\ 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 is not used as instructed, the
safety protection provided may be impaired.
12

2.1.1 Intended Use

IngMar Medical’s ASL 5000 is a high fidelity breathing simulator for interfacing with respiratory support
devices in lieu of an actual patient. The ASL 5000 can be used for multiple purposes:
• It can be used for ventilator demonstrations and evaluations, as well as for in-‐service and
respiratory staff training.

• With the appropriate software (test scripts), it can also be used for ventilator performance
verification (see also Test Automation Interface, page 203).
When using the ASL 5000 for this purpose, you have to bear in mind, however, that designs of
modern ventilators are complex and these devices incorporate a great variety of features and
performance parameters.

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.

In the context of ventilator performance verification, the purpose of the ASL 5000 Breathing
Simulator is solely to assist in implementing test procedures as designed, mandated, or
recommended by the ventilator manufacturer.

Always follow ventilator manufacturers’ instructions and recommendations regarding
performance verification procedures.

WARNING!
Do not use the ASL 5000 as a ventilator. Its capability of moving tidal volumes of breathing
gas is not intended to be used for any kind of treatment of humans or animals.

User’s Manual ASL 5000, SW 3 .6, Rev.1, © IngMar M edical, L td. 2016

13

2.1.2 Smart Pump™ Mode

In addition to the applications of the ASL 5000 as a breathing simulator (using R, C, patient effort), it
can also be operated in an alternative mode, as a flow (or volume) waveform generator. This
application is essential when developing devices for the delivery of pharmaceutical aerosols.

CAUTION!
Do not allow aerosols to contaminate the cylinder of the ASL 5000. Contamination with
aerosols may result in equipment malfunction. For applications requiring the “inhalation” of
substances, always use accessory 31 00 600, the Auxiliary Gas Exchange Cylinder (“AGEC”).

WARNING!
Use of the ASL 5000 in the presence of flammable anesthetics may present an explosion
hazard.

2.1.3 RespiSim® Option
Use of RespiSim® with the ASL 5000 provides a fully integrated respiratory simulation experience for
training students in the subjects of mechanical ventilation and ventilator management. With
RespiSim®, as an educator, you can:
1. Capture data from a real ventilator as well as from the ASL 5000 Breathing Simulator.
2. Mark and annotate events as well as display vital signs of the patient on a separate monitor.
3. Replay simulation recordings for debriefing sessions or use them during classroom instruction.
RespiSim® brings 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® is not intended to monitor, chart, or store data coming from real patients or for
the purpose of assisting in clinical decisions regarding real patients

WARNING!
Electromagnetic Interference: Do not use the ASL 5000 in patient rooms or other areas where
life supporting equipment is in use.

14

`.` Summary of General Precautions

CAUTION!
Electrical Supply: Connect ASL 5000 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 procedures 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 concentrations of oxygen (ventilators set to
FiO2 > 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 < 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.

15

3 AN INTRODUCTION TO THE ASL 5000
k.\ System Overview

IngMar Medical’s ASL 5000 (Active Servo Lung) represents a unique concept in lung “analogs.”
Spontaneous breathing is an integral function of the respiratory mechanics of the ASL 5000 as opposed
to traditional lung simulators that are passive bellow-‐spring systems requiring an external driver for
spontaneous breathing.

The ASL 5000 comprises 2 main components—the ASL 5000 device (containing the firmware) and the
ASL 5000 software (running on a standard Windows® PC).
The ASL 5000 device is based on a piston moving inside a cylinder and is computer-‐controlled to
accomplish motion based on the equation for gas exchange in a ventilated and/or spontaneously
breathing patient. This Equation of Motion includes patient effort, which can be freely programmed.


Figure 3-‐1 Functional Overview

The firmware in the device communicates with a standard PC containing the installed host software,
via a serial (USB) or Ethernet connection.
The ASL 5000 host software version that this manual refers to, is version 3.6.
Please refer to section 13.3, How It Works, page 257 to learn more.
16

k.` Software Overview

You use the ASL 5000 host software on the PC for all interactions with the simulator.
Software 3.6 introduces a new interface tailored to each of the two primary user groups of the
ASL 5000 — a) engineers/ researchers, and b) educators.

• The Standard Window Manager:
Also called the Standard Interface, this interface is designed for engineers and researchers,
enabling them to have highly responsive and seamless interactions with the software.

Figure 3-‐2 Standard Windows Manager tabs

• The RespiSim® Window Manager:
With the purchase of educational packages (Essential, Plus, or Pro Package) the standard
interface (Standard Window Manager) of the software is replaced by the RespiSim® Window
Manager, optimized and designed especially for the educators.

Figure 3-‐3 RespiSim® Window Manager tabs

All necessary software components as well as pdf-‐files of support documents (including this User’s
Manual) are pre-‐installed on the PC that comes as part of your ASL 5000 purchase.

For manual installation of the software on the PC, please refer to section
Manual Software Installation / Software Upgrade, page 272.

• The Application Programming Interface (API):
For users who want to integrate the ASL 5000 into an R&D or QC test environment, IngMar
Medical has developed an application programming interface (API) the allows remote control of
the simulator from any customer-‐developed software (see Test Automation Interface, page
203).

17

k.k System Features and Options

The ASL 5000 offers features and options for the basic as well as the advanced user.
Software features include:

• Realistic Rendering:
The ASL 5000 features many advanced options for realistic rendering of a patient’s respiratory
mechanics, from that of a premature baby to a full-‐size adult. You may set or control the
following parameters for respiratory mechanics in the ASL 5000:
• Compliance (linear, non-‐linear)
• Resistance (linear, parabolic, mixed, or independent for inspiratory and expiratory)
• Muscle pressure (patient effort, for defining spontaneous breaths)

• SmartPump™ mode of operation:
The ASL 5000 operates as a flow waveform generator, where you can directly define flow (or
volume) output, not using a patient model.

• The Virtual Ventilator™:
Using the Virtual Ventilator™, accessible from a button in the RunTime Home tab in Software
Only Mode, you can study the interaction between a ventilator and a patient without engaging
the physical hardware (either ASL 5000 device or the actual ventilator). The Virtual Ventilator™
features both pressure and volume ventilation modes, with or without triggering by patient
effort (volume and flow trigger). As an educator, you can perform online training to help
students understand the basic concepts of ventilation before they are exposed to a clinical-‐

scenario simulation.
• Full Simulation Control:
You control simulations either in real time (Interactive Control), from a Script, or using the
optional RespiSim® educational interface (scenario-‐driven patient models), or using the
application programming interface (API) for remote control of the simulator (Test Automation
Interface, TAI)

The Hardware Expansion options include:
• Simulator Bypass and Leak Valve Module (SBLVM) that serves two functions:
For one, you can bypass the ASL 5000 while no simulation is running and engage a separate test
lung. In this way, nuisance alarms from connected ventilators are avoided.
In addition, you can use its manual setting option to manually set airway leaks at three levels.

• Fast Oxygen Measurement (FOM) option, based on a paramagnetic oxygen sensor, for breath-‐
by-‐breath oxygen analysis.

• Cylinder Temperature Controller for regulating the temperature of the simulator cylinder walls
for calibration-‐type measurements or to avoid rainout from humidified breathing gas.

18

• Auxiliary Gas Exchange Cylinder, a bag-‐in-‐bottle style external accessory for protecting the
simulator from aggressive aerosols or anesthetic agents as well as from water in humidified gas.

• Oxygen Saturation (SpO2) Simulation option—using the OxSim, third-‐party device—that
generates optical signals, corresponding to the level of oxygen saturation in the patient model,
to be fed into an SpO2 monitor or ventilator.

• RespiPatient®, a respiratory torso manikin with bilateral chest rise and anatomically correct
airway and chest structure. Using the RespiPatient®, you can also perform the needle
decompression (pneumothorax), chest tube insertion, and cricothyrotomy and tracheotomy
training procedures as well as generate realistic CO2 waveforms with the optional CO2-‐Box
accessory.


19

4 ASL 5000 SETUP

As discussed earlier, the ASL 5000 software comes pre-‐installed on the PC supplied with the ASL 5000
RespiSim® Packages (Essential, Plus, and Pro). This also includes the license keys for any software
components that you have purchased, such as the RespiSim® option.
If you need to perform an installation on another PC, or to gain access to separately licensed features
purchased later (for example, RespiScope™ added to an Essential Package), please refer to section
15.2, Manual Software Installation / Software Upgrade, page 272.

m.\ Electrical Connections

The first step is to establish safe and proper electrical connections following the instructions in this
section.

NOTE
The following instructions for connections refer to a generic ASL 5000 (including the Essential
and Plus Packages). RespiSim® Pro Packages are plug-‐and-‐play pre-‐wired on their cart and ready
to be used.

• Connect the ASL 5000 Breathing Simulator to a line power supplying 100 -‐ 240 V AC, 50/60 Hz with
the power cord supplied in the package.


Figure 4-‐1: ASL 5000 Line Power Connection

CAUTION!
Electrical Supply: Connect ASL 5000 only to a properly grounded wall outlet providing
100 -‐ 240 V AC, 50 -‐ 60 Hz.
20

WARNING!
Electric Shock Hazard: Always disconnect from line power before opening ASL 5000.

• Configuring the Ethernet:
Using the supplied (purple) Ethernet cable, connect the Ethernet port of the ASL 5000 to any one of
the ports labeled 1 through 4 on the supplied router.

NOTE
Only use ports 1…4 on the router for this, do NOT use the yellow port labeled “Internet.”

For a fully wired Ethernet configuration (recommended):
Using the second supplied (purple) Ethernet cable, connect the Ethernet port of the PC to one of the
ports labeled 1 through 4 on the supplied router.

NOTE
Only use ports 1…4 on the router for this, do NOT use the yellow port labeled “Internet.”


Figure 4-‐2: Ethernet Connection between ASL 5000 and PC

Or, go wireless
If you prefer a wireless connection between the router and the PC, you may omit the second step
(connecting using the Ethernet cable).
The PC is pre-‐configured to make an automatic WiFi connection to the router, and thus to the ASL
5000.

For special configurations, for example connecting to a facility-‐wide intranet that requires fixed IP
addresses, please refer to section 15.1, Issuing a Fixed IP Address, page 271.

21

USB Serial Connection
Alternatively, the ASL 5000 can also use a USB serial connection, omitting the Ethernet router.
For this option:
• Using the supplied USB cable connect the USB port of the ASL 5000 directly to one of the USB
ports of the PC.

Figure 4-‐3: USB Connection between ASL 5000 and PC

NOTE
For best results, we recommend using the fully wired Ethernet configuration, since it provides

the most stable data exchange between ASL 5000 and the PC.


22

5 RUNNING A SIMULATION
After safely making the electrical connections and setting up the ASL 5000, you are now ready to run
your first simulation.

To begin, turn on the system:
1. Flip the green power switch at the back of the ASL 5000 to the ON position; it will light up. The blue
LED of the IngMar logo on the front panel of the ASL 5000 will also light up, indicating that the
device is now on.

Figure 5-‐1: Turning On the Device

2. Observe the red light of the switch on the front panel.
The red light should turn off after approximately 20 seconds, indicating that the device has
completed the boot process.

NOTE
Please note that the red light is an emergency OFF switch for disabling the piston drive in the ASL
5000.

2. If the red light does not go off after 20 seconds, depress the switch to enable the drive.
3. Turn on your PC.
4. Double-‐click the ASL SW 3.6 icon on the desktop to launch the ASL 5000 Welcome window.

Figure 5-‐2: ASL SW 3.6 Icon

23

The ASL 5000 Welcome window is displayed (with the slider in the Full System Mode default
position). A message will remind the user to ensure that proper settings are in place to connect to
the ASL 5000 Breathing Simulator.
5. Click .
5

Figure 5-‐3: IngMar Medical ASL 5000 Welcome window

The Welcome window now presents three choices (these three choices are available with the licensed
RespiSim® version).


Figure 5-‐4: Welcome window choices

24

Based on your purpose of use and requirement, you can:
• Select Standard Window Manager (SWM) designed primarily for engineers and/or
researchers; or,
• Select RespiSim® Window Manager (RWM) designed primarily for educators; or,
• Select User Settings to modify any user settings as an advanced user.
For learning more about modifying User Settings, please refer to User Profiles, page 152.

Now, based on the Window Manager of your choice, follow the step-‐by-‐step instructions given ahead
to run your first simulation.

o.\ Running a Simulation from the Standard Window Manager

To run a simulation from the Standard Window Manager:

2
1

Figure 5-‐5: Welcome window, Full System Mode

On the Welcome window:
1. Make sure the slider is in Full System Mode.
2. Click .

• A system status message “Loading ASL 5000 Software…” appears for a brief moment following
which the Standard Window Manager opens to the Run Time Home tab.

25

3. Click the Script/Patient Model tab to begin scripting the simulation.

2 3

Figure 5-‐6: SWM opened to Run Time Home tab

26

4. From the Scenario Scripts sub-‐tab, in the Directory Contents list, click script file
Adult_Normal_unassisted.sct (we will refer to this example as our practice simulation script when
running your first simulation).

4

Figure 5-‐7: Scenario selection

27

The view switches to the Manual Scripting sub-‐tab.

5. Click .

5

Figure 5-‐8: Starting the Simulation

The view switches to the Run Time Home tab.

28

6. The simulation begins after you select a location for saving your data in the Select an Output File
dialog box. As there is no particular reason to save the data in a special location for this practice
run, simply accept the default location by clicking OK.

7. Click Replace when the confirmation message appears.
The practice simulation will now start running.

6
7

Figure 5-‐9: Running a Simulation from the Run Time Home tab

29

o.` Running a Simulation from the RespiSim® Window Manager

NOTE
If you are an educator and have purchased the ASL 5000 as an Essential, Plus, or Pro Package,
or if you have upgraded to the educational RespiSim® software option, your RespiSim®
Window Manager will offer the user-‐specific interface shown below.

To run a simulation from the RespiSim® Window Manager:

1. On the Welcome window, make sure the slider is in Full System Mode.

2. Click .

2

1

Figure 5-‐10: Welcome Window RWM

A system status message “Loading ASL 5000 Software…” appears for a brief moment following
which the RespiSim® Window Manager opens to the QuickChoice/Interactive tab.

30

3. In the QuickChoice Menu, sequentially, make your selection of:
a) Patient Type
b) Diagnosis
c) Disease Severity
And,
4. Click .

5. Click Start Simulation to start with the selected patient model.

You will be asked to specify a location for the data output set of the simulation

3a 5
3b 8
b
3c
c
4 Please carry out step 8
after completing step 5,
6, and 7.
Continue reading ahead
for steps 6 and 7.

Figure 5-‐11: QuickChoice/Interactive Patient Model Selection

31

6. The simulation begins after you select the data set output location on the Select an Output File
dialog box.
6. As there is no particular reason to save the data in a special location for this practice run, simply
accept the default location by clicking .

7. Click when the message appears.

The practice simulation will now start running.

7
6

Figure 5-‐12: Selecting an Output Location

8. Click Display Waveforms on the QuickChoice tab to view flow, pressure, and

volume waveforms (as viewed on a ventilator screen).

32

9. The waveforms are displayed on a separate Equation of Motion Display window.

9
10

Figure 5-‐13: Equation of Motion Waveform View

To study the contribution of the different components of the Equation of Motion in detail, you may
review the last single breath in slow motion.
10. To do so, click .

The Equation of Motion waveform view changes to display a single breath.

33

13
11

12

Figure 5-‐14: Equation of Motion Single Breath View

11. Drag the green cursor line through the waveform to see the change in contribution of each
component of the equation over time .
12. Click Return to Simulation to get back to the real-‐time view of the simulation
Or,
13. Click the Close “X” button at the top right corner of the Equation of Motion Display window to
close the Equation of Motion waveform view.

When finished, click from the QuickChoice tab.

34

6 UNDERSTANDING THE PATIENT MODELING PROCESS

You can now create patient models for the ASL 5000 Breathing Simulator in several ways, using
different options of the software.
Even when created using different options, all models will always conform to a specific representation
of respiratory mechanics of a human patient.
s.\ Structure of an ASL ottt Patient Model

NOTE
You can learn in detail about ventilatory mechanics in the Theory of Operation chapter later in
this manual (page 236).

6.1.1 True Patient Models
The ASL 5000 uses a simplified model of respiratory mechanics.

It represents a patient’s lungs …
Either as a: Or as a:
“Lumped-‐together” single compartment Two-‐compartment model with resistance in the
compliance and resistance airway and in the lungs themselves


Figure 6-‐1: Types of Lung Models

NOTE
Do not think of a 2 compartment model as a right and left lung, but rather as regions of the lung
with similar disease states and therefore similar properties

35

In either case, the model does not separate between lung compliance and chest wall compliance.
A patient’s spontaneous breathing is represented by patient muscle pressure effort Pmus (Pchestwall in
Figure 6-‐1 below), entered into the model as a profile that you can shape according to pre-‐configured
patterns or in free form (import from files).

Figure 6-‐2: Spontaneous Effort Profile

Notably, such effort profiles can also include inverse efforts (active exhalation), making the simulated
patient, for example, “fight” the ventilator or cough.

6.1.2 Smart Pump Models
Sometimes it is not necessary to use a model that responds to pressure changes, representing an
actual patient.
Rather, a flow or volume pattern is desired as a representation of just the spontaneous breathing

activity. For this purpose, you can switch to Flow Pump Mode or Volume Pump Mode instead of a one-‐
or two-‐compartment lung model.

Figure 6-‐3: Pump Modes

36

s.` Patient Model Library

Patient Model Libraries provide a convenient way to invoke patient models that have been described
in the medical literature for a number of specific patient types and disease states. You can access the
main Patient Model Library both when working with scripts and when working interactively.

The following models are provided with the software:


Figure 6-‐4: List of Patient Models

NOTE
These models, as names indicate, include patients that are independently breathing
spontaneously, as well as those that are expected to be on ventilator support.

When working in the RespiSim® Window Manager, QuickChoice allows you to select a patient model
from the QuickChoice library in a process that defines:
• Patient Type
• Diagnosis
• Disease Severity

Models from any of the libraries are fully editable and you can save them under a name that is
different from the original (protected) name. Please see Interactive Control Panel Patient Model
Library, page 259, referencing the parameters of these models.

37

s.k Scripted Modeling

Scripted modeling assigns each patient model a predetermined number of repetitions in a continuous
sequence.
• The sequence, in its entirety, becomes the simulation that will be run, much like a step-‐by-‐step
work instruction to assemble a physical object.
• When designing tests for evaluating respiratory devices, where exact repeatability is important,
scripted modeling is usually the preferred method.

Script
Segments


Figure 6-‐5: Script Editor, Manual Scripting View

NOTE
The repetitions in the script do not necessarily indicate the number of patient breaths.

The transitions between each segment (i.e., line) in a script normally occur without transitioning steps.
Each segment, however, may contain model components that vary from breath to breath, so that
“soft” transitions may be programmed into a script.

38

For the use of such time-‐varying-‐parameters, please refer to 11.1 Advanced Patient Modeling.
You can also use time-‐varying-‐parameters to create repeatable, quasi-‐randomized sequences for more
effective testing schemes.

s.m Interactive Modeling

With interactive modeling, you can create sequences where the timing of transitions between patient
states is not fixed, but can be changed at will. This is usually the preferred method in situations where
the required timing is not predictable. Examples are:
• Live training classes
• Experiments for detecting performance thresholds or issues that require only a single
parameter to be tuned for a specific outcome
• Authoring of training simulations
You can always save models created in Interactive Mode in a library, for use later.
You can immediately evaluate the changes made to a patient model during a simulation run and adjust
parameters. Most of the tools that are available for advanced modeling are also available in Interactive
Mode.
s.o QuickChoice Modeling in the RespiSim® Environment

New Feature
QuickChoice represents a simplified approach to access a patient library through the steps of
selecting:
• Patient Type
• Diagnosis
• Disease Severity

The QuickChoice Panel is part of the RespiSim® Window Manager, to be used primarily for educational
simulations.
While you can further customize the standard severity selections for different patient types and
diagnosis from the QuickChoice selections (and, again, save them in a custom library), the standard
patient options offer a quick way to be up and running with a wide array of educational simulations.

39

s.s RespiSim® Patient Models in Curriculum Teaching Modules

RespiSim’s plug-‐and-‐play curriculum teaching modules feature carefully chosen patient models that
are matched to the treatment options a student may select.
They are also aligned with the physiological parameters displayed during the different stages of a
RespiSim® simulation. As such, they can represent a patient’s response to either successful or inferior
treatment options.
Each module contains the necessary bundle of patient models, covering initial status to possible
treatment options, to a resolution state.

40

7 FEATURES AND FUNCTIONS OF THE STANDARD USER ENVIRONMENT

Via the Standard Window Manager’s six tabs you can access all functions of the software, except those
reserved for the RespiSim® environment. They are only accessible, with the proper license in place,
from the RespiSim® Window Manager.
u.\ Run Time Home

The Run Time Home tab is the default view after starting the software.

The Run Time Home view (see Figure 7-‐1 on next page):
1. In the Status box, the first line indicates whether:
• The ASL 5000 is starting up.
• The simulator is ready for a simulation,
• Currently a simulation is running.
• What the breath count is in the running simulation.

2. The second line in the Status box indicates the file path of the currently used patient model.

3. When a script is running, the orange Time fields show the remaining time for the script and the
overall simulation run time.
To view the exact part of the script (segment and repetition) that is being executed, click
Launch Script Progress Window (see page 64).

4. While a simulation is running, you can always look at the patient model being used.
To do so, just click View Current Patient Model .

41

1
2
4 3

Figure 7-‐1: The Run Time Home Tab


Graph Area and Options (see Figure 7-‐2 on the next page):

5. The large graph area in the center displays waveforms in the following order:
Top ➤ Flow
Middle ➤ Pressure
Bottom ➤ Volume
6. Alternatively, clicking on Loop View will switch to displaying loop graphs.
Top ➤ Flow/Volume loop
Bottom ➤ Pressure/Volume loop
When Loop View is active, the button will switch to the Wave View option .

42

The waveform graphs contain multiple traces. Depending on the model used (one or two compartment
model), you will see individual traces for each compartment’s flow and volume.
The additional “piston” traces indicate the compound flow or volume.
In the case of single compartment models, these will match the trace for the model indicating that the
system is performing the expected piston moves accurately.

7. To change trace colors or make a trace invisible, right-‐click on any of the graph legend items.

8. To change the background color, for example, when you want to print a hard copy of the screen,
click Help/Customize from the top menu bar and the Graph Colors submenu. See 10.4
Appearance/General Settings, page 158, for more information.
9. Click to “freeze” the graphs for better viewing of details. The simulation, however, will
continue uninterrupted.

8
Flow 6 9
7 5 Pressure
Volume

Figure 7-‐2: Graph Area and Options

43

Interactive Control, Debrief, Virtual Vent, Start/Stop Sim., and Set Pause:
10. Click located in the left upper corner of the window to open the Interactive Control
Panel. (see Figure 7-‐3)

11. The Go To RespiSim® Debrief button right below will only be visible if your copy of the
software is licensed for RespiSim. Click it to open the RespiSim® Instructor Debrief window from
which you can also access the Instructor Dashboard.
12. In the right upper corner the Virtual Vent button is visible when you are running the software
in Software Only Mode. Click Virtual Vent to bring up the Virtual Ventilator pane.

13 14 12
10
11


Figure 7-‐3: Interactive Control, Debrief, Virtual Vent, Start/Stop Sim., and Set Pause

You can use the Virtual Ventilator to simulate the effects of a ventilator (that would be connected
to the ASL 5000) if you were running your simulation in Full System Mode. (For more information
on the Virtual Ventilator, see page 101)

44

13. Click Start Sim. to start a simulation from the Run Time Home tab. The button changes to Stop
Sim. when the simulation is running.

14. To pause the simulation, click Set Pause . This invokes a patient model “pause.vr3” which you
can define as needed (for example as a passive patient, or one who breathes in a particular
fashion).

NOTE
The “Pause” model is fully editable. You can select and edit a patient model that is convenient
to use whenever you would like to interrupt the flow of a simulation without actually stopping
it.

Fill Bar, Create Report, and Exit Software (see Figure 7-‐4 on the next page):

15. To open a window showing a colored bar graph as a visual aid for an instructor or student, click Fill
Bar. It provides feedback on a patient’s filling of the lungs, for example when training for manual
ventilation skills. (also see Figure 7-‐20: 2-‐Compartment Lung Fill Indicator, page 66).

16. The Create Report button will become selectable once enough data has
been collected after starting a simulation. Click Create Report to generate a simple report showing
waveform data and calculated breath parameters.

17. In situations where the simulator cannot render the model behavior faithfully, for example because
the demanded flow rates are too high or you have exceeded the volume range of the ASL 5000, the
indicator in the lower right corner will indicate a “large volume error.”

18. When done, click to close the software.
You are, at this point, given two choices:
• To save any changes made to User Settings before closing, or
• To return to the Welcome Window.

45

15
16
18 17

Figure 7-‐4: Fill Bar, Create Report, and Exit Software


46

u.` Interactive Simulations

The Interactive Control Panel (ICP) is, by default, not active. When you click Start Interactive, all
settings made in the Interactive Control Panel will override those made in a script or in RespiSim. The
button then changes to End Interactive.

1. The ICP itself is structured with tabs facilitating the setting of patient model parameters.

The control buttons and indicators on the left side of the panel are always selectable, independent of
the ICP tabs. You can:
• Click Start Simulation to start a simulation directly from the ICP; the button then changes to
Stop Simulation .
• Once the simulation is running, you can click the Save Waveform Data button to start
waveform recording.

NOTE
ICP settings take precedence over any settings that might otherwise be active, either from a
script or from RespiSim® patient settings (see also page 113, ICP “rules”).

By default, the Interactive Control Panel starts out with the Patient Library tab as shown in
Fig. 7-‐5 on the next page.

2. Double-‐click on any item from the list of preconfigured patient models to activate it for a running
simulation.

New Feature
3. The new model selected will be phased in over several breaths. The Steps Per Change setting
determines how many iterations are used to fully implement the new model settings (see also 10.6
Transition Settings, page 163).

NOTE
Switching between pre-‐configured models allows you to make changes to several model
parameters simultaneously, with one click, without the need to individually adjust each
parameter. These models may also include time-‐varying patient models (see page 173), with
gradual changes over extended periods of time (for example, to simulate induction of
anesthesia).

4. The active patient model will always be indicated here.

47

5. Use the Browse Folder icon to change to a different directory, for example to create a user-‐
customized library of patient models.

NOTE
The patient model library auto-‐updates if items have been added or deleted from it, no manual
refresh is needed.

6. In order to assist the decision making process of your students during a simulation,
enter values for vital signs into the template and click the Show Vital Signs Monitor button
.

The Vital Signs Monitor window opens. It can be moved, for example, to a second screen facing
students working on a simulation, as a stand-‐in for a patient monitor. (For more details on the Vital
Signs Monitor, see page 117 in the RespiSim® section of this manual)

1

5
4
2
6
3

Figure 7-‐5: Interactive Control Panel

48

7.2.1 Lung Model Parameters Tab

You control individual aspects of C and R from the Lung Model Param. tab. When a two-‐compartment
model— that also uses different values for inspiratory and expiratory resistance— is running, the ICP
display will look as follows:

2
1


Figure 7-‐6: Lung Model Parameters tab

• To change a parameter you can either “turn” knobs in a click-‐and-‐drag move or enter values
into the fields below the respective knob and press Enter. Knobs turn orange while the change
is being applied, after which they revert back to a darker green color, indicating that the
parameter has been changed from its original value.

1. To revert a change that you have made, (i.e., return to the model that was running when ICP was
invoked), click Revert to Original Model Settings.

• To save changes made, click Save Current Model Settings.

2. To simply view the current patient model or the original model that was active when ICP was
invoked, click View Original Model Settings or View Current Patient Model.

49

7.2.2 Spontaneous Breathing Parameters Tab

The Spont. Breath Param. tab is used for making changes to parameters associated with spontaneous
breathing of the model.

1


Figure 7-‐7: Spontaneous Breathing Parameters Tab

The knobs on this tab define all aspects of the effort profile of the interactively modified patient.
Please see page 38 in the

Scripted Simulations section for details of the patient modeling possibilities.

1. For all parameters of this tab to be active, the Closed Loop slider on the left needs to be in the No
Loop position. Otherwise, muscle pressure and, possibly, breath rate may become unavailable
(they will appear grayed out) since their values are then determined automatically by the control
loop and not by the user.

50

7.2.3 Trends

The Trends tab is a convenient way to look at historical data, specifically if the model was used with a
closed loop strategy, where patient effort and breath rate may change to maintain a specific tidal
volume Vt or minute ventilation MV.

It shows data history for tidal volume Vt, patient effort Pmus, and breath rate.


Figure 7-‐8: Trends Tab

51

7.2.4 Closed Loop Vt Tab

Closed Loop Vt manipulates patient effort (Pmus) in such a way that the resulting Vt matches the set
tidal volume. It is not intended to represent a physiological model.

3
2
1


Figure 7-‐9: Closed Loop Vt

1. Before using the Closed Loop Vt tab, you must select Const. Vt in the Closed Loop selector.
2. Set the desired Vt value.
3. Set upper and lower limits for Pmus. These values are observed as thresholds that will not be
exceeded while auto-‐adjusting patient effort.

NOTE
If the patient is connected to a ventilator, adjusting patient effort might not successfully result
in bringing Vt to the desired value; for example when the ventilator uses volume control and is
set to deliver a higher volume than the Vt set in the Closed Loop Vt tab. Likewise, set
thresholds (3) might prevent actual values from reaching the desired values.
52

7.2.5 Closed Loop MV Tab

Closed Loop MV attempts to manipulate patient effort (Pmus) and breath rate in such a way that the
resulting minute ventilation (MV) matches the set value. It is not intended to represent a physiological
model.

2
3
1

Figure 7-‐10: Closed Loop MV

1. Before using the Closed Loop MV tab, you must select Const. MV in the Closed Loop selector.
2. Set the desired MV value.
1. Set upper and lower limits for Pmus and for breath rate. These values are observed as thresholds
that will not be exceeded while auto-‐adjusting patient effort.

NOTE
If the patient is connected to a ventilator, adjusting patient effort and breath rate might not
succeed to bring MV to the desired value; for example when the ventilator uses mixed mode
control and is set to deliver a higher MV than the MV set in the Closed Loop MV tab. Likewise,
set thresholds (3) might prevent convergence of actual and desired value.

53

7.2.6 Closed Loop CO2 Tab

The last of the Closed Loop control tabs is Closed Loop CO2.
In this mode, different Patient Case options may be selected to shape the way in which the desired
value of end-‐expiratory CO2 (ETCO2) is reached. Patient cases may include:
• Normal Healthy Adult
• Pulmonary Fibrosis
• COPD, Severity III
• User-‐defined
These are based on a study of respective publications, but again, do not represent a fully developed
physiological model of the patient. Additionally, an ETCO2 set point as well as a value for CO2
production (reflecting a metabolic rate) can be selected.

2

1 4
3

Figure 7-‐11: Closed Loop CO2

1. Before using the Closed Loop CO2 tab, you must select CO2 in the Closed Loop selector.
2. Set desired Patient Case (type), ETCO2 value, and CO2 production limit.
54

3. Adjust upper and lower limits for Pmus and for breath rate as needed to keep adjustments within a
physiologically relevant range. These values are observed as thresholds that will not be exceeded
while auto-‐adjusting patient effort.
4. Observe that the ETCO2 set-‐point and actual value converge.

NOTE
Closed Loop CO2 has no effect on the current patient model (vr3-‐file) being run. It is intended
for didactic training only.

u.k Scripted Simulations

Scripted simulations designed from the Script/Patient Model tab are an alternative to the direct,
interactive modeling described in section 0 7.27.2It may be helpful to conceptualize a simulation script
(see also 6.3, Scripted Modeling, page 38) as a “recipe” or “work instruction” to produce a final
product. Each line in a script is populated with a specific patient model that will be repeated for a
predefined number of times. Therefore, always keep in mind the distinction between the individual
patient model (file extension *.vr3) and scripts (file extension *.sct).

The different screens (STEP 1 through STEP 4) of the Simulation Editor provide the full complement of
tools to create and adjust a patient model in all its aspects, even beyond what is accessible in the
Interactive Control Panel.

7.3.1 Scenario Scripts
From the Standard Window Manager, click the Script/Patient Model tab to open the Simulation
Script Editor, which opens in the Scenario Scripts sub-‐tab view.

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.

55

1

Figure 7-‐12: Scenario Scripts Library


NOTE
You can also reach the Simulation Script Editor from the RespiSim® Window Manager by
clicking Show Tools under the ASL Tools menu item.

Most of the scripts you see in the Scenario Scripts library contain simply a large number of repetitions
of the patient model of the same name as the script name itself. Exceptions are the
Kussmauls_Breathing and Adult_apnea scripts.

1. For example, double-‐clicking Adult_Normal_unassisted.sct opens a script that looks as follows:

56

2

Figure 7-‐13: Manual Scripting

Each line in a script can be edited separately.
2. To edit a line in the script, double-‐click the respective line. The Step 1: Select Simulation Parameter
Set dialog box opens.

3
4

Figure 7-‐14: Simulation Editor, Step 1

57

You may also click Browse to select a different patient model file if you do not want to base further
edits on the file presented in the path box.

3. Enter the number of repetitions that you want the patient model to be exercised.
4. Click to start the editing process in the Step 2: Choose a Lung Model window.

6
5

7 8

Figure 7-‐15: Lung Model Editing, Step 2

On this page, you define the respiratory mechanics of the patient, Resistance R and Compliance C.

5. Click on diagram to select a model: At the top of the Step 2 window, choose the type of patient
model that you want to use. Select a patient model from four choices by clicking the respective
image or by clicking the vertical Up and Down arrows provided next to the image.
58

As mentioned before, Flow Pump and Volume Pump are not patient models in the true sense, since
they do not contain R and C values. Rather, for these models, patterns of flow and volume are set
directly in Step 3. (For step 3, see page 60)
The number of available parameters depends on the type of model chosen. In the case of a single
compartment model where inspiratory and expiratory R are the same, there are only two parameters
to select, R and C. Whereas, in a more complex model, (two compartments with independent
inspiratory and expiratory bronchial resistors), this number can be as high as 8. For further details on
the different models, please refer section Modeling Based on Ventilatory Mechanics, page 255.

NOTE
Please keep in mind that the modeling process does not separate between lung compliance
and chest wall compliance, but rather “lumps together” these two effects.

6. To finish modeling, you also need to confirm the selection of the residual capacity (URC) of the
model. By default, this is set to 0.5 L and you can leave the value unchanged. URC defines a volume
inside the ASL 5000 cylinder which acts similar to a FRC (functional residual capacity). It allows
forced exhalation below the baseline volume.

NOTE
In a real, adult patient, FRC would likely exceed 2L, but for the benefit of a more compact
device, this volume has been scaled down. You can, of course, increase it, when larger
exhalations otherwise would likely be limited. Just keep in mind that, in this case, the maximum
(positive) tidal volumes, accordingly, are more limited.

Other advanced modeling parameters, shown in the bottom half of the STEP 2 window
(Compensations, Non-‐Linear Compliance, Time-‐Varying Parameters) add further detail to the patient.
(also see Advanced Patient Modeling, page 178)

7. Select a Waveform Sampling Rate based on the use of the intended data set and the length of the
simulation. The default of 512 Hz gives maximum resolution in the time domain but is not
recommended for generating data sets from hours of simulation.

NOTE
The Waveform Sampling Rate for the entire simulation is determined by the first patient model
in a script. The setting of this parameter in all subsequent script entries is ignored.

8. Click to proceed to Step 3.
The Step 3: Choose a Patient Effort Model window opens.

59

9

Figure 7-‐16: Patient Effort Model, Step 3

You will select the patient’s spontaneous breathing effort from a number of basic patterns, or,
alternatively, define it freely via a single column of data points from a spreadsheet (see File-‐Based
Patient Effort, page 182).
Patient effort may also be entered as an analog signal into one of the analog inputs of the ASL 5000.
The pattern selection looks as follows:

60

For a realistic rendering of a patient’s breathing effort, the Sinusoidal Half-‐Wave is most commonly
used. Please see Sinusoidal Patient Effort in Theory of Operation section (page 178) for details of the
setup of this pattern.

NOTE
While an argument can be made suggesting that the release of muscle pressure in a real patient
is more of an exponential decay, the differences in the actual effect on flow and volume are
minimal.

A Trapezoidal Half-‐Wave pattern performs very similar to a Sinusoidal Half-‐Wave, with straight ramps
during increase and release of effort.

Pressure Trigger shapes the pressure waveform as a rectangular pressure “blip” (no ramps), defined
only by amplitude and duration. For the condition of an occluded port, this setting will produce a
rectangular pressure profile as airway (mouth) pressure.

Flow Trigger generates a constant flow defined by duration and amplitude. The pressure profile
necessary to maintain a constant flow over the duration of the effort is calculated internally to
overcome just the effects of R and C of the patient model in a no-‐load situation (open port). Actual

61

flow levels will be influenced by negative pressure in the circuit when, for example, flow delivery from
a ventilator is delayed.

NOTE
Keep in mind that the system is still operating within the context of a respiratory mechanics
model that responds to external pressure. For flow patterns independent from pressure
changes, use the Flow Pump Mode or Volume Pump Mode.

Less predictable effort patterns or those captured from actual patients are entered into a simulation
either via one of the analog inputs of the ASL 5000 (External Analog Input) or as a user specified data
file (User specified (freeform from file))

9. When all adjustments to the settings of Patient Effort Model are made, click to
proceed to the Step 4: Save Simulation Parameter Set dialog box, to save the parameters of the
edited patient model.

11

10

Figure 7-‐17: Patient Model Save As dialog box, Step 4

10. Click to save all parameters under the same file name (after confirmation to overwrite).
11. Click to open a dialog box for choosing a new file name and path.

62

NOTE
Built-‐in patient models, which are part of the software release, cannot be altered. You may,
however, save a patient model that is based on such an original under any other name using
the Save As option. The Save button will be unavailable (grayed out) in this case (see Figure
7-‐17).

Finishing the Save process will return you to the Script Editor tab.
• Click to run the script if you modified only the patient model parameters but kept
the name of the patient model file same.
• If you used a new name for the patient model and the script therefore changed, first save the
script (either under its previous name or under a new name).
• Click View Current Patient Model at any time from the Run Time Home screen to see a
summary of the patient model parameters that are active in the simulation.


Figure 7-‐18: Current Patient Model Summary

• Click to directly access the patient model editor from this window.

63

While a scripted simulation is running, you can monitor the progress of the script with the Current
Script Progress window.

• Click on the Run Time Home tab of the Standard Window Manager. The Current Script Progress
window will open. The currently executing window is highlighted.

Figure 7-‐19: Current Script Progress window

64

u.m Data View and Analysis

7.4.1 Run Time Home Screen
As indicated previously, two views exist for viewing time domain data:
• Flow, pressure, and volume waveforms, or
• Flow/volume and pressure/volume loops

To switch, click the Loop View button from the Waveform View. The button changes to Wave
View .

In Waveform View, a simulation run creates the following parameter traces:
➤ Calculated model flow for compartment 1
➤ Calculated model flow for compartment 2
➤ Calculated total model flow  
➤ Simulator (cylinder) flow  
➤ Airway pressure (this is the pressure measured inside the simulator cylinder)  
➤ Calculated tracheal pressure  
➤ Calculated alveolar pressure for compartment 1  
➤ Calculated alveolar pressure for compartment 2  
➤ Inverted 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 (cylinder) volume

NOTE
No corrections for barometric pressure, temperature, etc., are made to the Run Time Home
displays of waveform or loop graphs to render true BTPS or other standard gas conditions.
Volumes and flows displayed there are geometric values at the existing gas temperature and
represent piston movement.

• Click Freeze to halt the display of all waveforms or loops. Move the cursor around on the
“frozen” graph. Observe the numerical value indicated in the corner of the graph. The
simulation will continue to progress and the piston will still be moving.

Chart Length controls the time for the overwriting of both waveform and loop graphs. When viewing
loops, this means that the redraw occurs not based on a fixed number of breaths but on the length of

65

time allowed by Chart Length. This feature accommodates different shapes of loops based on
parameter changes, all in one graph.

If you prefer to have auto-‐scaling turned off, right-‐click on the respective graph and clear the
Autoscale Y selection in the pop-‐up menu.

NOTE
Do NOT clear the Autoscale X option as this will render your graphs invisible.

To change the color of a trace, click on the respective plot sample in the legend of a graph and
select the new color from the color palette under Color.
• Click Fill Bar to open the Fill Bar window. A real time bar graph indicates in a visual
representation the amount of air entering each lung compartment. A single bar graph is shown
for single-‐compartment models.


Figure 7-‐20: 2-‐Compartment Lung Fill Indicator

• Enter a number for the lower and upper threshold. Color changes of the bar graph are
controlled by these thresholds. Green indicates a tidal volume Vt that is within range, Black
indicates a low Vt, and Red is used for Vt that exceeds the high threshold.

66

Figure 7-‐21: Data Field Real Time Information

Select the Enabled in the Data field of the Run Time Home screen to see real time information about:
• O2-‐concentration (if the Fast Oxygen Measurement is installed)
• Barometric pressure
• Gas temperature average in the cylinder
• Cylinder wall temperature (if Cylinder Temperature Controller is installed)
• Auxiliary analog input parameters.
If no ASL 5000 is connected, the fields will show default parameters as indicated in above image.

NOTE
The gas temperature sensor has a response time of several seconds and measures an averaged
temperature. For Working with Advanced Features: Analog Inputs, see page 199.
Aux1 and Aux2 indicate the input voltage to these channels in the range of 0 to 10 V.
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 Broadcast Configuration, page 198.
More detailed data analysis is provided via the Real Time Analysis and Post-‐Run Analysis tabs from the
Standard Window Manager.

67

7.4.2 Real Time Analysis

To see a pre-‐selected set of parameters in real time, as well as to check and adjust breath detection for
the analysis algorithms, click the Real Time Analysis tab from the Standard Window Manager.
1. Analysis is, by default, enabled. It may be turned off in the rare case where no data collection is
desired. To do this, uncheck the Enable Analysis checkbox.
Select Save Waveform Data to save data at the data sample rate determined by the patient
model file that is active at the start of the simulation (64, 128, 256, or 512 Hz, see page 59).
Waveform data capture is automatically ON when RespiSim® is active.
2. Select the Conditions (of measurement) for volume corrections from the drop-‐down menu.
Ventilators typically display volumes for BTPS conditions, the default for the ASL 5000 is “as
measured.”

1 2 3


Figure 7-‐22: Real Time Analysis Settings

68

New Feature
Corrections for the different conditions are now applied to the saved processed data, and are
reflected both in Real Time Analysis and in Post-‐Run Analysis data views. The raw data file is
not changed based on the selection of Conditions. You can therefore always apply different
volume corrections by re-‐processing data sets that include waveforms (see 7.4.3.1, Data Re-‐
Processing, on page 73).

NOTE
The selection of Conditions is always made at the time of data processing, i.e., either from the
Real Time Analysis tab or when re-‐processing data in Post-‐Run Analysis. Individual data views
will indicate the choice but will not allow a change of Conditions.

3. For the purpose of reducing noise, a 10-‐point moving average filter is applied to the pressure
readings from the Paw sensor by default. Use the Pressure Filter drop-‐down to turn this filter off or
to select a 5Hz Butterworth filter.

4 5
6
7

Figure 7-‐23: Real Time Analysis Parameters and Breath Detection

69

4. With the Auxiliary Compensation Parameters you can compensate in effects of parasitary circuit
compliance and resistance. The ventilator, for example “sees” both the programmed patient
compliance as well as the compliance of the circuit that is due to gas compressibility.
If the ventilator does not take this into consideration, for example by using a pre-‐op test of the
circuit, its readings of tidal volume will not match the readings of the ASL 5000.
The ASL 5000 will only report what the patient actually has received, which does not include
what was “lost” in the circuit compressibility.
If you enter values for compliance and resistance compensation, you will include those
amounts in the ASL 5000’s volume readings and can adapt the readings to a non-‐compensating
ventilator.

NOTE
The effects just mentioned are typically negligible when working with adult patients. In
neonatal applications, however, it would not be uncommon that half of the volume delivered
by the ventilator never makes it to the patient, since patient compliance and circuit compliance
are approximately of the same size.

NOTE
Make sure not to confuse this type of compensation with the “Compensations On” setting in
the Patient Model Editor. There, you actually manipulate the patient model settings in such a
way that the parasitary effects are compensated out and the model presents to the ventilator
the exact parameters programmed.

5. Breath Detection Settings collectively determine what actually constitutes a breath on the part of
the patient (and what, on the other hand is to be considered simply noise or unwanted “wiggles”).
Breath Start Volume Threshold and Exp Start Volume Threshold are, by default, set to 5mL. You
will need to adjust these down for neonatal applications (suggested: 0.5mL). Effort Start Threshold
determines what patient effort (Pmus signal) is considered an actual spontaneous effort.

6. 8 breath parameters, out of a list of more than 100, are simultaneously displayed in the Real Time
Analysis tab. Click any of the parameters and select a different parameter from the list that pops
up.

7. The volume plot in the Real Time Analysis tab serves as a reality check for breath detection.
Markers from the legend need to appear in their logical sequence in the plot, in all detected
breaths, for a meaningful analysis.
70

NOTE
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.

7.4.3 Post-‐Run Analysis
From the Standard Window Manager, click the Post-‐Run Analysis tab to get a menu of various analysis
views accessible after a simulation has completed.

1

Figure 7-‐24: Post-‐Run Analysis, Select a Simulation

71

The Analysis Menu is structured from left to right to:
• Select Files ( )
• Process/Preview Data (blue)
• View Data ( )
• Performance Analysis ( )

1. Click Select a Simulation and navigate to a simulation data set in the window that opens.

You will either see all buttons become selectable or just the Multi-‐Parameter Trend button, depending
on whether waveforms were saved during the simulation or not.
A message to that effect is also displayed as a note on the panel.


Figure 7-‐25: Post-‐Run Analysis Menu

72

7.4.3.1 Data Re-‐Processing

Re-‐processing of data is only necessary when you have determined that, for example, breath detection
with the threshold settings used during the simulation yielded unsatisfactory results.
Re-‐processing also enables the Analysis Progress Graph indicating which portion of the overall graph is
currently being displayed.
The Data Re-‐Processing window features many of the same elements as the Real Time Analysis tab.

2
1

Figure 7-‐26: Data Re-‐Processing Window

1. Select a volume correction Condition from the drop down in the same way as you would have done
in the Real Time Analysis tab.

New Feature
Corrections for the different conditions are now applied to the saved processed data, and are
reflected both in Real Time Analysis and in Post-‐Run Analysis data views. The raw data file is
not changed based on the selection of Conditions. You can therefore always apply different
volume corrections by re-‐processing data sets that include waveforms. (See also 7.4.2).

73

NOTE
The selection of Conditions is always made at the time of data processing, i.e., either from the
Real Time Analysis tab or when re-‐processing data in Post-‐Run Analysis. Individual data views
will indicate the choice but will not allow a change of Conditions.

2. Additional adjustments pertain mostly to ventilator performance analysis.
They may include:
• Insp. Waveform SD Threshold
• Fraction of Target for Steady State
• Inspiratory Target Override
• Expiratory Target Override
• Inspiratory Breath Type Override

Insp. Waveform SD Threshold is a setting to be used by the algorithm for determining the type of the
inspiratory waveform (pressure or flow as the primary control variable). It is the fraction of the mean
below which the standard deviation of pressure must fall to consider it the primary control variable.
This setting does normally not require adjustment.

Fraction of Target for Steady State determines at what point after a transient a new steady state is
assumed because the overshoot etc. stays within certain limits. The default value is 0.1 (=10% of
target) and usually never needs to be adjusted.

For Inspiratory Target Override and Expiratory Target Override you can enter values if you know what

target pressures were set on the ventilator (as it is recommended that you not leave it to the ASL 5000
algorithm to determine this from the data in those cases).

Sometimes it is difficult to determine whether breath delivery was following a constant flow or
constant pressure scheme. For Inspiratory Breath Type Override, you can enter a “0” as the override
value for constant flow ventilation or a “1” indicating that constant pressure approach had been used
(pressure-‐controlled ventilation).

Click to produce new breath parameter (*.brb) and processed waveform data (*.dtb) files.
The *.dtb file contains the processed 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 you can perform further reprocessing, for example with
changed threshold parameters, if needed.

Click to close the window and return to the Post-‐Run Analysis tab on the Standard Window
Manager. You may also have several analysis windows open at the same time.

74

7.4.3.2 Raw Data Preview

In the Raw Data Preview display:
1. Enter the amount of time of waveforms to be displayed. The default is 60 seconds.
Use this button-‐set to navigate through a waveform recording.
2. Click any of the four parameters to select a waveform from the drop-‐down menu.

NOTE
The raw data selection, notably, does not contain flow, since, in the ASL 5000, flow is a
parameter calculated from changes in volume.
3. Click the individual gain factor for each trace in the superimposed graph and select a gain factor
that reasonably equalizes amplitudes between graph traces for better viewing.
4. The cursor palette shows the X and Y coordinates for the horizontal and vertical cursor.
• Right-‐click on the cursor name and select Go to Cursor to move the displayed region of the
graph to make the cursor visible.
• Select Bring to Center to move the cursor position in the center of the graph.

5. Click the magnify icon in the graph palette to select a zoom tool. Click or to change
the number of decimal digits in the graph labeling.


2 3
1
5
4

Figure 7-‐27: Raw Data Preview

75

7.4.3.3 Breath by Breath Data
1. In the Breath by Breath Display area, at the top left side of the window you will find this button-‐set
for navigating through a waveform recording, in this view separated into
each individual breath that was detected by the ASL 5000’s algorithms. The BreathType field will
read Spontaneous if there was any patient effort during the breath; otherwise the same field will
read Mechanical. The volume correction Conditions follow what was set for either real time
analysis or during re-‐processing of the data set.

2. Four sets of numerical parameters characterize each individual breath:
• Timing
• Inspiratory Flow
• Pressures
• Volumes

1 3
4

2

Figure 7-‐28: Breath by Breath Display

3. To select the breath by breath waveform for each of the three graphs individually from its drop-‐
down list, click the respective drop down menus of the Flow, Pressure, and Volume, fields.
76

The cursor palette shows the X and Y coordinates for the horizontal and vertical cursor.
graph to make the cursor visible.




77

7.4.3.4 Multi-‐Parameter Graph (Breath-‐by-‐Breath)

The Multi-‐Parameter Graph window overlays four traces in one graph, in a breath-‐by-‐breath fashion,
making it easy to look at relative timing between different parameters.
The familiar navigation through all detected breaths via this button-‐set is also
part of this window, as are indicators for Conditions and Breath Type (see 7.4.3.3).

1
3
2

Figure 7-‐29: Multi-‐Parameter Breath-‐by Breath View

down list > click the respective drop down menus of the Flow, Pressure, and Volume, fields.
• Click the magnify icon in the graph palette to select a zoom tool. Click or to
change the number of decimal digits in the graph labeling.
• Click the individual Gain factor for each trace in the superimposed graph and select a gain that
reasonably equalizes amplitudes between graph traces for better viewing.

graph and make the cursor visible.

3. Click to close the window and return to the Post-‐Run Analysis tab on the Standard
Window Manager. You may also have several analysis windows open at the same time.
78

7.4.3.5 Loops
The familiar navigation through all detected breaths via this button set is
moved to the right side of this window, as is the indicator for Conditions.

1. Click the X and Y legend of the loop graph and select a parameter for each axis from its drop-‐down
list.
2. The loop is separated into Inspiration and Expiration, with a dividing line from the graph origin to
the point of volume maximum, where inspiration turns into expiration.

• Click to close the window and return to the Post-‐Run Analysis tab on the Standard

1
3
2
4
1

Figure 7-‐30: Loop View

79

7.4.3.6 Multi-‐Parameter Waveforms

The Multi-‐Parameter Waveforms view resembles largely the Raw Data Preview. However, processed
data is shown in this case, which, specifically, includes flow waveforms.
The familiar navigation through all detected breaths via this button-‐set is also
part of this window, as are indicators for Conditions and Breath Type (see 7.4.3.3).

down list, click the respective drop down menus of the Flow, Pressure, and Volume, fields.
reasonably equalizes amplitudes between graph traces for better viewing.

• Select Bring to Center to move the cursor position in the center of the graph
Click the magnify icon in the graph palette to select a zoom tool. Click or to change

1

2

Figure 7-‐31: Multi-‐Parameter Waveforms

80

7.4.3.7 Multi-‐Parameter Trend (Breath Parameters)

down list of over 100 breath parameters, click the respective drop down menus of the Flow,
Pressure, and Volume, fields.

reasonably equalizes amplitudes between graph traces for better viewing. Use x 0.001 to force
a trace to baseline if you want to view less than four parameters.
• Click the magnify icon in the graph palette to select a zoom tool. Click or to
change the number of decimal digits in the graph labeling.



Figure 7-‐32: Multi-‐Parameter Trend

81

3. A horizontal line of the respective trace color represents the mean of the parameter values
between (and including) the vertical cursors. Its numerical value, together with the standard
deviation is also shown.


7.4.3.8 Work Calculations and PV Loops
The Work Calculations and PV Loops view provides a summary of all work-‐of-‐breathing related
parameters calculated by the ASL 5000 software. The calculations are provided as Work (mJ), Power
(mJ/s) and Work per Volume (mJ/L).

1. Work calculations are based on different reference points:
• Patient Work (Pmus)
• Externally imposed work (Paw, ventilator work)
• Total system work (combination of both)

For further details on WOB, please refer to the Theory of Operation section of this Manual, specifically
to An Introduction to Ventilatory Mechanics (page 236).

The loop graph shows the Pressure Volume Loop; therefore, the areas under the curves represent

imposed WOB. The graph uses colors to differentiate between the inspiratory and expiratory part of
the loop.

2. A dividing line runs from the graph origin to the point of volume maximum, where inspiration turns
into expiration.

3. The familiar navigation through all detected breaths via this button set is
also part of this window, as are indicators for Conditions and Breath Type.



82

3
1
2 5
4

Figure 7-‐33: Work Calculations and PV Loops



7.4.3.9 Trigger Analysis
The Trigger Analysis view summarizes parameters and time marks related to the response of a
ventilator to the patient’s spontaneous effort. Since the ASL 5000 knows the exact start point of the
inspiratory effort, trigger time delay is calculated from this point to the time where airway pressure
returns to baseline (zero or PEEP).
The two components of this time span, i.e., time to reach the minimum pressure, and time to return to
baseline pressure, are also indicated explicitly. Please also refer to page 88, Parameter Definitions.

83

3
4 5
2
1

Figure 7-‐34: Trigger Analysis

NOTE
The lowest point in the volume excursion is used to determine the start of a breath. Depending
on the circumstances, this might not always be appropriate. You may, for example, encounter
situations where the patient’s effort starts after this point and the algorithms used may not be
able to appropriately determine whether there actually was a triggered breath or not. A visual
plausibility check of the traces in the graph is therefore always recommended. You can then
determine a trigger time manually.

1. Move the vertical cursor marked Trigger to manually select a trigger point.
2. You will see the difference between the original and the new trigger point as trigger time
difference.
3. Click to update the calculation in the Trigger Analysis view.

4. The familiar navigation through all detected breaths via this button set is
also part of this window, as are indicators for Conditions and Breath Type.
84



7.4.3.10 Ventilator Performance Analysis
The Ventilator Performance Analysis view is a breath-‐by-‐breath display of parameters for assessing
the constant delivery of flow or pressure by the ventilator. Therefore, user discretion is advised when
using these parameters to judge breath delivery. If there was, based on the mode of the ventilator, no
target of either flow or pressure, the calculated parameters have no basis. If there was, however, a
clear target, you can either accept the calculated value of that target or manually enter a different
value as a manual target override before re-‐processing data (see

85

86
Data, page 74).

1. To determine the validity of the assumed target:


2. Insp. Breath Type indicates whether Constant Flow or Constant Pressure is used for calculating the
performance variables related to the inspiratory part of the breath.

3. The familiar navigation through all detected breaths via this button-‐set is
also part of this window, as are indicators for Conditions and Breath Type (spontaneous or
mechanical).


3
2
1
1 User’s Manual ASL 5000, SW 3 .6, Rev.1, © IngMar M edical, L td. 2016
4

Figure 7-‐35: Ventilator Performance Analysis


87

7.4.4 Parameter Definitions

Figure 7-‐36: Timing of Pressure, Flow, and Volume in a Typical Breath

(Points A...F in the following table refer to Figure 7-‐36, above)

Table 7-‐1: Definitions of Time Marks in a Breath
Parameter Label/Unit Definition Comment
Start Insp [SoE] End of Expiration (of Point A

Effort previous breath) The time Serves as the zero point for each breath
(time stamp count) at which in the time domain. If no spontaneous
the inspiratory pressure effort is detected, Start of Patient

profile (patient effort) Inspiration will default to the volume
begins, i.e. the inverse of minimum before Point B ([SoI], Start of
Pmus drops below zero Inspiration).
Start of [SoI] Time stamp for the Software uses Point B to discriminate
Inspiration beginning of an inspiration breaths and takes minimum volume
(the minimum volume in a (before Point B) as [SoI]
breath)
Point B Time when the Breath Start Volume threshold default value is 5mL,
Volume Threshold has been suitable for adult size models; 0.5mL is
exceeded recommended for neonatal models.
Point E The time mark for the This marks the start of expiration.
maximum volume However, when a "flat" volume
maximum is encountered, the end of
that line is used as Start of Expiration.
88

Parameter Label/Unit Definition Comment
Start [Start Exp] The time stamp for the The time stamp for the beginning of
Expiration beginning of expiration. expiration.
Point F Time when the Exp Start Volume threshold (counted down from
Volume Threshold has been the volume maximum in a breath)
exceeded. default value is 5mL, suitable for adult
size models, 0.5mL is recommended for
neonatal models.

Time to Pmin ms The time interval to the From Point A to Point C
after SoE largest Paw depression
below baseline pressure
occurs, calculated from
[SoE].
Trigger Time [Ttrig] Point in time at which From Point A to Point D
airway pressure has
returned to baseline after a
downward deflection (i.e.,
the pressure level before
the start of inspiratory
effort).

7.4.4.1 Parameters in the *.brb-‐(Breath Parameter) File
Parameters appear in alphabetical order of names in the drop-‐down menus in the analysis windows.
Parameter names are given as they are used in drop-‐down menus in the analysis windows. [name] and
[unit] indicate parameter names and units in brb-‐file (where different). For points A...F refer to Figure
7-‐36).

Table 7-‐2: brb-‐File Parameters
Parameter Unit Definition Comment
% of Peak Flow % Relative flow at the time A measure of the rapid opening of an
when exp 20 ms before [Start expiratory valve of a ventilator (at Point F).
begins Expiration] Parameter definition changed in sw 3.5
(20 ms)

89

Ambient Temp oC Gas temperature inside This is always an average temperature
the cylinder as measured Added parameter in sw 3.4
by the ASL 5000’s own gas
temp. sensor
Auto-‐PEEP 1 cmH2O P_compartment_1 -‐ Pcompartment_1 = Alveolar Pressure in
[PEEP_1auto] Paw at [End of Expiration] Compartment 1 of the lung model
Added parameter in sw 3.3
Auto-‐PEEP 2 cmH2O P_compartment_2 -‐ Pcompartment_2 = Alveolar Pressure in
[PEEP_2auto] Paw at [End of Expiration] Compartment 2 of the lung model
Aux 1 Volt [V] Signal on channel 1 of Default value, when no source is connected,
analog input (0-‐10V) is 5 V
Aux 2 Volt [V] Signal on channel 2 of Default value, when no source is connected,
analog input (0-‐10V) is 5 V
Breath Num. integer The number of the breath Only breaths that exceed the inspiratory and
starting from the expiratory volume thresholds are counted,
beginning of the eliminating “volume noise”. The count is "a
simulation, as determined posteriori", independent from ventilator or
by the analysis software model settings!

Breath Rate BPM Overall breath rate Combines mechanical and spontaneous
[ftot] calculated from the time breaths
between peak volumes Added parameter in sw 3.3

Breath Type flag Spontaneous (1) or Based on the presence of spontaneous effort
Mechanical (0) anywhere during the breath
End Exp Index integer Time stamp for End of Internally used index for marking the times
expiration = Start of a new of specific events during a breath cycle.
breath cycle Spacing is (1/data rate), default at 1/512
E Time s Expiratory time, counted Between Point E (or just before F) and G
from [StartExp] to
[EndExp]
Exp Active mJ If [Exp Work] is < 0, [Exp A Total System Work parameter, Expiratory,
Work Active Work] = -‐[Exp Active
Work], zero otherwise

90

Exp Mean cmH2O2 Mean squared deviation A ventilator performance parameter

Squared Error from [Exp Target] during
expiration
Exp Overshoot % Relative pressure change A ventilator performance parameter
from Pmax to [Exp
Target]:
([Exp Target] -‐ Pmin) /
(Pmax -‐ [Exp Target])
Exp Res Work mJ [Insp Elastic Work] -‐ [Exp A Total System Work parameter, Expiratory,
Work] Resistive
Exp Settling ms Time from [Start Exp] to Will always refer to pressure
Time the point where
fluctuations around
[target] are less than 10%
Exp T90 ms The time to accomplish A ventilator performance parameter
90% of the drop from
peak pressure to [Exp
Target] (PEEP)
Exp Target cmH2O The pressure at steady If known in advance (for example, because it
state during expiration is a ventilator setting) this parameter may be
(where steady state is set via an override in the Post Analysis Data
derived from median Re-‐Processing window
airway pressure during
expiration), normally
equivalent to PEEP
Exp Vt mL Expiratory tidal volume From start of expiration to end of expiration
Exp Work mJ ∫ (Pairway -‐ PEEP + Pmus) A Total System Work parameter, Expiratory
dV from [Start Exp] to Definition changed with sw 3.3
[End of Exp]
Ext Exp Res mJ [Ext Insp Elastic Work -‐ An external (imposed) WOB parameter,
Work External Exp. Work] Expiratory

91

Ext Exp Vent mJ If [Ext Exp Work] is < 0, An external (imposed) WOB parameter,
Work [Ext Exp Active Work] = -‐ Expiratory
[Ext Exp Work], zero Added parameter in sw 3.3
otherwise
Ext Exp Work mJ ∫(Pairway -‐ PEEP) dV from An external (imposed) WOB parameter,
[Start Exp] to [End of Exp] Expiratory
Ext Insp Res mJ [Ext Insp Work] -‐ [Ext An external (imposed) WOB parameter,
Work Elastic Work] Inspiratory
Ext Insp Elastic mJ ((Pairway{at Vmax} -‐ An external (imposed) WOB parameter,
Work PEEP) x [Vmax-‐Vo] -‐ (Pmin Inspiratory
x [Vo-‐Vmin Added parameter in sw 3.3
])) / 2, where Vo is volume Parameter definition changed in sw 3.5
at Paw=PEEP and Pmin is
the smallest pressure
during inspiration
Ext Insp Work mJ ∫ (Pairway -‐ PEEP) dV from An external (imposed) WOB parameter,
[SoI] to [StartExp] Inspiratory
Heat mJ If [Exp Work] is > 0, [Heat A Total System Work parameter, Expiratory

Production Production] = [Exp Work],
zero otherwise
I Time s Inspiratory time counted Between Point A and Point E (or just before F)
from the minimum to the
maximum volume
(positive flow is detected)
I/E ratio Inspiratory time / Inspiratory time includes a potential pause
Expiratory time time
Ins Settling ms Time from [Start Insp] at A ventilator performance parameter
Time which inspiratory steady
state (insp. pressure or
flow between 0.9 ... 1.1 of
target) is reached
Insp % % [I Time] expressed as % Between Points A and E (or just before F)

92

Insp Breath flag Pressure controlled or Based on the behavior of pressure and flow,
Type Flow controlled an algorithm determines the type of the
breath (and the target and performance
parameters are selected accordingly
Insp Elastic mJ ((Paw{at Vmax}-‐ A Total System Work parameter, Inspiratory,
Work PEEP+Pmus) x (Vmax-‐Vo) -‐ Elastic
({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
Insp Mean cmH2O2 Mean squared pressure or A ventilator performance parameter, either
Squared Error or flow deviation from [Insp a value of pressure or of flow, depending on
(L/min)2 Target] during inspiratory the type of inspiratory breath delivered by
flow time the ventilator
Insp Overshoot % Pressure (or flow) A ventilator performance parameter, a value
overshoot relative to [Insp derived of either pressure or flow,
Target] depending on the type of inspiratory breath
delivered by the ventilator
Insp Res Work mJ [Insp Work] -‐ [Insp Elastic A Total System Work parameter, Inspiratory,
Work] Resistive
Insp T90 ms The time to accomplish A ventilator performance parameter, either
90% of the rise to [Insp a value of pressure or of flow, depending on
Target] pressure or flow the type of inspiratory breath delivered by
the ventilator
Insp Target cmH2O The pressure (or flow) at If known in advance (for example, because it
or steady state during is a ventilator setting) this parameter may be
(L/min) inspiration (where steady set via an override in the Post Analysis >
state is derived from Data Re-‐Processing window
median pressure during
the middle part of
inspiration)
Insp Vt mL Tidal volume measured Note that threshold size does not affect
from SoI to [Peak Volume] reported tidal volumes

93

Insp Work mJ ∫(Pairway -‐ PEEP + Pmus) A Total System Work parameter.
dV from [SoI] to [StartExp] Definition changed with sw 3.3
Max Flow Acc L/s2 Maximum change of slope Parameter may be used as a measure of a
of the Insp. flow curve. ventilator’s “flow ramp” setting
Max Pres Drop cmH2O Deflection of airway A parameter that can be used to evaluate
During Trig pressure from baseline the quality of CPAP or the adequacy of flow
[PEEP] to [Pmin] settings
Mean Flow L/min Mean value of flow taken Value derived from flow taken over
from [SoI] to [Ppeak] inspiratory part of a cycle, excluding a flow
pause, if it exists
Median Exp cmH2O/ Median of {(Pairway -‐ Values of exp. flow less than 2 L/min are
Res (L/s) Median of Pairway) / excluded from the calculation
(dV/dt)} during expiration
Median Flow L/min Median value of flow Value derived from flow taken over
taken from [SoI] to inspiratory part of a cycle, excluding a flow
[Ppeak] pause, if it exists
Min Flow Acc L/s2 Maximum (initial, A measure for the level of a patient “cough”
negative) change of slope (forced exhalation)
for the Exp. flow curve.

Oxygen % Oxygen concentration Value will be assumed to be 20.9 vol% if no
measured in the ASL oxygen sensor is connected
cylinder
Pat Exp Muscle mJ If [Pat Exp Work] is < 0, A Patient Work parameter
Work [Pat Exp Muscle Work] = -‐
[Pat Exp Work], zero
otherwise
Pat Exp Res mJ [Pat Insp Elastic Work] -‐ A Patient Work parameter, Expiratory,
Work [Pat Exp Work] Resistive
Pat Exp Work mJ -‐∫Pmus dV from [Start A Patient Work parameter, Expiratory
Exp] to [End of Exp]
Pat Heat mJ If [Pat Exp Work] is > 0, A Patient Work parameter, Expiratory
Production [Pat Heat Production] =
[Pat Exp Work], zero
otherwise
94

Pat Insp Elastic mJ Pmusmax x (V{at A Patient Work parameter, Inspiratory,

Work EndPatEffort} -‐ Elastic
V {at StartPatEffort}) / 2
where maxima and
minima are taken during
the time between [SoI]
and [Start Exp]
Pat Insp Res mJ [Pat Insp Work] -‐ [Pat Insp A Patient Work parameter, Inspiratory,
Work Elastic Work] Resistive
Pat Insp Work mJ ∫Pmus dV from [SoI] to A Patient Work parameter, Inspiratory,
[StartExp] Elastic
Pat Total Res mJ [Pat Insp Res Work] + [Pat A Patient Work parameter, Resistive
Work Exp Res Work]
Pat Trig Work mJ ∫Pmus dV from [SoE] to A Patient Work parameter, Trigger Work,
to PEEP [Trigger Time] (during (see also its components):
Trigger Response Time) Work between SoE and Pmin and
Work between Pmin and PEEP
Pause % % [Pause time] expressed as
%
Pause Time s Time counted from the Algorithm uses peak pressure instead of
point of maximum peak volume
pressure to [StartExp] Parameter calculation changed in sw 3.5
P_awTime cmH2O*ms ∫ (Pairway -‐ PEEP) dt from (prior to sw 3.4 labeled: Pressure Time
Product [SoE] to [End of Product also in drop-‐downs)
[Pressure Time
Product]
Inspiration]
P_0.1 cmH2O Pairway at 100 ms after

[SoI] Added parameter in sw 3.6
P_aw_TPtrigger cmH2O*ms ∫ (Pairway -‐ PEEP) dt from May be used as a substitute for Trigger-‐WOB
[SoE] to [Time to PEEP Added parameter in sw 3.5
after Pmin]
P_aw_TP300 cmH2O*ms ∫ (Pairway -‐ PEEP) dt from
[SoE] to 300 ms Added parameter in sw 3.5

95

P_aw_TP500 cmH2O*ms ∫ (Pairway -‐ PEEP) dt from

[SoE] to Added parameter in sw 3.5
500 ms
P_baro kPa Barometric pressure Reading from a dedicated pressure sensor
Peak Flow L/min Maximum flow Highest positive value of flow
PEEP cmH2O Minimum pressure PEEP = Positive EndExpiratory Pressure

maintained at the end of
the breath cycle
P_mean cmH2O Average pressure over the Includes any offset due to PEEP/CPAP
full breath cycle (Definition has been restored to previous,
was averaged over the inspiratory cycle in
sw 3.3 only!)
P_mean Ch1 cmH2O Average pressure for Includes any offset due to PEEP/CPAP
comp. 1 over the full Added parameter in sw 3.5
breath cycle
comp. 2 over the full Added parameter in sw 3.5
breath cycle

P_mean Insp cmH2O Average pressure over the Includes any offset due to PEEP/CPAP
inspiratory part of the Added parameter in sw 3.4

breath cycle
Insp comp. 1 over the Added parameter in sw 3.5
inspiratory part of the
breath cycle
Insp comp. 2 over the Added parameter in sw 3.5
inspiratory part of the
breath cycle
P_mean Exp cmH2O Average pressure over the Includes any offset due to PEEP/CPAP
expiratory part of the Added parameter in sw 3.4
breath cycle

96

Exp comp. 1 over the Added parameter in sw 3.5
expiratory part of the
breath cycle
Exp comp. 2 over the Added parameter in sw 3.5
expiratory part of the
breath cycle
P_min cmH2O Lowest pressure reached
during a breath cycle,
typically during inspiration
P_mus Time cmH2O*ms ∫Pmus dt from [SoE] to Pmus Pressure-‐Time Product
Product [PmusTP] [End of Effort] Added parameter in sw 3.3
P_pause cmH2O Pressure at start of Calculated as median of pressure between
expiration time of peak pressure and [StartExp]
Ppeak cmH2O Peak pressure Highest pressure during the breath cycle
SD Exp Res cmH2O/(L/s) Standard deviation of

Pairway / (dV/dt) during
expiration
Time between ms The time it takes, during a See also [Time to Pmin after Start of Effort]
Pmin and PEEP patient effort, to return to and [Time to Trigger]
baseline pressure,
counting from [Time to
Pmin]
Time to Pmin ms [Time to Pmin after SoE] See also [Time between Pmin and PEEP] and
after Start of [Time to Trigger]
Effort
Time to Trigger ms [Time to Pmin after SoE] + With this definition trigger delays are
[Time between Pmin and measured as the total time it takes for a
PEEP] 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]
Total PEEP 1 cmH2O PEEP + PEEP_1auto Total PEEP in Compartm. 1 of the lung model
[PEEP_1tot] Added parameter in sw 3.3

97

Total PEEP 2 cmH2O PEEP + PEEP_2auto Total PEEP in Compartment 2 of the lung
[PEEP_2tot] model Added parameter in sw 3.3
Total Res Work mJ [Insp Res Work] + [Exp Res A Total System Work parameter
Work], Resistive Work
Vent Exp Vt mL Expiratory volume as seen Ventilators that actually use corrections to
by the ventilator, taking take into account volume “lost” in circuits
into account compressible would be expected to report volumes similar
gas volumes in circuits, as to the ASL’s uncompensated parameter
define3d in Auxiliary (Vtin), at BTPS conditions
Compensation Parameters
in the Breath Detection /
RT-‐Analysis window
Vent Insp Vt mL Inspiratory volume as Ventilators that actually use corrections to
seen by the ventilator, take into account volume “lost” in circuits
taking into account would be expected to report volumes similar
compressible gas volumes to the ASL’s uncompensated parameter
in circuits, as defined in (Vtex), at BTPS conditions
Auxiliary Compensation
Parameters in Breath
Detection / RT-‐Analysis

Vol 1 Peak mL Total Volume = Vol1peak In a 2-‐compartment model, volume is
+ Vol2peak distributed based on R & C values input into
the Lung Model

Vol 2 Peak mL Total Volume = Vol1peak In a 2-‐compartment model, volume is
+ Vol2peak distributed based on R & C values input into
the Lung Model
Vol Max Index integer Time stamp for the time Internally used parameter for marking the
of maximum volume times of specific events during a breath
during a breath cycle cycle. Spacing is
1/(data rate), default at 1/512
o
Wall Temp C Temperature as measured Added parameter in sw 3.4
on the aluminum cylinder
Work between mJ ∫Pmus dV from [Time of A component of Trigger-‐WOB
Pmin and PEEP Pmin] to [Paw = PEEP]
Work between mJ ∫Pmus dV from [SoE] to A component of Trigger-‐WOB
SoE and Pmin [Time of Pmin]
98

7.4.5 Data File Types

Data file types of SW 3.6 may be translated to ASCII types using the File Translation Utility (see
Exporting Data Files, page 187). The file types are:

binary ➤ ASCII
*.brb ➤ *.bra breath parameter data file
*.dtb ➤ *.dta high resolution breath data file
*.rwb ➤ *.rwa high resolution raw data file

NOTE
The headers of these files contain information on the different parameters contained in them.

ASL 3.5 .bra ASCII

The format of this file is tab delimited text. Each entry is 12 characters wide and padded with spaces.

Breath Num. Breath Type I Time Insp % E Time
Pause Time Pause %Insp Vt Exp Vt Ppeak Pmean
Peak Flow Mean Flow Median FlowI/E Ppause PEEP
Trigger Response Time Vent Exp VT Vent Insp Vt Insp Work (J) Insp Elastic Work(J)
Insp Res Work(J) Exp Work(J) Exp Res Work(J) Exp Active Work(J) Heat Production(J)
Total Res Work(J) Pat Insp Work(J) Pat Insp Elastic Work(J) Pat Insp Res Work(J) Pat Exp Work(J)
Pat Exp Res Work(J) Pat Exp Muscle Work (J) Pat Heat Production(J) Pat Total Res Work(J) Pat Trig Work(J)
Time to Min Pres after Trig (s) Max Pres Drop During Trig Work between flow
starts after trig to pmin (J) SD Exp Res (cmH2O/l/s) Median Exp Res (cm H2O/l/s)
Exp Mean Squared Error Exp Overshoot (%) Exp T90 (ms) Exp Target Percent of Peak Flow
when exp begins
Ins Settling Time (ms) Insp Overshoot (%) Insp Breath Type Insp T90 (ms) Insp Target
Insp Mean Sq’d Error Exp Settling Time (ms) Vol 1 Peak Vol 2 Peak Start Insp Effort Index
Start Insp Index Vol Max Index Start Exp Index End Exp Index Max Flow Acc (mL/s**2)
Min Flow Acc (mL/s**2) Oxygen (%) Aux 1 (V) Aux 2 (V) Time betw. Pmin , PEEP (ms)
WOB betw. Pmin , PEEP (mJ) PawTP ftot (BPM) Pmin PmusTP
PEEP_1 auto PEEP_2 auto PEEP_1 tot PEEP_2 tot Ext Insp Work
Ext Insp Elastic Work Ext Insp Res Work Ext Exp Work Ext Exp Vent Work Ext Exp Res Work
Ext Exp Heat Production (mJ) Pmean Insp (cmH2O) Pmean Exp (cmH2O) Pbaro (kPa) Ambient Temp (C)
Wall Temp (C) PawTP300 (cmH2O*ms) PawTP500 (cmH2O*ms) PawTPt (cmH2O*ms) Pmean Ch1 (cmH2O)
Pmean Ch1 Insp (cmH2O) Pmean Ch1 Exp (cmH2O) Pmean Ch2 (cmH2O) Pmean Ch2 Insp (cmH2O) Pmean Ch2 Exp (cmH2O)

Table 7-‐3: Breath Parameter Data File (*.brb, *.bra)

99

ASL 3 .4 .dta ASCII
The format of this file i s tab delimited text. Each entry i s 1 2 c haracters wide a nd padded with s paces.
Airway Muscle Chamber 1 Chamber 2

Breath Compressed Pressure Pressure Total Volume Total Flow Pressure Pressure
Number (#) Volume (mL) (cmH2O) (cmH2O) (mL) (L/min) (cmH2O) (cmH2O)
Tracheal Ventilator
Chamber 1 Chamber 2 Chamber 1 Chamber 2 Pressure Ventilator Ventilator Pressure
Volume (mL) Volume (mL) Flow (L/min) Flow (L/min) (cmH2O) Volume (mL) Flow (L/min) (cmH2O)
Table 7-‐4: Processed Waveform Data File (*.dtb, *.dta)

Time (sec) Airway Muscle Tracheal Chamber 1 Chamber 2 Total Volume

Pressure Pressure Pressure Volume (L) Volume (L) (L)
(cmH2O) (cmH2O) (cmH2O)
Chamber 1 Chamber 2 Breath File Aux 1 (V) Aux 2 (V) Oxygen Sensor
Pressure Pressure Number (#) (V)
(cmH2O) (cmH2O)

Table 7-‐5: Raw Data File (*.rwb, *.rwa)

100

8 THE VIRTUAL VENTILATOR

The Virtual Ventilator (VV) is intended as a stand-‐in for a real ventilator when the software is used in
Stand-‐Alone Mode. With it, you can simulate the effects of positive pressure ventilation in a
straightforward way both as CMV-‐PC (Continuous Mandatory Ventilation, Pressure Controlled) and
CMV-‐VC (Continuous Mandatory Ventilation, Volume Controlled). In both modes, breaths can be either
patient triggered or machine triggered (i.e. fully independent from the breathing pattern of the
patient).

NOTE
Please note that pressure support or other more advanced operational modes are not part of
the simplified interface of the VV!

• Click Virtual Vent on the Run Time Home screen to open the Virtual Ventilator (see Figure
8-‐2).

NOTE
The Virtual Ventilator button is only visible when you open the software in Stand-‐Alone Mode,
and not when you are connected to the actual breathing simulator.


101

1 2
3

Figure 8-‐1: Virtual Ventilator in Pressure Control Mode

1. “Dial” the respective parameter control knob (or enter a number into the field below the knob) to
adjust:
• Breath Rate

• Inspiratory Flow Time
• Inspiratory Pause Time

• Inspiratory Pressure (in PC-‐CMV),
or
Set Tidal Volume (in VC-‐CMV)
• Patient Flow Trigger Threshold, and
• PEEP

2. The rotary switch control has four active positions in addition to OFF (representing no mandatory
ventilation is given, at all), two for CMV-‐PC and two for CMV-‐VC.
When CMV-‐PC is selected, the Set Tidal Volume control knob becomes inactive. It is vice versa,
when CMV-‐VC is chosen, where the Insp. Pressure control knob becomes inactive.

3. It is usually unnecessary to make adjustments to any of the parameters in this area. They represent
the “inner” compliance and resistance of the ventilator, similar to what is used in calculations
around electric circuit diagrams.

102

To illustrate use of the VV, please follow along the example below that is used for demonstrating
expiratory dyssynchrony.

• Go to the patient library and select the Adult Normal patient model as a starting point.
• Run this model (start simulation)
• Observe Waveforms, they should look as follows:

Figure 8-‐2: Virtual Ventilator Button on Run Time Home

103

• Next, activate the Virtual Ventilator and set all parameters as shown below:

Figure 8-‐3: Virtual Ventilator Settings for Exp. Dyssynchrony

104

The waveforms now look as follows:

Figure 8-‐4: Virtual ventilator Example -‐ Inspiratory Time Mismatch

You have created a situation where the duration of the patient’s breath is longer than the inspiratory
time delivered by the ventilator.

The resolution to this is increasing the inspiratory time on the Virtual Ventilator.

• Use the virtual knob on the VV panel, and increase Insp.Flow Time gradually to a value of 1.5 s.

105

The waveforms now look as shown in the screen below, where the problem of expiratory dyssynchrony
has been resolved.


Figure 8-‐5: Virtual ventilator Example -‐ Inspiratory Time Mismatch Resolved

• On the ASL Virtual Ventilator window, click to close and exit the Virtual
Ventilator and return to the simulation with only the patient’s spontaneous breathing.

106

9 THE RESPISIM® USER ENVIRONMENT

RespiSim® is the ventilator management training environment created for the ASL 5000 Breathing
Simulator when this device is used in an educational setting.
RespiSim® encompasses, where fully implemented, a number of hardware add-‐ons, including IngMar
Medical’s RespiPatient®, and the Ventilator Interface Kit, but it is also an extension of the ASL 5000
software, with greatly expanded functionality.
The RespiSim® software is designed around the idea of two physically independent screens, one for the
instructor, and the other for displaying information to the students.

NOTE
The standard licensing of the ASL 5000 software does not include the full RespiSim® package,
but a basic version (QuickChoice) that can be used for ad-‐hoc simulations in simulation centers
or respiratory care schools. A full RespiSim® license is required to enable all features described
in this manual.

z.\ Concept of RespiSim®

RespiSim® is conceptually built on immersive simulation and dynamic clinical reality. Combined with
the high fidelity ASL 5000 Breathing Simulator as the lungs of the simulated patient, it represents a
new method of teaching the subject of managing interactions between a patient and the ventilator in a
truly interactive fashion. RespiSim® follows the concept of instructor-‐driven simulation with predefined
physiology and gives the instructor the ability to:
• Have full control of all aspects of a simulation
• Provide learners with the patient status using the vital signs monitor
• Capture data from the ASL 5000 Breathing Simulator, a connected ventilator (via a Ventilator
Interface Kit), and the vital signs monitor
• Mark and annotate events
• Replay a compiled recording during a debriefing sessions or classroom instruction

There are three tabs in the RespiSim® Window Manager:
• QuickChoice/ Interactive, a quick-‐access, simplified approach to selecting and using a patient
model,
• Instructor Dashboard, a control panel for multi-‐stage scenarios authored in the RespiSim®
environment,
• Debriefing, a comprehensive view of data during a simulation and for playback after a
simulation is completed.

With the full license in place, click RespiSim® Window Manager in the Welcome window (see 5.2, page
30). RespiSim® opens in the QuickChoice/ Interactive tab view.

107

z.` QuickChoice/Interactive
QuickChoice/Interactive is the preferred approach for an instructor who does not have access to or
does not need a fully developed RespiSim® Curriculum Module for a simulation involving a patient
suffering from a number of different disease states. Notably, no specific numeric values for patient
respiratory mechanics need to be entered.

New Feature
QuickChoice/Interactive has been added to RespiSim® in Software 3.6 answering the
frequently voiced need for a simplified approach for standard disease states.


Figure 9-‐1: QuickChoice/Interactive Panel

108

1
2
3
4

Figure 9-‐2: QuickChoice/Interactive Patient Model Selection

Sequentially, make your selection of a patient model from a library that is structured by:

1. Patient Type
2. Diagnosis
3. Disease Severity

NOTE
The library for these models is separate from the one that is associated with the scenarios that
you access from either the Interactive tab or the Patient Script Editor. For details, please see
QuickChoice Patient Model Library, page259.

4. Go to Custom Severity to add any further detail to disease severity. Choices for Resistance and
Compliance range from healthy to severe, with the spontaneous breath Rate selections depending
on Patient Type and Diagnosis. You may also cancel patient effort completely (apneic).

109

6
7
8
5

Figure 9-‐3: QuickChoice/Interactive -‐ Activate

5. Click Activate Current Selection to enable Start Simulation , which will now
become selectable. Below the activation button, the message will

flash.

6. Click Start Simulation to start the simulation with the selected patient model.
Specify a location for the data output set of the simulation in the dialog box that opens.

7. Click View Current Model . The Patient Model Summary window opens, showing
the numeric values for the resistance and compliance selections and the patient effort profile (see
page 63).

8. Click to see a visual representation of lung filling as it occurs during each breath (see page 66)

NOTE
The models used in the QuickChoice library are all single-‐compartment models that use a single
bar graph as FillBar.
110

9

Figure 9-‐4: QuickChoice/Advanced Interactive

9. Alternatively, you may select or modify a patient model from the Advanced Interactive Control
Panel (AICP). Click Advanced Interactive ; the panel opens as a separate window.

111

Figure 9-‐5: Advanced Interactive Control Panel

Selections can be made from this panel as described in

112

Interactive Simulations, page 47.

NOTE
The Advanced Interactive Control Panel (AICP) of RespiSim® is limited to the tabs—Lung Model
Param., Spont. Breath Param., and Patient Library.

New Feature
The Steps Per Change (SpC) Interactive setting now allows for gradual transitioning of patient
parameters from one selection to another.

An SpC setting is applied as long as simulations are controlled from the AICP. When Interactive mode is
deactivated and scenarios are run from the RespiSim® Instructor Dashboard (see page 113), the Steps
per Change RespiSim® setting is applied (see Figure 9-‐6, page 114).

NOTE
Settings made in the Interactive Mode always override both scripted patient parameter settings
and those from a RespiSim® Instructor Dashboard Change Event. Interactive always rules.
z.k Instructor Dashboard

RespiSim’s Instructor Dashboard greatly simplifies management of multi-‐stage scenario simulations. It
also facilitates authoring of full-‐featured simulations, a process that is not covered in this manual.

To pick a RespiSim® scenario:
• Select the Instructor Dashboard tab from the RespiSim® Window Manager
• Click and pick a RespiSim® scenario from the file dialog box.
If you pick scenario NIV2000 (Non-‐Invasive Ventilation example included with the RespiSim®
software), the Initial Settings sub-‐tab of the Instructor Dashboard will look as follows:

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1
4
7
5
8
6
9
3 11 10
2

Figure 9-‐6: Instructor Dashboard, Initial Settings

1. Control and Navigation Buttons: Start/stop a simulation, invoke a pause patient model as well as
navigate to other tabs and windows within the ASL 5000 Software, including:
• Advanced Interactive Control Panel

• RespiSim® Debrief
• Run Time Home
• Vital Signs Monitor
• Event Markers.
2. Display Parameters:
Displays real time parameters from the ASL 5000, a connected ventilator (using the Ventilator
Interface Kit) or the Vital Signs Monitor in these six fields when a simulation is running. All
fields can be reassigned anytime by clicking on the parameter name.

3. Lung model, Vent Reference Settings, Vital Signs Values and ABG Values: Assigned according to a
patient’s disease state and the scenario’s starting point for treatment (ventilator reference
settings). Click Show Instructor Actions to open a window with text for
assisting the instructor with what next steps to take, or what information to provide as a feedback
to students.

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4. Current Module File (.xml): Is the file that is currently loaded as the RespiSim® scenario.

5. Instructor Guide -‐ Provides step-‐by-‐step instructions on running the simulation to meet learning
objectives (in PDF format for viewing or printing).

6. Preferences File (.rsp): Load and access RespiSim® preferences. Customize the instructional
environment to the specific subject being taught (parameters to be displayed, event categories,
alarm categories, etc.).

7. Steps per Change: Helps you define the transition from one set of patient model parameters to the
next (see also 10.6 Transition Settings, page 163).

8. PulseOxim Settings: Controls the connection port for the external SpO2 simulator (PulseOxim).

9. CO2 Setting: Controls CO2 production of IngMar Medical’s RespiPatient® (mL/min).

10. Launch RespiScope opens the software for controlling the stethoscope simulator
(RespiScope™).

11. lnstructor-‐Driven Patient Vitals: Allows you to set ABGs, chest X-‐rays, lab results, as well as heart
and lung sounds that can be made available to the student upon request.


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Additional tabs that cover subsequent stages of a simulation scenario are also structured in columns:

4
1
2
3
5 6

Figure 9-‐7: Instructor Dashboard, Change Event View

1. A total of 6 columns are provided for entering predefined scenario data representing patient states
of treatment and physiological response. They cover the typical attempts of learners to fix the
challenges presented by the particular change event (stage of the scenario). These Instructor
Settings are usually (where applicable) ordered in a worst-‐to best-‐lineup (red to green
background), with the optimal solution entered in the rightmost column. Parameters of special
significance may be highlighted with a yellow background.
2. Right-‐click on any of the columns to open a pop-‐up window with tools to copy and paste all column
entries, as well as for highlighting, and pneumo settings (applicable when used with RespiPatient).
3. If Pneumo Settings were enabled, a button for triggering a pneumothorax will be part of the
Instructor Settings column.
4. Click any of the Enable Instructor Setting buttons to activate the respective column.
5. Activate sounds and auxiliary information for the Vital Signs Monitor (student facing screen) from
the row of buttons on the bottom of the Instructor Dashboard (see page 117).
6. Click the Assessment button to see a pop-‐up that contains information
about the expected assessment at the end of the change event (stage of the simulation).
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z.m Vital Signs Monitor

The Vital Signs Monitor serves as a source of information for students engaged in simulations that
involve physiological parameters in the decision-‐making process. You may invoke it from several
screens within the RespiSim® environment:

• Click Vital Signs Monitor directly from the QuickChoice/Interactive tab, or
• Click Show Vital Signs Monitor from the AICP or the Instructor Dashboard.
• The Vital Signs Monitor window opens.

2
1
Figure 9-‐8: Vital Signs Monitor Window

New Feature
The Vital Signs Monitor now features a small scale duplicate that the instructor can place conveniently
in a fixed location on his/her primary screen to check that the students see the correct information.

1. Drag the main Vital Signs Monitor window to the desired location on the secondary, student-‐
facing screen and click Save Position on the main Vital Signs Monitor window
2. Drag the small Vital Signs Monitor Duplicate to a convenient location on the primary
(instructor) screen and click its button.

When the software is reopened later, these positions will be reapplied as preferred locations.

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The Vital Signs Monitor displays physiological data from the Vital Signs Values fields.

Figure 9-‐9: Vital Signs Values Fields

You find this same panel for data entry in:
• The Interactive Control Panel of the Standard Window Manager
• The Advanced Interactive Control Panel of the RespiSim® Window Manager
• The Instructor Dashboard

Additionally, the instructor can also make X-‐rays, ABGs, and lab results available to the student (see
Figure 9-‐10).

• While a simulation is running, click X-‐ray and Display ABG
in the row of buttons at the bottom of the Instructor Dashboard. These items will then display
as part of the Vital Signs Monitor as shown below (when available as part of a RespiSim®
Module).

• Click Hide X-‐ray and Hide ABG to remove the items from
the Vital Signs Monitor.

NOTE
Only one set of numerical data can be displayed simultaneously, either ABGs or lab results.

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Figure 9-‐10: Vital Signs Monitor with X-‐ray and ABGs


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z.o Debriefing Environment

RespiSim’s Debriefing tab provides a coherent and full featured debriefing screen that brings together
all relevant information for instructor and students in one place. While a simulation is running,
you see…

1 4
2 6

3
5
Figure 9-‐11: RespiSim® Debriefing Tab

1. Module inventory: Displays the available patient models created for a RespiSim® module
(e.g. NIV2000).
2. Simulation Control:
• Start/Stop a simulation
• Invoke the “Pause” patient model
• Freeze the display for review during a simulation
• Choose between Waveform, Loop, or Trend view
3. Navigation
• View the currently running patient model
• Open the Event Markers window
• Open a recorded simulation for playback
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• Start Interactive Mode

• Start/End RespiSim® Mode
4. Event Graph: Shows
• each breath based on Vt,
• event markers invoked by the instructor
• selected alarms from or changes made to the ventilator (with the Ventilator Interface Kit) or
changes made to the ASL 5000 simulator (patient model) settings.
5. Real Time Graphs
6. Numeric Parameters

• Click Open Playback Mode in the Navigation area to open the Playback
Mode view.

2
1
3 4

Figure 9-‐12: Debriefing, Playback Mode

When in Playback Mode, the visual appearance of the left portion of the window changes and
information about the recorded simulation is displayed, together with a set of playback controls.

1. Click the Play button to replay a simulation.

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2. You may also directly drag the green cursor in the Event Graph to a spot that you want to view.
The Event Graph shows the entire simulation and any documented changes from the Event
Markers.
3. The graphs shown are from the time indicated by the cursor line in the Event Graph.
4. Numeric parameters in the Parameter List update automatically to reflect values at the time
indicated by the cursor line in the Event Graph.
z.s Event Markers

For meaningful debriefing it is important to mark events during a simulation exercise. In the RespiSim®
environment, you do this from the Event Marker window.
To mark events from the Event Marker window:

• Click Event Markers from the Instructor Dashboard or click Open Event Markers from the
Debriefing tab.
The Event Marker window opens.

1 2 3 4


Figure 9-‐13: Event Marker Window

1. Large buttons, pre-‐labeled for each curriculum module for the instructor to mark events and
2. color codes for markings of the Event Graph, are predefined.
3. In addition to simply marking an event, instructors can enter text to be recorded for an event
before the event’s button is pressed. The text will be cleared from the field as the event is
recorded.
4. These indicators are lit for “latching events”, i.e., events that had been defined to produce a
continuous line in the Event Graph for the duration between subsequent clicks of the marker
buttons (activate/deactivate). When clicking, the corresponding event button color will stay
orange (e.g. in our example).
• Click Close Event Markers from the Instructor Dashboard or the Debriefing tab
to close the Event Marker window.
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z.u RespiSim® Preferences

RespiSim® includes preference settings for many aspects of a scenario simulation that can be used in
multiple modules or be specific to the subject taught.

• Click Open RespiSim® Preferences on the Initial Settings tab of the RespiSim®
Instructor Dashboard or via the File drop-‐down menu of the Debriefing screen (see below).

Figure 9-‐14: File Drop-‐Down Menu from Debriefing

The RespiSim® Preferences window opens in the Module tab view.


Figure 9-‐15: RespiSim® Preferences -‐ Module Tab

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In this tab, you can define paths for the module inventory support directory and the Current
Preference File Location itself. Additionally, you will also find a Module Description here.

• Click the Load button to load a new preference set (configuration). After navigating
to a support directory of a curriculum module, the file path will be indicated in the Current
Preference File Location field.
• Click the Event Graph tab to define markings in the Event Graph.


Figure 9-‐16: RespiSim® Preferences -‐ Event Graph Tab

Alarm Events are associated with alarm signals coming from a ventilator via the Ventilator Interface
Kit.

To set up markings in the Event Graph when specific ventilator alarms occur during a simulation:
• Select the parameter from the drop-‐down menu in Alarm Events.
• Select the box on the left of the parameter name.
• Define the color to be used for the markings by clicking on the color swatches on the right of
the parameter field.

The Scans marking is also associated with the Ventilator Interface Kit. When Student Scan is checked,
you will receive a marking when students have used their interface device (iPad etc.) for patient
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charting, i.e., downloaded ventilator information into their chart. Regular Auto Scan marks indicate
that ventilator data in the simulation data-‐set is up to date.

Simulation Markers are set up scenario-‐specific in the RespiSim® Preferences. They give the instructor
a means to quickly insert a mark into the Event Graph with the click of a button.

Event Text entered here in the RespiSim® Preferences will make it show up as the default text when
the Event Marker window is open during a simulation. This can beneficially be used when a student’s
verbal response needs to be captured, for example as answer to a question, or as a dosage of
medication.
• Click the green button in the Latch? column for any simulation marker. The clicked button
lights up to indicate that latching is ON (showing a line in the Event Graph that signifies a
duration rather than just an event moment). To turn latching OFF, just click the same button
again.

• Click the Parameters tab for setting up the numerical parameters in Debriefing.


Figure 9-‐17: RespiSim® Preferences -‐ Parameters Tab

You can define up to 18 visible parameters for the RespiSim® Debriefing window. The colors of the
parameter fields and any scaling for Trends in the Debriefing graphics area can also be predefined
from the RespiSim® Preferences.

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• Click any of the name fields to see the drop-‐down of all available parameters, from:
➤ ASL 5000
➤ Ventilator
➤ Vital Signs Monitor
• Select the appropriate parameter option for the position on the left to make it visible in
Debriefing.
• Click the color swatch and select a color for the numerical field in Debriefing from the color
menu that opens.
• Click the respective Trend Scale field to pick a gain factor. Since multiple trends will be
displayed in the graphic of Debriefing, it is advisable to adjust gain factors to make even small
numerical values visible in the graph.

z.| RespiSim® Teaching with Curriculum Modules

Ventilator management is a critical responsibility that demands sophisticated skills. The RespiSim®
system is capable of providing a sophisticated training environment for many aspects of the tasks
related to ventilator support.
The mechanical ventilation curriculum in respiratory care programs has, of course, the most need for
such training. On the other hand, other caregivers, such as physicians and nurses, also have to be
trained in the basic handling of ventilators. They need to have the ability to recognize potentially
dangerous events or challenging patient conditions. Scenarios for teaching those skills can be taught

within the scope of the RespiSim® system.


9.8.1 Using Pre-‐Scripted Modules
Developed in collaboration with leading educators, preconfigured RespiSim® curriculum modules save
instructor-‐time by providing a comprehensive, multimedia package of materials that describes and
demonstrates a concept or scenario within the subject matter of mechanical ventilation.

The typical components of a Curriculum Module are:
• Scenario Concept Presentation (SCP, mp4 movie-‐file)
• Instructor Guide (IG, pdf-‐file)
• Patient Model File Inventory (*.vr3-‐files)
• Support Files (sounds, X-‐rays, lab values in different formats)
• Instructor Actions and Assessments (part of the main XML-‐file) .

NOTE
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The Scenario Concept Presentation (SCP) is not directly accessible from the Instructor
Dashboard since it is not intended to be used at the time of the simulation session, but rather
as a home study item.

1. After starting the ASL 5000 software into the RespiSim® Window Manager (see page 30), go to
the Debriefing tab and click Start RespiSim® .

2. Go to the Instructor Dashboard tab. It will be open to the Initial Settings view (see page 128).

3. Click Load Scenario/Patient .

4. Navigate to the RespiSim® Modules directory and load the xml-‐file of a RespiSim® Curriculum
Module from the library (for this example, we use the included NIV2000 Module).

Figure 9-‐18: Navigation to RespiSim® Curriculum Modules

The Initial Settings pane will now look as follows:

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Figure 9-‐19: Initial Settings -‐ NIV2000

5. Click Display Instructor Guide to open the pdf of the Instructor Guide for the module.

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GENERAL SCENARIO INFORMATION
DEVELOPER NAME: ERIC KRINER CONTACT E-MAIL: info@ingmarmed.com
CASE NAME: RT 2000 NON-INVASIVE POSITIVE REVISION DATE: TARGET DURATION (MIN): 15
PRESSURE VENTILATION (NIPPV) 10/17/2014
INTENDED LEARNERS: CRITICAL CARE CLINICIANS REVISION #: 2.0 SCENARIO CONCEPT

PRESENTATION: RESPISIM NIV
!
CASE DESCRIPTION (Information for INSTRUCTOR; description for LEARNER, see p. 3)
This case initially involves a non-intubated, spontaneously breathing patient who is admitted into the ER. On initial
assessment the learner is provided enough information to deduce that the patient most likely has an exacerbation of
COPD. The learner is permitted to initially provide albuterol (and/or ipratropium), increase the FiO2, or request systemic
steroids, however, there is no appreciable improvement in the patient’s acute condition and the learner must initiate non-
invasive ventilation (NIV). Once NIV is initiated the learner must provide an inspiratory pressure of 10 cmH2O to alleviate
the patient’s work of breathing. Once an inspiratory pressure of 10 cmH2O is reached and work of breathing is alleviated,
the learner must assess and correct inadequate oxygenation. The learner will be required to increase the expiratory
pressure, but must also increase the inspiratory pressure limit to maintain ventilation. If the learner increases only
expiratory pressure and fails to increase the inspiratory pressure limit coinciding, ventilation will again be compromised
!
LEARNING OBJECTIVES (will become the basis for debriefing questions)
At the end of this scenario, learners will be able to:

1) Perform an appropriate assessment of ventilation in a non-intubated spontaneously breathing patient
2) Appropriately recommend and initiate NIPPV
3) Assess and adequately manage ventilation while utilizing NIPPV
4) Assess and adequately manage oxygenation while utilizing NIPPV
!

Figure 9-‐20: NIV2000 -‐ Instructor Guide

6. Click Initial Assessment on the Instructor Dashboard to see the patient’s
background information onscreen.
RespiSim Instructor Guide • Page 1

RespiSim Template © IngMar Medical. All rights reserved.-
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Figure 9-‐21: NIV2000 -‐ Initial Assessment

7. Drag the Initial Assessment window to a convenient location and click Save Position
. The Assessment windows will now always pop up in this location, on the
instructor’s screen.

8. Since, in this module, a supporting image exists (X-‐ray), click the Display Supporting Image
button to load it onto the screen.

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Figure 9-‐22: NIV2000 -‐ Supporting X-‐ray

9. Click Show on VSM Screen to move the image to the secondary (Vital
Signs Monitor, VSM) screen, which will make it available to the students.
10. When finished with the pre-‐simulation briefing of the students, click Close All
on the Initial Assessment window to clear the VSM screen.
11. Click on the X in the top right corner to close the Initial Assessment window.

12. On the Initial Settings tab of the RespiSim® Window Manager, click Enable Initial Setting
to make the patient model and VSM parameters active.
The button will change to Initial Setting Enabled .

13. Click Show Lung Model . You will be able to see the details of the
underlying patient model for the initial stage of the simulation.

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Figure 9-‐23: NIV2000 -‐ Initial Patient Model

14. Close this window and click Show Instructor Actions .
A window will reiterate the learning objectives for the initial assessment.


Figure 9-‐24: NIV2000 -‐ Initial Instructor Actions

15. Finally, click Start Sim. to get the simulation started. You will be asked for a location for
the data set. Please note that data sets saved from RespiSim® always have the “Save
Waveforms” checked.
16. Click Event Markers to open the window for marking up your Debriefing Event
Graph and move the window to a convenient location on the screen for ready access.

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The next step in a simulation exercise is to move to the next Change Event, which represents
possibilities of student responses to the first challenge of the scenario simulation.

• On the Instructor Dashboard, click Change Event 1 to see the first set of possible responses.


Figure 9-‐25: NIV 2000 -‐ Change Event 1

• After students pick one of the possibilities, click the respective Enable Instructor Setting
button, which then turns yellow .
• Click Show Instructor Actions for the column that represents the students’
choice.

1

Figure 9-‐26: NIV 2000 -‐ Instructor Actions

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• In the window that opens, both the Change Event and the Instructor Setting are marked.

The background color (red to green) symbolizes the progression from problematic to optimum.

NOTE
For a successful conclusion of a simulation stage (the Change Event), the instructor will always
have to ensure that the learner arrives at the Optimum Setting, otherwise it would not make
sense to proceed with subsequent Change Events.
Use the buttons on the Event Marker window for placing markers as appropriate while the simulation
is running.

• Click Assessment . Instructions regarding what to communicate to
students will pop up.


Figure 9-‐27: NIV 2000 -‐ Final Assessment

• Advance to Change Event 2 on the Instructor Dashboard and activate the leftmost Instructor
Settings column. The button will change color:

In the same fashion as described above, proceed through the steps for Change Event 2. This is the last
stage for this simulation (NIV2000). When finished,
• Click Stop Sim. to end the session.

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9.8.2 Debriefing the Simulation

After completing the simulation, open Debriefing on the RespiSim® Window Manager.
• Click the Play button to start the replay of the NIV 2000 simulation session.


Figure 9-‐28: NIV 2000 -‐ Debriefing

• Observe the location of the markers that were set previously.
• The vital parameter SpO2 change informed by the Instructor Settings that were chosen on the
Instructor dashboard during the simulation.
• The height of the yellow lines for individual breaths represent tidal volumes.
• The stepwise increase of PEEP in the simulation is also reflected in the Volume plot. As you go
to different times in the simulation, the volume plots look like this:

Figure 9-‐29: Volume Plots with Spont. Breathing, 2 Levels of PEEP

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• Click on the down arrow to pull open the Event Graph to view more details. Hovering
over individual marker entries shows the associated text and a time stamp.

Figure 9-‐30: Debriefing -‐ Event Graph Details

• After finishing the debriefing session, click the End RespiSim® button
to end the RespiSim® session.
z.z Authoring Custom Modules

IngMar Medical has developed complete curriculum teaching modules covering topics from
understanding modes of ventilation to more advanced concepts such as Dyssynchrony. The curriculum
library currently comprises about 60 modules. As you become more familiar with the RespiSim®
concept, however, you may want to develop your own custom modules.

IngMar Medical offers training in the use of RespiSim® both as on-‐site training and live distance
training (online). Please contact Customer Care or Clinical Education for details .

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As stated earlier, the strategy is to support a learner to arrive at optimal settings based on the
challenge presented in the module. The learner is expected to make ventilator adjustments based on
feedback from the patient model and vital signals. The instructor can then enable new patient models
(in a Change Event tab). For a more complex simulation, the instructor/author can populate new
Change Event tabs with changing patient models and associated vitals.

Next, the topics ahead describe the use of important elements in the creation of custom modules.

9.9.1 Instructor Guide
An Instructor Guide Template and Authoring Guide are included in the RespiSim® software distribution
(installed into ..\documentation) to guide the instructor must take for the preparation of RespiSim®
modules.

The Instructor Guide must provide the following elements:
• General Scenario Information: 
Information about the module, developer, intended learners.  
• Case Description:  
Summary of the background of the patient and the environment for the upcoming simulation.  
• Learning Objectives:
A listing of the objectives expected to be achieved by the learners. 
• Scenario Overview:
Includes the Initial Assessment and Change Events to be used.  
• Patient Information and History:
Details about age, setting, history, vitals, labs, etc.  
• Initial Assessment:
Detailed assessment and files used in the simulation in the Initial Settings tab.  
• Change Events:
Breakdown of each Instructor Setting group within a given Change Event. This covers vent
reference settings, lung models to use, vitals, etc.  
• Debriefing Planning and Questions:
• Information on preparing for the debrief session, questions to be asked at the conclusion of the
simulation and during debrief.  

9.9.2 Instructor Settings Columns
The Change Event tabs encompass several Instructor Settings columns which hold the characteristics
of each step of a patient scenario.
>>Always start with the Initial Settings tab. In the four additional Change Event tabs, each column can
be populated based on the module being created. The instructor/author is expected to fill each column
that is going to be used as a potential state with the following information pertaining to the scenario:
• Patient model
• Vent reference settings (the ventilator settings expected for a particular state of the simulation)
• Vital signs

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• ABG values
• Instructor actions
You will not always use all Instructor Settings offered in a Change Event. Unused columns will be
covered up when re-‐calling the scenario later.

1


Figure 9-‐31: Change Event -‐ Vent Reference Settings

• Enter baseline settings into the leftmost column that reflect the conditions at the onset or
discovery of the problem/challenge.
• Create different treatment pathways (vent settings) that a learner may choose to manage the
patient status.
As you move from left to right , provide the least optimal to the most optimal
treatment decision (vent settings) and how the patient’s body would react to these changes (vitals
and/or ABG values). It is in selecting these settings that the instructor/author’s clinical experience and
knowledge is critical for creating a meaningful and authentic learning experience.

• Create a patient model that corresponds to the respiratory mechanics of the disease state of
the patient and reflects the spontaneous breathing pattern while under treatment.
• Enter vitals and ABG values that match the expected patient response based on your clinical
expertise.
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9.9.3 Populating Instructor Setting Columns

Right-‐clicking inside of any of the editable fields within an Instructor Setting column enables a number
of editing features (see below figure).

• Copy Column – copies all data from a single column  
• Copy All Columns – copies all columns from the currently open Change Event onto the
clipboard 
• Paste Column – paste copied data from the clipboard into a single column
• Paste All Columns – paste data from the clipboard into all columns within a Change Event
• Clear Column – clear all data  
• Enable/Disable Highlighting – highlight specific parameters within a column (see Figure 9-‐33) 
• Enable/Disable Pneumo Settings – enable/disable tension pneumothorax control for an
individual column (RespiPatient® option)
• Enable All Pneumo Settings – enable tension pneumothorax control for all columns in the
ChangeEvent (RespiPatient® option)
• Disable All Pneumo Settings – disable tension pneumothorax control for all columns in the
ChangeEvent (RespiPatient® option)

It is good practice to highlight specific parameter changes as you progress through a scenario. In the
plug-‐and-‐play RespiSim® modules, for example, vent settings that need to change in order for the
patient to reach optimal status, are highlighted.

1. Right click on any Instructor Setting column and the drop-‐down menu (see Figure 9-‐33)  will
appear.


Figure 9-‐32: Instructor Setting Editing Features

2. Click Enable/Disable Highlighting and the Parameter Highlight Configuration window will display.

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In the Parameter Highlight Configuration window:
3. Select the parameters you want to highlight

4. Click Close for the changes to take effect, or
5. To start over, click Un Highlight All to start over.


Figure 9-‐33: Parameter Highlight Configuration

9.9.4 Instructor Actions
You can enter information into the Show Instructor Actions windows for all settings columns and
Change Events. The information in each Instructor Actions window should be based on the choices
made by the learner.
This is where the instructor or physician can agree or disagree with a treatment choice made by the
learner and provide corrective suggestions. A second purpose of comments entered here is to help
instructors guide/coach themselves too.

140

• In any Instructor Setting column in a Change Event panel, click Show Instructor Actions
.

Figure 9-‐34: Instructor Actions Example

• Edit text as needed directly into the window.
• Click Close to return to the Change Event panel.

NOTE
Edits are not saved immediately. They become permanent only after the whole module is saved
from the Initial Settings tab.


9.9.5 Patient Models
Patient models (*.vr3 files) can be designed to include various compliance, resistance, and effort
settings that represent the diseased or improving states of a patient while on the ventilator.
Patient models may be:
• Passive and only respond to the ventilator, or
• Spontaneously breathing, thus requiring synchrony in the ventilator settings.
These models can be put into the Instructor settings columns on the Instructor Dashboard to
represent the advancement of a patient’s condition from the stage of initial challenge to the final
assessment (improved state).
To add a patient model to the simulation,

• Click the folder icon at the top of each Instructor Setting column on a Change Event panel (see
Figure 9-‐25).
• Navigate to a prepared patient model and click to select.

141

The instructor should develop each patient model before creating the RespiSim® module. This may also
be done in the Standalone Mode of the ASL 5000 software, without the actual simulator attached.
Patient models can be designed and placed anywhere on a computer, but it is recommended to keep
all *.vr3 files within a directory that will be used as a general repository for model files.

NOTE
It is recommended to always start with the Initial Settings tab as the first state of the patient.

You can always use Show Lung Model to view details of the patient model (see
Figure 7-‐18: Current Patient Model Summary, page 63).

9.9.6 Lung and Heart Sounds
RespiSim® provides two methods for working with lung and heart sounds:
• The first (conventional) method is to add sounds for playback from the PC’s speaker.
• The second (advanced) method uses the IngMar Medical RespiPatient® in combination with a
RespiScope™ auscultation simulator.

For the conventional method,
1. Right-‐click on Lung Sounds or Heart Sounds
from any Change Event view and the View/Edit Lung Sounds or View/Edit Heart Sounds
window, open respectively.


Figure 9-‐35: View/Edit Lung Sounds Window
2. Click the folder icon to navigate to the appropriate sound file. Formats accepted are
*.wav or *.au.
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3. Type directly into the Lung Sounds Description field to describe the sounds.
4. Click Display to make the description of the sound visible on the Vital Signs Monitor window for
the students.
5. Preview the sound directly from the View/Edit window by clicking the Play button inside
the WindowsMediaPlayer, or by clicking the Play Sound button
.

6. Click OK to close this window.

During a simulation, you can click Lung Sounds or Heart Sounds on a Change Event panel at any time
to hear the sound. The computer running the simulation will need to have the volume and speakers
ON to hear these sounds.

NOTE
It may help to have external speakers when using this option and projecting sound to a larger
group.

The second—advanced—method of producing sounds for learners during a simulation is through
IngMar Medical’s RespiScope™ software. With it, you can select realistic sounds for nine different lung,
heart, and bowel regions on the RespiPatient® manikin that the learner can listen to via the SimScope™
stethoscope, an auscultation simulator. RespiScope™ software saves specific sound configurations to a
playlist file (*.car), that assigns sounds to the nine listening regions of the RespiPatient® manikin.


Figure 9-‐36: View/Edit Lung Sounds With RespiScope™

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• Click the folder icon , and select the *.car-‐file (instead of loading a *.wav file) for use
during the simulation.
• Click to edit the RespiScope™ sound file, > the RespiScope
Sounds Editor interface opens.

You can also open the RespiScope™ software from the Initial Settings tab of the Instructor Dashboard:
• Click Launch RespiScope .

To learn more about using the RespiScope™ software, please see the RespiPatient® manual.

9.9.7 Chest X-‐ray
Upload chest X-‐rays from your EMR system/archives as additional information on patient status. They
will typically be shown upon learners’ request or as an initial briefing on the patient at hand.
X-‐rays display in the Vital Signs Monitor screen. The RespiSim® software can use two image sizes based
on instructor preference:
• Large X-‐ray – 600 x 600 pixels
• Small X-‐ray – 300 x 400 pixels

New Feature
Images you may have selected that do not conform to these dimensions will be automatically scaled
with black margins to adjust aspect ratio, but they will not be cropped. No manual resizing is necessary.

• Right-‐click X-‐ray from any Change Event view > the View/Edit X-‐ray
window opens (refer below image).

• Click the Display button to make the X-‐ray visible on the Vital Signs Monitor
window for the students.

144

Figure 9-‐37: View/Edit X-‐ray

• Select either the Large X-‐ray or Small X-‐ray option button, depending on the format you want
to assign. You can use the same X-‐ray image for both formats or assign separate ones.
• Click the folder icon to open the navigation window and find the location where the
image is stored. Select the file and return to the View/Edit X-‐ray window.

The small image will be attached to the side of the Vital Signs Monitor.


Figure 9-‐38: Small X-‐ray
The large X-‐ray will be overlaid over the Vital Signs Monitor.

145

Figure 9-‐39: Large X-‐ray

• Click to close the View/Edit X-‐ray window.

During a simulation, you can click or on a Change Event
panel at any time to toggle between the visible and hidden display modes for X-‐rays.

NOTE
In case the VSM window was closed when you activate X-‐ray, it will be opened automatically.

9.9.8 Lab Results
Lab results in RespSim curriculum modules help learners to use the results of laboratory tests when
managing mechanical ventilation. To prepare a text file to be used as lab results file follow these simple
steps:
• Open a simple text editing application like Notepad on your Windows-‐based computer
provided.
• Type the lab test name on the left (i.e. BUN) and then click the tab button on the keyboard
once.
• Type the numerical value with correct units (i.e. 21 mg/dL).
• Click the Enter/ Return button on the keyboard to add another lab result.
• Save the lab results as a *.txt file. (i.e. NIV2000labresults.txt) in the module’s support files
directory.
146

To assign lab results files to simulation exercises:
• Right-‐click on Lab Results from any Change Event view > the
View/Modify Lab Results window opens.

Figure 9-‐40: View/Edit Lab Results

• Click the folder icon to open the navigation window and find the location where the lab
results text file is stored. Select the file and then return to the View/Edit X-‐ray window.
• Click the Display button to make Lab Results visible for the students on the
Vital Signs Monitor window.


Figure 9-‐41: Vital Signs Monitor -‐ Lab Results

147

During a simulation, you can right-‐click or on a Change

Event panel at any time to toggle between visible and hidden display modes for lab results.

NOTE
If the VSM window is closed when you activate Lab Results, it will be opened automatically
when you activate Lab Results.

9.9.9 Arterial Blood Gas Values

1. ABG values are entered directly into each settings column within the Instructor Dashboard Change
Events. When a simulation is running, the ABG values from the column that is enabled are
displayed.
2. To show ABG values in the Vital Signs Monitor window upon a learner’s request, click Display ABG
.

1
2
Figure 9-‐42: Display ABG Values from Instructor Dashboard

148

9.9.10 Instructor Dashboard Real Time Parameters
You may customize modules by selecting up to six parameters (ASL, Vent, or Vital) that will be visible
to instructors on the Instructor Dashboard. Select parameters that are crucial to the progression of the
specific simulation. For example, if a learner decides to initiate a lung protective strategy (LPS) on the
ventilator (decrease Vt, increase RR), the instructor may want to have visual feedback of those setting
changes (using either the ’ASL’ or ’Vent’ parameters) in order to know when to activate the patient
model appropriate for the LPS.

These parameters are intended to assist an instructor who may not be present in the simulation room
or have a direct view of the changes being made on the ventilator.

1 User’s Manual ASL 5000, SW 3 .6, Rev.1, © IngMar M edical, L td. 2016

Figure 9-‐43: Instructor Dashboard Real Time Parameters

1. Click a parameter name (default is (ASL) Breath Number) to open the drop-‐down for all available
breath parameters. Select the desired parameter and proceed in the same fashion for all 6
available parameter fields.

149

NOTE
The selections will be saved together with other settings and content in the module’s xml-‐file
and are independent from the parameter selection for Debriefing, which is managed by the
Preferences file (*.rsp-‐file)

9.9.11 Saving RespiSim™ Modules
A module, when finished, comprises several files. The main module file is an XML-‐file that contains
information about the structure of the module, instructor actions, file locations, etc. This is the file that
you will load if the model is going to be used later, for example trigdys.xml.
In addition, saving a module creates a support file directory of the same name as the xml-‐file. This is
where all other files that belong to the module, such as sound files, X-‐rays, patient models, lab results,
are placed. In this example it is—trigdys support files.


Figure 9-‐44: RespiSim® Module File Directories

Frequently, you may want to link to supporting files that are kept in other locations, for example to X-‐
ray images in a larger X-‐ray repository. RespiSim® will place copies of those files into the support file
directory of your new module automatically for you.

NOTE
When you move a whole module file directory including its support file directory to a new
location, the file links might become “broken”. This might happen when you place modules
from an earlier installation of the ASL 5000 Software into the new location (3.5 becomes 3.6,
but the file reference is still to 3.5, see Figure 9-‐45).
150

Figure 9-‐45: Support File Notification

The feature of automatically recreating a support file directory can be used to easily move a module.

1. Only move the xml-‐file (the “module file”) to the new location (instead of moving all the files)
or
2. Copy the whole module directory (xml-‐file, concept presentation mp4-‐file, support file
directory) to the new location, without deleting the files in the old location.
3. Save the module.

NOTE
To use this technique, it is important that the support files still exist in the original location.
After you saved the module (and copies were made in the new location), you can safely delete
the old module.

CAUTION!
Simulation Concept Presentations are not part of the automatic process of recreating a
support directory and need to be moved manually (unless you copied the whole directory from
the old location).

151

10 CUSTOMIZING THE USER ENVIRONMENT

The ASL 5000 Breathing Simulator is being used in many different environments, from validation and
verification testing to research and development, to educational studies and training.
Frequently, different groups of users use the same device for different purposes. Considering this, the
ASL 5000 software has been designed to provide a way to store such multiple User Profiles for many of
its default settings.

NOTE
Preferences for the RespiSim® environment are separately covered in 9.7 RespiSim®
Preferences, page 123.
\t.\ User Profiles

• Click User Settings to access the ASL User Settings window directly from the Welcome
Window after opening the software.


Figure 10-‐1: Welcome Window -‐ User Settings Selection

You can also access the ASL User Settings from all tabs of the Standard Window Manager or the
RespiSim® Window Manager by clicking the Help/Customize menu item.

152

Figure 10-‐2: Help/Customize -‐ User Settings

On the ASL User Settings window that opens, there are separate tabs for all the types of customization
you can perform. The ASL 5000 stores these settings in a Project File.


Figure 10-‐3: ASL User Settings Window

Connection Settings include:
• Output Data Settings
• Appearance/General Settings

153

• Script Editor Preferences

• Transition Settings
• Default Analysis Parameters
• Virtual Ventilator

The default user settings are kept in Current ASL Project File.ini.
• Click Load to access a previously saved profile of user settings.
• The file selection dialog box opens (xxx.ini). Navigate to the desired Project File and click OK.

Similarly, once you have made all adjustments to the user settings and want to preserve the new
profile,
• Click Save As and navigate to the folder where you want the profile to be stored.
• Enter the file name (without the .ini file extension) and click OK.

Figure 10-‐4: ASL User Settings Files in ASL User Settings Window

\t.` Connection Settings

There are two different ways to connect the ASL 5000 Breathing Simulator to the PC, via Ethernet or

the USB (serial connection). For the physical connections, please refer to 4.1 Electrical Connections,
page 20. The ASL 5000 Connection Type, as default, will be showing “Ethernet” in the Connections
Settings tab.

10.2.1 Ethernet Connection
The preferred method of connection is wired Ethernet. A wireless connection is possible using the
supplied router (which then has a wired connection to the ASL 5000). See Figure 4-‐2 on page 21 for this
setup. The router creates its own network and issues IP addresses to each device on the network, (the
ASL 5000 and the PC). This service is called DHCP and is the default setting.
You then select the connection to the ASL 5000 by its ID, i.e., ASL_xxxx where xxxx is the serial number
of the ASL 5000.

On the Connection Settings tab of the User Settings window (see Figure 10-‐3):
• Verify that the Use ASL Identification Number option button is checked.
• Enter the serial number of the ASL 5000. In the example pictured it is 1000.
154

Sometimes, you might be required by your IT-‐department to give the ASL 5000 a specific, fixed IP
address. In this case,
• Click the Use IP Address option button.
The Connection Settings tab will then appear as follows.


Figure 10-‐5: Connection Settings -‐ Fixed IP Address

• Enter the full IP address into the IP Address fields.
(IP addresses are always a set of four numbers with a maximum of 3 digits each, separated by periods.)

NOTE
Before you can connect to an ASL 5000 via a fixed IP address, it itself first needs to be set up
with this address. Please refer to the Maintenance section of this manual for the proper
procedure.

155

10.2.2 Serial (USB) Connection

The ASL 5000 operates with a built-‐in serial-‐to-‐USB converter which, on your PC, has an assigned
communications port (COM-‐port) number, usually the default number 1. It is recommended that you
check this assignment before making any adjustments in ASL User Settings. In Windows 7 or Windows
10, you can check in the Device Manager to ascertain which port is assigned to the hardware ASL Host
(or SeaLINK +232 USB to RS-‐232Converter in legacy devices).

With the ASL 5000 Connection Type showing the default “Ethernet” in the Connections Settings tab,
• Click the drop-‐down and select the COM-‐port that corresponds to the assignment that you have
found on the PC for the serial hardware of the ASL 5000.


Figure 10-‐6: Connection Settings -‐ COM1
156

\t.k Output Data Settings

The Output Data Settings tab allows you to assign a name of your choice to all files in the output data
set, with the different extensions for each file type. To do so:
• Click the folder icon to change the ASL 5000 Output File Path.
• The file selection dialog box opens. Navigate to the desired location (file folder) and click Select
Folder .
All files in the output data set will now will be assigned the name you chose, with the different
extensions for each file type.

The ASL 5000 Report Header Information applies to reports generated from the Run Time Home panel
(see page 45).

• Type new text directly into the field for ASL 5000 Report Header Information to replace the
default text ASL5000 Software.

Figure 10-‐7: Output Data Settings

157

\t.m Appearance/General Settings

On the Appearance/General Settings tab of the ASL User Settings, you can define the color scheme to
be used in all graphs.
The graphs use a uniform background color and a plot color assigned by the order of the plot in the
graph.


Figure 10-‐8: Appearance/General Settings

1. To change a color, click on the plot sample and make your selection from the Color menu item.

NOTE
Other plot attributes, such as Line Style or Line Width will not be preserved in the ASL User
Settings, but can be set for an individual plot in a specific graph.
“Notes:” is intended to keep information about the ASL User Settings configuration (the
profile).

2. To enter your notes, type directly into the Notes: field.
158

In the Window Managers’ menu bar, you also find a menu item for customizing graph colors.

Figure 10-‐9: Help/Customize – Graph Colors

3. Click Graph Colors. The Customize Graph Colors opens:

Figure 10-‐10: Customize Graph Colors

To change a color, click the plot sample and make your selection from the Color menu item (see Figure
10-‐8).
4. Click Apply if you want to use the new color scheme immediately.
5. Click Save to Project File if you want to permanently save the new color scheme in
ASL User Settings with a user profile.
6. Click IngMar Default Colors to revert to the default color scheme.
7. Click Finish to finish and close the window.

159

\t.o Script Editor Preferences

Script Editor Preferences helps with managing relative file locations.
The purpose of scripts is to:
• Define the sequencing of the repetitions for patient model files (*.vr3-‐files)
• Help find the locations of the patient model files: The ASL 5000 Script Editor uses, where
available, shortcuts for specific file folder paths. With shortcuts, also referred to as tokens,
existing scripts can easily be moved together with their inventory of patient model files to a
new location. Instead of having to “fix” all individual file location references in a script, only the
definition of the token that points to the file folder where the files were saved, needs to
change.

The Relative Path Configuration Tool can be accessed from the Script Editor Preferences in ASL User
Settings (see below) as well as from the Manual Scripting tab under Script/Patient Model (Standard
Window Manager) (see Figure 6-‐5, page 17).


Figure 10-‐11: Script Editor Preferences

160

Scenario Scripts Library is the directory that you want assigned to your Scenario Scripts upon start of
the software (see 7.3.1, Scenario Scripts on page 55).
It is C:\Program Files (x86)\ASL Software 3.6\vars\Scenarios by default.
• Click the folder icon to define the new file path for the Scenario Scripts Library.
Folder .

Click Launch Relative Path Configuration Tool to
open the Relative Paths Configuration Tool window.

Figure 10-‐12: Relative Path Configuration Tool

The table of Configured Relative Paths will always have two entries by default:
<ASLVarsDirectory> C:\Program Files (x86)\ASL Software 3.6\vars
<ASLDefaultInstallDir> C:\Program Files (x86)\ASL Software 3.6.

NOTE
Both of these tokens/entries and their definitions are protected and cannot be changed by the
user.

Click an entry and click Edit to open a window for assigning a token name to an actual
path (or segment of a path).

161

Figure 10-‐13: Add/Edit Relative Path

• Click the folder icon to define the actual file path for which the token will be the symbol.
Folder .

• Type the name for the shortcut in the Token: field.
• Click OK to accept the choices and to close the window.

• For adding a token, start with in the Relative Path Configuration Tool and
proceed in the same fashion.

• Click Done on the Relative Path Configuration Tool when finished with
assigning tokens.

162

\t.s Transition Settings

New Feature
Not always is it advisable to have patient models abruptly change from one state to the other,
specifically when parameters between two states differ significantly. Therefore, a mechanism is
available to assign, in advance, how many breaths it will take to transition from one state to another.


Figure 10-‐14: Transition Settings

Steps Per Change are set independently for Interactive Mode (applies both to the Standard Window
Manager and in the RespiSim® Window Manager Interactive Control) and simulations controlled from
the Instructor Dashboard (RespiSim). You have four settings available, Immediate, 3, 6, and 12 steps
(breaths) to fully transition to a new setting. Multiple parameters can change simultaneously.
If, in Interactive Mode, an additional change is requested while the system is still responding to a
previous one, the state the patient model is in at the time the new change was requested will serve as
new starting point, and it will again take the predefined number of steps for the transition.

163

The locations where you can adjust Steps per Change locally are highlighted in the below images:

Figure 10-‐15: Steps per Change Locations

NOTE
Here, Interactive Mode rules implies that the setting you fixed for Steps per Change in
Interactive Mode takes precedence over the setting for RespiSim, as long as Interactive Mode
is activated.

164

\t.u Default Analysis Parameters

A set of 8 Breath Parameters is displayed in the Real Time Analysis page (Standard Window
Manager). The choice of these parameters is defined in the Default Analysis Parameters view.
Additionally, you can also predefine the traces for Trend View here, which are tracked in Post Run
Analysis.

1. For these trends, choose a gain factor to ensure good visibility of all four parameters relative to one
another.

1

Figure 10-‐16: Default Analysis Parameters Settings

165

\t.| Virtual Ventilator

In the Virtual Ventilator settings tab, you can preset all controls of the Virtual Ventilator.

1
2


Figure 10-‐17: Virtual Ventilator Settings

1. To make a change, directly type the new value into one of the fields provided.

2. Settings for the four modes possible in the Virtual Ventilator are number coded:
• 1 = PC-‐CMV (Pressure Control – Controlled Mandatory Ventilation), no patient trigger
• 2 = PC-‐CMV (Pressure Control – Controlled Mandatory Ventilation), with patient trigger
• 3 = VC-‐CMV (Volume Control – Controlled Mandatory Ventilation), no patient trigger
• 4 = VC-‐CMV (Volume Control – Controlled Mandatory Ventilation), with patient trigger

The Vent Resistance and Compliance settings normally should not be adjusted/modified from their
defaults.

166

11 WORKING WITH ADVANCED FEATURES

In the first part of this manual, a more concise, step-‐by-‐step approach was used to familiarize the
novice user with the main concepts and to make the ASL 5000 Breathing Simulator more accessible.
More advanced features that would not apply to many users, are now covered in the chapter ahead.
\\.\ Advanced Patient Modeling

You can create sophisticated detail-‐to-‐patient models for the ASL 5000 Breathing Simulator in both the
respiratory mechanics portion of the model (the Lung Model), as well as in the spontaneous breathing
model (the Effort Model).

11.1.1 Advanced Features for the Lung Model
While the simplest single compartment lung model requires only 3 parameters to be set, a two-‐
compartment model can have as many as 9 parameter settings.

1. Uncompensated Residual Capacity or URC:
URC designates a baseline volume as measured from the simulator piston home position
(excluding the 200 mL in the “safety zone1” or “Cylinder Deadspace” at the very front of the
cylinder).

2. The value for tracheal resistor Rt (which can either be linear, parabolic, or mixed, depending on
the respective switch setting in the lower half of the screen), with different values for
inspiration and expiration as Rin and Rout if the switch in the lower half of the screen has been
activated. 

3. The values for R1 and R2, the respective bronchial resistors leading to compartments 1 and 2
(with the additional, independent values R1out and R2out (for independent setting of
resistance during expiration).  

4. The values for C1 and C2, i.e. the respective compliances of compartments 1 and 2.  

1
200 mL is the value of the home position volume that is always maintained as a safety zone against any piston-‐
overruns at the forward position. This value is only 25 mL when using the Preemie Cylinder add-‐on option.

167

NOTE
As a rule, you should try to keep the complexity of the models low and only use two-‐
compartment models when there is a specific reason (for example, a pneumothorax
simulation).

A fully featured linear lung model will look as follows in Step 2 of the patient model creation process:

1
2
3
5

4
2

Figure 11-‐1: Two-‐Compartment Linear Patient Model (1)

1. URC (independent of a real patient’s FRC values):
Functional Residual Capacity or FRC of adult patients might be considerably larger than what is
allowed as the largest setting for URC in the ASL 5000, i.e., 1.5 L. Since calculations for model
response do not, however, depend on the size of residual capacity, a value for URC may be
chosen that is independent of a real patient’s FRC values.

168

% #&$#

! "##$

Figure 11-‐2: Volumes in the ASL 5000 Cylinder

'
()*

The choice needs to consider, on the one hand, sufficient baseline volume to allow any
expected forced exhalation without running into the forward piston position limits. On the
other hand, URC values need to allow the expected tidal volumes within the simulator’s volume

capacity (Vt+URC+0.2L < 3L is required).

NOTE
As long as the Compensations switch has not been set to ON, the compressibility of this volume
will add “parasitary” compliance. (See also "Advanced Model Settings -‐ Compensations" below.)
! "##$

2. Tracheal Resistor Rt: The different modes for this resistor adhere to these definitions:
• A linear resistor value is defined by a simple proportionality between pressure and flow of
the type % #

P= R x Flow , where units of R are usually given as L/s.

• A parabolic resistor, on the other hand, is defined by a k-‐value that originates in the F1100

ANSI standard and the following relationship between pressure and flow:

k Flow2, again, flow being measured in L/s.
P =

• In the mixed case, the linear relationship is used for low flows/pressures and the parabolic
for the
higher pressures. The transition "##$
! occurs at the point where resistance calculated as
parabolic exceeds linear resistance (see Figure 11.3 on the next page). The rationale for this
is that the linear approach for low pressures avoids a particular effect that occurs around
zero pressure. Here, even the slightest change in pressure would be associated with a
significant flow change, because of the shape of the parabolic curve.

169

Figure 11-‐3: Pressure/Flow Relationship for Different Resistor Types

3. Lung (alveolar) Resistors R1 and R2: These resistors only exist as linear resistors, since flow in the
alveolar lung vessels can be assumed to be laminar. Their pressure/flow relationship follows the
same formula as described for the linear Rt above.

4. You can elect to make all resistors dependent on flow direction, i.e., select independent values for
inspiration and expiration. For example, in cases of asthma, a patient is likely to exhibit a more
restricted air flow during expiration.

5. Compliances C1 and C2: Compliances, in the modeling for the ASL 5000, are always considered
compound compliances that include both the effects of lung elasticity as well as those of the chest
wall. They can be either linear or non-‐linear.

In the standard case, the model would use a linear C for both these parameters, where the relationship
is simply C = V/P, where volume is given in mL and pressure is measured in cmH2O. Today, you will
frequently find Compliance given in units of the ISO system, and it is helpful to remember that a C50
[mL/cmH2O, for example, corresponds roughly to a C 0.5 when measured in kPa/mL.

170

6 8
7

Figure 11-‐4: Two-‐Compartment Linear Patient Model (2)


6. Compensations: When building a patient model, you will use compensations as a way to arrive at
the exact specified respiratory mechanics for the overall system in the presence of parasitary
compliances and resistances. If, for example, compliance of the patient circuit should be taken into
consideration and the overall compliance (what the ventilator “sees”) should be exactly the
nominal value, switch Compensations ON and enter the additional volume of the circuit into the
field Vtubing (L).

7. The Waveform Sampling Rate (Hz) selection allows you to specify how many data points per
second you would like when capturing waveforms. Choices are 512 (default), 256, 128, and 64 and
not always is the high resolution of the default setting necessary. Especially when capturing long
simulations, choosing a lower resolution in the time domain will keep data file sets more
manageable in size.

171

11.1.1.1 Non-‐Linear Compliance

Non-‐linear compliance means that the relationship between volume and pressure is modeled
realistically as a sigmoidal (S-‐shaped) curve.

8. You can design non-‐linear Compliance into your model using the Non-‐linear Compliance switch
(see Figure 11-‐4, page 171). It will become available only when you have chosen a two-‐
compartment model, otherwise it will be inactive (grayed out).

NOTE
Internally, the ASL 5000 patient models are always interpreted as two-‐compartment models.
When you select a one-‐compartment model, it is implemented as two compartments with
exactly the same features. When choosing non-‐linear compliance, you can still opt for this
configuration by clicking the C1=C2 checkbox.

• To open the Non-‐Linear Compliance Editor window, click Edit C1 or Edit C2 . .

3 1
2

Figure 11-‐5: Non-‐Linear Compliance Editor

You can directly drag points and intercept lines with your mouse pointer in the graphical
representation or enter numbers into the columns on the right. The graph shows the full range of
pressures for which you have defined a volume response in the lung compartment.

172

NOTE
In order to avoid unpredictable results, you must define the relationship for the whole range of
pressures that are expected to occur when using this patient model, 0 to 40 cmH2O in the
example.

Please keep in mind that you will always see the volume for one compartment only on the left of the
graph. With C1=C2 checked before entering the Non-‐Linear Compliance Editor, an additional legend
Total Volume Both Compartments (L) will show on the right of the graph.

1. The curve is linear between the two horizontal intercept lines.

2. Nominal Compliance is a value that is determined as the linear compliance equivalent; it is the
middle point of the linear portion of the curve (starting at the origin of the graph). It is represented
by the green line in the graph. If you switch back to a linear compliance model, this is the value that
will be used as a starting point for C in this case.

3. Inflection Point 1 and Inflection Point 2 are the equivalent of what is commonly referred to as the
lower and upper inflection points in P/V graphs.

NOTE
Compensations will be turned OFF when working with non-‐linear compliance. Allocation of
compliance adjustments would have to be arbitrary and therefore should rather be made
proactively by the user.

11.1.1.2 Time-‐Varying Parameters for the Patient Model
It is sometimes desirable to be able to create patient models that vary, breath-‐by-‐breath, over time.
Instead of having to create a script that has a new entry for every breath of the patient, you configure
such time-‐varying-‐parameters’ models (TVP models) inside of a specific patient model.

The TVP-‐set of patient parameters exists in parallel to the static values and is called upon when the
TVP flag is ON. For this reason, once the TVP switch activates TVP mode, it is required that all
parameters of the model are present as TVP. This will include also those that you don’t actually want as
time-‐varying. In this case, simply assign constant values to these parameters inside the TVP Editor.
1. With the Time-‐Varying Parameters switch in the Time Varying position, click Edit .

The Time-‐Varying Parameter Menu pop-‐up displays:

173

2

Figure 11-‐6: Time-‐Varying Parameters Menu

2. Double-‐click any of the parameters to edit its time-‐varying behavior in the Variable Parameters
Editor. The Variable Parameters Editor is essentially a script editor window for building change
behavior in individual segments (not unlike how it is done for the simulation script itself).

174

Figure 11-‐7: Time-‐Varying Parameters Editor

• Single-‐click one of the entries in the table highlights (with a thicker line) the corresponding
segment in the graph.
• Double-‐click on a segment to bring up the Curve Segment Editor, where you can actually design
the type of transients you want the parameter to perform.


Figure 11-‐8: Curve Segment Editor, Curve Types

Several types of functions are available:
• Linear start value and slope
• Endpoints start and end values)
• Power Y = Start Value + Constant * X^(exponent)

175

• Exponential Y= Start Value + Constant * e^(exponent * X)

• Sinusoidal Y= Start Value + Amplitude * sin ( X/Period + Phase Shift)
• Random uniform and Gaussian distributions
Additionally, you can also use a text file to insert parameter points (File option).

NOTE
When sequencing parameter curve segments, it is the user’s responsibility to match up
parameter values at intersections between segments, in order to achieve smooth parameter
transitions.

Both stochastic distributions are modified from their originals for reasons of practicality.

The uniform distribution uses a seed value, a mean, and an amplitude threshold limiting the range of
allowed values. Values outside of the range are clipped.


Figure 11-‐9: Curve Segment Editor, Uniform Distribution

176

Figure 11-‐10: Curve Segment Editor, Gauss Distribution

The Gauss distribution defines its amplitude by mean and standard deviation. Max and min values are
added providing a range. Values outside of the range are clipped.

NOTE
You can also invoke pre-‐defined TVP from the Interactive Control Panel’s Library. Individual
control of parameters is then disabled in the ICP tabs
• After completing a segment, click and proceed to the next segment from the Time-‐
Varying Parameters Editor, as needed.
• After completing setup of all segments for an individual parameter, click in the Time-‐
Varying Parameters Editor to return to the TVP-‐Menu. Repeat the process for all other
parameters.

If no variation over time is desired for a particular parameter, simply use a segment of 1 repetition of
the linear type and enter the desired value into the start and endpoint (or start point with a slope of 0).
TVP-‐transients are always defined relative to the beginning of the segment, not relative to the whole
simulation.

NOTE
If a parameter is used in a simulation for more repetitions than the cumulative segments in the
TVP Editor gives values for, the last used value will be repeated indefinitely.

177

11.1.2 Advanced Features for the Patient Effort Model

11.1.2.1 Technical Trigger Effort Model
The two patient effort models Pressure Trigger and Flow Trigger (see also page 89) are designed for
generating constant pressure (or flow, respectively) for short periods of time.

In order to do that for Pressure Trigger mode, Pmus is calculated internally to overcome resistance and
compliance of the model in addition to generating the respective negative pressure. The negative Paw
to be achieved is expected a with a fully obstructed port ( a fully open port, on the other hand, would
not allow to generate any negative Paw).

For Flow Trigger mode, Pmus is, again, calculated to overcome resistance and compliance of the model
as the ASL 5000 inhales, but here the goal is to provide a constant flow as long as there is no external
load (open port). The intent is to provide the user with a way to evaluate the flow and pressure trigger
thresholds of a ventilator with an artificial signal of a predefined magnitude and rapid onset.

Figure 11-‐11: Technical Trigger Efforts

NOTE
Of course, an argument can be made that it is more realistic to evaluate ventilator trigger
performance with a natural breathing pattern. Regardless, it is always important to note that
trigger sensitivity is greatly influenced by the shape of the patient effort. A gradual onset of
effort is likely to cause larger delay than a rapid increase.

11.1.2.2 Sinusoidal Patient Effort
Sinusoidal Patient Effort is the most frequently used mode when generating natural, realistic patient
efforts, both for patients that are supported with positive pressure ventilation as well as those
breathing completely on their own.

NOTE
The following details about editing a sinusoidal patient effort model apply in the same way to
the trapezoidal effort model. The resulting flow and volume patterns are actually not very
178

different. Sometimes it might be more straightforward to explain the effort pattern that
consists of linear elements rather than the sinusoidal pattern.

3
8
2 7 5
4
7
1
6

Figure 11-‐12: Sinusoidal Effort Model

1. The pressure graph at the bottom left shows the effort of the model.

New Feature
2. Above it, the Expected Spont. Vol. will indicate how much tidal volume this patient will breathe if
not assisted by a ventilator. Of course, when ventilator assistance is given, the spontaneous effort
of the patient may no longer be the determining factor for tidal volume or minute ventilation.

3. The image of the phases of the breath cycle shows all elements of a spontaneous effort.

179

4. They are set in the respective fields (4).

The ASL 5000 patient effort model distinguishes between effort during Inspiration and Expiration.
You shape both in-‐ and expiratory effort with a time period for Increase, possibly a Hold, and Decrease
of the Pmus. Time periods are entered as percentages of the overall cycle time, which, in turn, is a result
of the selected Breath Rate.

5. Select this option to limit inspiratory time to ½ of the cycle time, i.e., to limit the I:E ratio to 1:1.

6. Inspiratory backing off is a method to mimic inspiratory inhibition on effort patterns (Hering
Breuer effect). Muscle pressure releases once the stretch receptors of a patient’s respiratory
system have responded to a significant tidal volume. While the ASL 5000’s backing-‐off feature is
based on pressure, and not on volume, it yields a similar effect for a patient with a given
Compliance, since volume is proportional to pressure via V = P x C.
Enter a number (other than 0, for example 30 %) into the Inspiratory backing off field. Then,
during all of inspiration, the amount of ventilator pressure multiplied with 30% is now
subtracted from the patient effort profile as it has been programmed otherwise with the
parameters from (4). The calculation only considers pressures above the baseline (PEEP).

PIP
Pvent
30% of Pvent above PEEP
PEEP

Pchest With patient

wall backing-off (30%)
No patient
backing-off
Inspir. Increase
. Hold Release
Active Inspiration
Cycle Time (100 %)

Figure 11-‐13: Backing-‐off the Patient’s Inspiratory Effort
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.
180

7. A patient will usually apply expiratory effort (Active Expiration) to overcome back pressure or to
remedy problems associated with insufficient expiratory time. Without those needs, expiratory
effort can mostly be kept at zero. Therefore, Expiratory backing off has been designed as the
opposite mechanism of what was just explained about Inspiratory backing off.

It means that Expiratory Pmus will only apply as specified when there is sufficient back pressure
and the application (not the reduction) of patient expiratory effort is based on the amount of
positive pressure (above baseline) the patient “sees” when attempting to exhale. No backing
off 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.

Figure 11-‐14: Backing-‐off the Patient's Expiratory Effort
As an added feature for realistic patient behavior, you can specify a full breath inhibition caused
by positive pressure ventilation (secondary Hering-‐Breuer Effect). When a patient model is
scheduled to start a spontaneous breath (based on the specified spontaneous breath rate), this
effort can be fully suppressed if, at the time of the beginning of the patient effort, the ventilator
is delivering already a positive pressure breath.

8. The setting Cycle Inhibition after pos. pressure adjusts the time for which, even after positive
ventilator pressure was present, the inhibition rule will apply. This time interval is defined as a
fraction (0…0.99) of a spontaneous breath cycle. A setting of 0.0 (default) disables the effect (no
skipping of breaths). If you enter a very small number (but one that is >0.0), you will, essentially,
limit the inhibition to just the time during which positive pressure is actually being delivered.
In the example of Figure 11-‐14, the light color line indicates the case where no Expiratory backing off is
specified and the original expiratory effort pattern is unchanged. If you specified a 30% backing off, a

181

patient effort as shown in the darker line will result and only a back pressure of 130% of the specified
Exp. Pmax would allow this Exp. Pmax to be fully applied.

11.1.2.3 File-‐Based Patient Effort
Select the User specified (freeform from file) option for effort patterns that are completely
independent from the preconfigured profiles.


Figure 11-‐15: File-‐based Patient Effort

External data files for defining spontaneous breathing patterns are typically created manually using a
spreadsheet application, or consist of data from esophageal pressure tracings (from actual patients).
Files to be used for this purpose must contain a column of pressure values at the default sample rate of
512 Hz. To adjust existing data files to conform to the requirement, use the Pressure/Flow Input
Resampling utility (see 11.2.1.4, page 194). The user-‐synthesized pattern should describe one or more
complete breath cycles which will be used repetitively during a simulator run.

NOTE
The maximum length of breath profiles allowed is 20 seconds (or 10240 data points), equivalent
to a breath rate of 3. The cycle time is always determined from the number of data points
available, and, for this reason, you will not set a breath rate.

182

11.1.2.4 Patient Effort from Analog Input

The analog inputs of the ASL are available as an alternative to configuring breath profiles from files.
Using an analog signal for patient effort is a convenient way to incorporate instantaneous feedback
effects into the effort profile that are not covered in the standard patterns (patient responding to
volume or pressure changes in a real time fashion).

Figure 11-‐16: Patient Effort Model

The input ranges from 0 to 10 V with a bias of 5V (5V representing zero effort) in order to allow both
positive and negative excursions (forced exhalation or flow pump with both negative and positive
flows).
A gain factor setting (Pmus = Volt x Gain) makes it convenient to adapt a given voltage source to the
exact model requirements. This may also be used to invert the signal without having to invert the
voltage applied.

CAUTION!
Always use inputs that are within the range of 0 to 10 V. Excessive voltage may damage the
processor board of the ASL 5000.

183

11.1.2.5 SmartPump™ Mode

TM
SmartPump Mode is a non-‐feedback (not servo-‐controlled) mode of operation for the ASL 5000.
Pressure is still measured, but motion of the simulator piston is exclusively controlled by the
programmed breath profile. You directly enter the desired pattern in units of flow (L/min) for flow-‐
pump mode or in units of volume (L) for volume pump mode.


Figure 11-‐17: Flow Pump Model

In SmartPump Mode, only sinusoidal, trapezoidal, and user-‐defined waveforms are permitted.

NOTE
When generating flow pump patterns, they are always symmetrical, i.e., they are automatically
duplicated as positive flow profile after the negative (inhalation) part of the cycle has been
completed.
184

Figure 11-‐18: Sine Wave Flow Pump Model

In the above example for a continuous sinusoidal flow pump with a Vt of 500 mL, enter the following
parameters:
• 15 Spont. Rate (bpm)
• 18.78 Peak Flow (L/min)
• 25 Increase %
• 0 Hold %
• 25 Release %

The tidal volume of 500 mL is a result of the chosen peak flow and breath rate and is not set directly.
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.

185

186

Figure 11-‐19: 500 mL Volume Pump Model

\\.` ASL ottt Software Utilities

From the Utilities tab (Standard Window Manager), you can access functions for:
• File Utilities (Conversion)
• Patient Playback (from a patient flow recording)
• Parameter Sharing (TCP client examples)


Figure 11-‐20: Utilities Selector Tab

11.2.1 Exporting Data Files
Data files are natively saved in a binary format, for reduced file size and speed of processing.
1. To make this data available to other applications (spreadsheet etc.) click Data File Export .
2. The ASL File Conversion window opens.

187

Figure 11-‐21: File Conversion Selection

You may perform 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 *.bra breath parameter data file
• *.dtb *.dta processed breath waveform data file
• *.rwb *.rwa high resolution raw waveform data file
• *.avb *.ava model parameter file
• *.ain *.ain log file

3. Click Select A Simulation to select a single data set. In the File Explorer window that opens,
navigate to your data directory and select the *.rwb file of the set that you want to convert.

NOTE
Only the raw data files (*.rwb-‐files) of each data set are shown in the File Explorer navigation,
but you will be converting/exporting the whole set.

4. Similarly, click Select A Directory to convert/export a whole directory. In the File Explorer
window that opens, click Select Folder once you are in the directory you want
to convert.

5. You can observe the translation progress in a small window that appears. For very large files the
process can take a short while, but typically it is only a few seconds.
188

NOTE
The *.bra breath parameter ASCII 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.

NOTE
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 (see page 59) is usually a good idea if any length of waveform is intended
for processing in a spreadsheet.

When translating files using the Advanced 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.

6. When done, click Return to return to the Utilities tab.

11.2.1.1 AUX Channel Output Resampling
AUX signals recorded by the ASL 5000 don’t provide natively equidistant data points. The frequency
with which they are recorded varies based on the processor load and other factors. It can be expected
to be around 3 Hz. The ASL 5000 software includes a utility which can turn the data stream into an
interpolated signal with equidistant points of a user-‐specified sample rate.

• In the Utilities tab, click AUX Channel Output Resampling .

A file configuration window—Resample Auxiliary Channels—opens:
189

Figure 11-‐22: AUX Channel Resampling

Here, you can define the desired output sample frequency as well as independent gains for all three
channels.
The third channel (AUX3) is reserved for the signal of the O2-‐measurement and directly reports oxygen
concentration (in percent) while the default gain factor of 1 is applied.
In the Resample Auxiliary Channels window:
• Click Resample after defining the output destination and, optionally, a descriptive text to be
inserted into the file.
• Click Return to return to the Utilities tab.

190

11.2.1.2 RespiSim® File Conversion

Data recorded in the RespiSim® environment (see Debriefing Environment, page 120) is in a format
called “TDMS.” A special utility is provided to make such data “import-‐friendly” for spreadsheet
applications etc. The utility converts 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.
• In the Utilities tab, click RespiSim® File Conversion .

The RespiSim® File Conversion Utility dialog box opens:

Figure 11-‐23: RespiSim® File Conversion Dialog Box

• Click the folder icon to navigate to the desired TDMS-‐file and click
Convert File .
You can find the converted file with the extension *.txt in the same directory as the original.

NOTE
Please be aware that the size of TDMS files from longer simulations can easily be several
hundred Megabytes and may not process quickly, or cannot be opened with some text editor
programs.

11.2.1.3 Processing Patient Flow Recordings
This utility automatically creates scripts of vr3-‐files from segments of patient flow data recordings for
playback in SmartPump mode.
The utility extracts flow data from ASCII files, as well as files saved in EDF (European Data Format).

1. In the Utilities tab, click the Patient Flow Extended Replay button . The Create Script
From Patient Flow Data Processor window opens:

191

Figure 11-‐24: Patient Flow Data Processor

EDF files typically will contain several parameter traces as well as headers (column labels).

It is the user’s responsibility to properly select the data column for flow.
Similarly, you must skip a certain number of rows at the beginning of an ASCII data file in order to
exclude file headers.

Offset is available with ASCII files and 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. You can test a script in Software Only Mode (no physical simulator attached) for the
amount of this bias (as L/min). With the proper offset in place, simulations that run over extended
periods of time will still show a volume consistently returning to baseline.

Gain may be used to convert patient recordings that report flow in L/s or mL/s to the required L/min
(multiply by 60 or 0.6, respectively). You will also have to invert flow direction (use a negative gain
factor, or just multiply with -‐1) if the recording does not conform to the convention in the ASL 5000,
i.e., counting inspiratory flow as positive.

2. Once the configuration is in place, click Start Processing to generate the script and
its segments of flow pattern (flow pump mode).

192

File names for the segment *.vr3-‐files are derived from the base file name of the original 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.


Figure 11-‐25: Recorded Patient Flow Script

Each segment represents a 10 second “snippet” of the originally recorded flow.
Approximate Script Duration is indicated in the lower right-‐hand corner of the window.

3. Double-‐click one of the segments to inspect. The Patient Effort Model window opens.

193

Figure 11-‐26: Patient Flow Segment

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 ventilator 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).

4. Click <Back in the Patient Effort Model window r to return to the Utilities tab.

11.2.1.4 Pressure/Flow Profile Resampling
The option of user-‐defined muscle pressure profile (or user-‐defined flow profile in SmartPump mode,
see page 184) in Patient Effort Model often requires a reprocessing of recorded profiles. Data for use
as a patient profile needs to be at a 512 Hz sample rate, which is higher than the rate used by most
patient monitors. With the Pressure/Flow Input Resampling utility, you adjust the data rate as well as
adjust the gain by multiplying the profile with a gain factor. The utility includes a batch processing
feature for efficient processing of a large number of these files.
• In the Utilities tab, click the Pressure/Flow Input Resampling button . The
Pressure/Flow Input Resampling window opens:
194

1
2
3

Figure 11-‐27: Pressure/Flow Input Resamling

1. Click the folder icon by the Directory field on the Input side. Then, to select profile(s) to be
processed from an input directory, navigate to these profiles from the standard dialog box.

2. There, enter assumed original and desired new sample rates (512 Hz as default). Flow measuring
devices typically sample at much lower rates than 512 Hz. Entering the actual value of sampling as
Original Sample Frequency (Hz) 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.

3. Additionally, you can choose a gain factor other than 1 to convert, for example, from a signal given
in L/s to one that conforms to the ASL requirement of L/min as unit of flow.
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. Scaling of patient efforts may also help meeting a
specific tidal volume requirement.

• Save the new profile under its own (new) name via the dialog box that opens once you click the
Resample button .
• To return to the Utilities tab, click the Return button to return to the Utilities tab.

195

11.2.1.5 TCP Breath Parameter Broadcast

It is possible to stream or “broadcast” the breath parameter 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 Standard Window Manager.


Figure 11-‐28: TCP Breath Client Demo Application

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 simply need to launch this application (after
copying it to the PC you want to act as a client or “listener”), and 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).

For pre-‐configuration of the TCP Breath Client, please refer to 11.2.1.7, TCP Broadcast Configuration
below.

196

11.2.1.6 TCP Waveform Broadcast

Similarly, waveforms are available on the network on port 6343 for volume and pressure data as
shown in the plots.

Figure 11-‐29: TCP Waveform Client (Raw Data)


Figure 11-‐30: TCP Waveform Client (Processed Data)

197

The demonstration application for a listening client, TCP Waveform Client.exe, is also included in the
ASL host software installation. You can access it from the Utility tab of the Standard 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 ASL host software).

See 11.2.1.7, TCP Broadcast Configuration for preconfiguring both client applications.

11.2.1.7 TCP Broadcast Configuration
• Select the TCP Configuration option in the Control drop-‐down menu of the Standard Window
Manager for changing the server’s port if such a change is necessary to avoid conflicts on a
network.

The TCP Broadcast Configuration window opens:

2

1

Figure 11-‐31: TCP Broadcast Configuration

1. Enter a number into Broadcast Precision to adjust the number of decimals with which the data
is streamed (15 is the default value).
2. Use the slider to switch between Raw and Processed data.

198

\\.k Analog Inputs and Outputs

4. Your ASL 5000 is equipped with inputs for two analog channels—AUX1 and AUX2, and two outputs.
Please refer to Figure 11-‐33, page 202 for the location of the analog socket.

New Feature
Analog outputs are supported by firmware 4.7.97 (released with software 3.6) and higher if
used on ASL 5000 units with serial numbers above 1400.

The specifications for the analog inputs are as follows:

Input range 0 to 10 V, differential input
Resolution 2.44 mV, 16 bit A/D
Over voltage protection up to 30 V
inputs not opto-‐isolated!
Max. sampling rate 1024 Hz -‐primary control analog input channel
512 Hz -‐secondary analog input

Output range software configurable (see 11.3.1, differential output)

Connector Hypertronics mates with
(style used for serial no.s up to 1400) Hypertronics D01 circular 4 pin D01PB406MST
Connector 4-‐position ODU, mates with
(style used for serial no.s above 1400) ODU S11M07-‐P04MJG0-‐5260 or
equivalent LEMO plug

Data from the analog channels is retrieved or output while the simulator is running.

Figure 11-‐32: Analog Data Panel on Run Time Home

199

From the Run Time Home panel, select the Record AUX option to generate a separate data file
data.aux containing the readings for both channels as well as vol% of oxygen as well as a time stamp.
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 Update rate

xxx.brb / O2 once per breath
xxx.bra
xxx.avb / Gas temp. once per breath
xxx.ava
xxx.avb / Cyl. wall temp. once per breath
xxx.ava
xxx.avb / Barom. pressure once per breath
xxx.ava

11.3.1 Analog Output Configuration
You configure the analog output channels (ao0 and ao1) in a configuration text file aout.cfg located in
the main installation directory for the ASL software (usually C:\Program Files (x86)\ASL Software 3.6\).
Each channel definition has four parameters, ident, range, gain, and zero.

Enumerations for ident assign the parameter to be used for analog output:

0 ➤ AOUT_OFF, // Vout is "off"; its value is always zero
1 ➤ AOUT_VOLUME_COMP1 // model volume in compartment 1
2 ➤ AOUT_VOLUME_COMP2 // model volume in compartment 2

3 ➤ AOUT_VOLUME_TOTAL // total model volume
4 ➤ AOUT_VOLUME_PISTON // piston volume relative to home position
5 ➤ AOUT_FLOW_COMP1 // flow into compartment 1
6 ➤ AOUT_FLOW_COMP2 // flow into compartment 2
7 ➤ AOUT_FLOW_TOTAL, // total model flow
8 ➤ AOUT_PRESSURE_AIRWAY, // model airway pressure
9 ➤ AOUT_PRESSURE_TRACHEA // model tracheal pressure
10 ➤ AOUT_PRESSURE_MUSCLE // spontaneous effort pressure
11 ➤ AOUT_PRESSURE_COMP1 // model pressure in compartment 1
12 ➤ AOUT_PRESSURE_COMP2 // model pressure in compartment 2
13 ➤ AOUT_AI_LUNGPRES // ain0 lung pressure
14 ➤ AOUT_AI_OXYGEN // ain1 O2 sensor
15 ➤ AOUT_AI_BAROMETER // ain2 barometric pressure
16 ➤ AOUT_AI_GASTEMP // ain3 gas temperature
200

17 ➤ AOUT_AI_JP1, // ain4 jumper JP1 to ref voltage

18 ➤ AOUT_AI_WALLTEMP // ain5 wall temperature
19 ➤ AOUT_AI_EXTCH1 // ain6 user external input ch1
20 ➤ AOUT_AI_EXTCH2 // ain7 user external input ch2

Enumerations for range assign the voltage span to be used:

0 ➤ AOUT_5V_POS, // 0.0 to +5.0
1 ➤ AOUT_10V_POS, // 0.0 to +10.0
2 ➤ AOUT_5V_CTR, // -‐2.5 to +2.5
3 ➤ AOUT_10V_CTR, // -‐5.0 to +5.0
4 ➤ AOUT_20V_CTR, // -‐10.0 to +10.0

The default settings (as installed) are with the analog outputs switched off as follows:

ao.0.ident = 0 "AOUT_OFF
ao.0.range = 0 "AOUT_5V_POS
ao.0.gain = 1 "
ao.0.zero = 0.0 "zero

ao.1.ident = 0 "AOUT_OFF
ao.1.range = 1 "AOUT_5V_POS
ao.1.gain = 1 "
ao.0. zero = 0.0 "zero

201

\\.m Digital Outputs

The digital output connector of the ASL 5000 provides three TTL2-‐signals.

• The first channel provides a high/low signal that switches with the direction of flow (high for
inspiration, low for expiration).
• 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 12.5, page 212).

In ASL 5000 units (below serial no. 1400), both signals share a line and the output for this channel
is, by default, set to generate the PWM signal (contact IngMar Medical support if you need to make
a change to this default setting).
In newer devices (above serial no. 1400) that have the new configuration of communication sockets
as shown in Figure 11-‐33, page 202 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 5000.

Output TTL
Short circuit protection Yes, outputs not opto-‐isolated!
Signal delay 2 ms
Connector Hypertronics
(style used for serial no.s up to —Mates with Hypertronics D01 circular 3 pin D01PB306MST

1400)
Connector 8-‐position ODU, mates with
(style used for serial no.s above ODU S11M07-‐P08MFG0-‐6550 or equivalent LEMO plug
1400)

On ASL 5000 Simulators beginning with serial no. 1401, the configuration at the back looks as follows:

Figure 11-‐33: ASL 5000 Communication Connections (Back Panel)

2
TTL = Transistor-‐Transistor Logic, referring to a logic signal that has nominal voltage levels of 5 V (high) and 0 V (low)
202

For pin assignments of the sockets, please refer to the “Preparation Addendum” provided with the
mating cables for Digital Out and Analog I/O in your ASL 5000 Accessory Kit (included).

\\.o Test Automation Interface

IngMar Medical Ltd. has developed an interface for the ASL 5000 Breathing Simulator, which will
enable you 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 “remote” ASL
control. The server will run in the background with a visible icon in the Windows task bar notification
area. You may access it remotely or locally by connecting to a TCP/IP port and sending ASCII formatted
commands. For controlling the ASL 5000(s) the TAI server will open the ASL host software in “hidden
mode” which prevents unwanted user interference through the Graphical User Interface (GUI) of the
ASL 5000 software.
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 that
is running the server. The remote interface will directly communicate with the ASL software. As a third
party user, you 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.


203

204
11.5.1 TAI Overview

Figure 11-‐34: Test Automation Interface

12 ADVANCED HARDWARE OPTIONS
\`.\ Cylinder Temperature Controller (CTC)

Optionally, the ASL 5000 Breathing Simulator may be equipped with a controller for maintaining wall
temperature of the cylinder. This controller is a unit that operates independently from the host
computer. Therefore, all settings are made directly on the controller interface on the ASL 5000 front
panel and not in the PC host software.

Figure 12-‐1: Cylinder Temperature Controller Front Panel
The upper digital display indicates the actual temperature reading (PV = Process Value).
To change the temperature setting:
1. Press MENU on the controller, until the SP1 (SP1 = Set Point 1) light, to the left of the set
temperature display SV (SV = Set Value), starts blinking.
2. Press ▲/MAX for changing digits, and ▶ /MIN for proceeding to the next digit.
3. After you are finished, press ENTER and the controller will acknowledge that the new value has
been stored.

When decreasing the temperature setting, keep in mind that the CTC unit cannot actively cool and the
decrease in temperature, therefore, will depend exclusively on heat diffusion to the environment. For
this reason, factors such as gas exchange of the simulator, room temperature, etc. will determine the
lowest possible temperature and the time it takes to reach a lower temperature.

As part of the instrument documentation, a separate Operator's Manual for the temperature PID
controller is enclosed for further reference. You may also contact IngMar Medical for additional setup
documentation, in case the basic settings of the controller is inadvertently changed.

205

\`.` Fast Oxygen Measurement (FOM)

The FOM-‐Option consists of a paramagnetic oxygen sensor with a miniature vane pump for side-‐
stream measurement of oxygen. These components are built into the ASL 5000 unit but may also be
retrofitted if needed. Please contact IngMar Medical about details.

Figure 12-‐2: Paramagnetic Oxygen Transducer
If this option is installed in your ASL 5000, simply click the checkbox in the ASL Run Time Home panel to
see the value of O2 readings (see Figure 11-‐32 on page 199).

NOTE

Ventilators always include a correction for O2 concentration in their flow sensors and should
report accurate volumes independent from the oxygen concentration.

WARNING!
Fire Hazards related to the use of oxygen:
When using the ASL 5000 with elevated concentrations of oxygen (ventilators set to
FiO2 > 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 < 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.

For specifications of the FOM, please see Technical Data, page 277.
206

\`.k PreemieLung™ Option

12.3.1 Intended Use
The preemie cylinder improves volume resolution of the ASL 5000 by approximately a factor 8 to
approximately 0.2µL. It can be used when simulations are fully within the range of 200 mL maximum
volume and flow rates below 40 L/min.

Figure 12-‐3: ASL 5000 with Preemie Option Installed
12.3.1.1 Assembly
To assemble the PreemieLung Cylinder:
1. First, attach the piston for the 2.5” cylinder is with its extension rod to the regular (7”, adult
size) piston plate.
2. Gently screw the assembly into the threaded adapter on the large piston plate, taking care to
not damage the seal on the small piston.

207

Figure 12-‐4: Installation of Preemie Cylinder

3. Take the preemie cylinder and slide it over the 2.5” piston plate at a slight angle, so that no
sharp edge cuts into the seal on the piston.
4. Push the cylinder gently all the way towards the threaded inlet of the ASL and turn it 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!

5. Fully thread the piston in (until the shoulder ring sits directly against the brass receptacle).
Gently tighten.
6. Remove the short cable connecting the internal temperature sensor (regular “adult/neonatal”
cylinder) to the measuring circuit.
7. Connect the 3-‐pole Hypertronics plug into the receptacle marked External Cylinder Temp. at
top of the ASL 5000.
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.

208

12.3.1.2 Software Adjustments

After the initial installation of the ASL software on the host PC, some adjustments should be made for
proper functioning of the unit with the external Preemie Cylinder.
Patient parameter files (vr3-‐files) for use with the Preemie Cylinder should have the value for parasitic
dead space adjusted to 25 mL (instead of 200 mL). Use Notepad or a 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) cylinder_dead_space = 0.025 (liters)

12.3.1.3 Firmware Adjustments
For the proper functioning of the device it is mandatory to invoke the correct mechanical parameters
from an initialization file in the ASL 5000 CPU.
In the directory c:\lung on 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, copy the file c:\lung\ASLNEO25.40 into ASL5000.DOS,
in the same directory.
• To interrupt the program flow with the keyboard combination Ctrl/C, use PuTTY or a similar
terminal program on the COM2 serial port of the ASL 5000 (labeled Terminal) with settings of
9600-‐8-‐N-‐1.
3
• Switch to the c:\ prompt (type: c:) and change directories to c:\lung (type: cd c:\lung)
• Execute the command: copy ASLNEO25.40 ASL5000.DOS

• Before use of the ASL 5000 with the standard 7” Adult Cylinder, perform a similar copy
command using the file ASLADL70.40 to return to the standard setting:
copy ASLADL70.40 ASL5000.DOS

12.3.1.4 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 (PC) instead of the Adult Cylinder (AC). Patient parameter files (vr3-‐
files) require settings that are compatible with the physical characteristics of the altered system (for

3
When using an ASL 5000 equipped with the most recent CPU (Helios), user interface (console) redirection first needs to be
turned on. For this purpose, immediately use the <Esc> key to enter BIOS mode from where you can enable console
redirection.

209

2 2
example, tidal volume). As a general rule, it is the relative size of the piston area (rPC /rAC = 0.12755)
that is responsible for the differences.

Figure 12-‐5: Preemie Cylinder: Pressure Line Manifold

Please make sure that the line for pressure measurement is properly reading the pressure from the
cylinder that is currently in use. Use the stopcock orientation as it is indicated on the label at the front

of the ASL.

CAUTION!
Do not block the port of the main (Adult) cylinder while operating the ASL 5000 with the
Preemie cylinder attached. It would prevent piston motion and could damage the unit!

12.3.1.5 Unmounting the Preemie Cylinder

• For unmounting, 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 the lid and/or the ASL 5000 main unit!
210

\`.m 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 interior
surface materials. 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 12-‐6: Auxiliary Gas Exchange Cylinder
• Connect the simulator to the female 22mm ISO port at the base of the AGEC with the 1 ft. long
flexible hose supplied.

A second 22 mm port is located on the top and will normally be used for directing 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, thereby adding a parasitary
compliance of 3 mL/cmH2O. This may be compensated by entering the 3 L as a tubing volume in the
simulation editor compensation settings (see page 171).
Please see also a special Application Note regarding the AGEC for further details.

211

\`.o Chest Rise Module for Laerdal SimMan™ Manikins

The ASL 5000 Breathing Simulator can be combined with Full Scale Patient Simulators, improving on
the pulmonary mechanics provided by these simulators. Integrating the ASL 5000 into the setup of
such manikins qualifies them for use with ventilators by enabling them to “hold PEEP” and by providing
them with the ability to truly breathe spontaneously (as opposed to simply showing the chest rise).
An option— the Chest Rise Module—has specifically been developed for the ASL 5000, for use with
Laerdal’s family of SimManTM 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 while
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.The Chest Rise Module can also be used to give the more basic Laerdal Kelly manikin
simulator true high-‐fidelity lungs and respiratory mechanics, including the ability to breathe
spontaneously.

Further software integration will be available with plug-‐ins currently in preparation for Laerdal’s LLEAP
software (expected release early 2017). Please contact IngMar Medical for details.


Figure 12-‐7: Chest Rise Module

212

\`.s 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. 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 an 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.

Figure 12-‐8: Simulator Bypass and Leak Valve Module

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.


Figure 12-‐9: SBLVM Schematics

213

The second feature of the SBLVM is that it provides 3 different sizes of leaks. This feature can be used
to simulate particular patient conditions, such as an ET-‐tube leak. The orifices for these leak settings
are exchangeable with ones that provide different leak rates.
The diagram below shows the characteristics of leak flow versus pressure for the standard orifices.


Figure 12-‐10: SBLVM Orifice Characteristics

214

\`.u Ventilator Interface Kit (for RespiSim)

The Ventilator Interface Kit (VIK) option connects RespiSim® to the data ports of most commonly used
ICU ventilators for capturing their data output. This supports a true 360-‐degree view of all interactions
between patient and ventilator, specifically adding those parameters that are not already captured by
the ASL 5000 Breathing Simulator, such as mode settings, alarms and alarm settings. Additionally, it
brings realistic patient charting into simulation scenarios. Any browser-‐enabled handheld device (not
included) can be used for charting and annotating patient status and ventilator settings. IngMar
Medical has partnered with Bridgetech Medical4, a specialist in electronic charting systems in
respiratory care, to integrate data from a wide range of ventilator manufacturers. For a list of
compatible ventilator models, please see page 278.
If your original purchase of the RespiSim® system included the Ventilator Interface Kit, you don’t have
to perform any software installation. Skip to 12.7.2, Ventilator Interface Connections.

NOTE
If you have upgraded to software 3.6 and you would prefer to use the VIK functionality “as is”,
i.e., without the browser-‐enabled charting capabilities, please contact IngMar Medical.

NOTE
Users with the first-‐generation (Bluetooth linked) data acquisition bridges who wish to upgrade
to the current capabilities will have to upgrade their VIK hardware (to a Fusion Bridge). Please
contact IngMar Medical for details about our hardware exchange discount program.


Figure 12-‐11: RespiSim® Ventilator Interface Kit (VIK)

4
For more information on Bridgetech Medical solutions for electronic charting, please visit www.bridgetechmedical.com.

215

The VIK contains

• Fusion Bridge (ALFA or BETA) with power adapter
• Short Cat-‐5 Ethernet cable
• 15 ft Ethernet cable for Fusion Bridge-‐to-‐router connection
• Set of ventilator specific serial adapters
• Blue/yellow serial-‐to-‐USB adapter combination (labeled as Fusion)
• USB flash drive with current software for installation on a PC (labeled MASTER)
• USB flash drive for Fusion Bridge configuration (labeled FUSION)

12.7.1 Software Installation for Users with existing VIK (Fusion Bridge ALFA or BETA)
interface.
To update your existing installation of the VIK software, follow these steps:

1. Uninstall RT Server and AutoScan applications.
From Programs and Features (in the Control Panel of Windows 7 or 10),
right click and Uninstall the following software components:
RT Server
AutoScan

2. Delete the existing (now obsolete) Bridgetech database.

In Windows 7 and Windows 10, click the Start button and type:
C:\programdata
and press <Enter>

to make hidden files visible.

Navigate to the folder C:\programdata\...

and delete the BridgeTech Medical folder inside.

3. In your main ASL 5000 software installation
(c:\program files (x86)\ASL5000 Software 3.6\Additional Installers\), double-‐click on VIK-‐Setup.

Wait for the installation to complete.

After installing the Bridgetech software, you will need to configure your Fusion Bridge ALFA or BETA
(the VIK interface box) to communicate with the database for ventilator data on the computer (see
Ventilator Interface Connections, page 223, for making the physical connections).

216

1. Open a browser and navigate to http://localhost/client

The browser will bring up a sign-‐in window

Figure 12-‐12: Bridgetech WebClinical -‐ Sign In

Log in with the following credentials
User name: ???
Password: ???

NOTE
Once the user name and password has been assigned they are permanent and cannot be
changed.

I have asked Tharen what should be used. I currently use Test and 123 to log in, but this does not
show an empty database since it logs you into Tharen’s test database. We want a new fresh
database for our users.

217

2. In the top right corner click on Admin and Bridges.

2

Figure 12-‐13: Bridgetech WebClinical – Starting Bridge Creation

3. Click on the pop-‐up window.

3

Figure 12-‐14: Bridgetech WebClinical -‐ Create Bridge

218

4. On the bottom of the Fusion Bridge, locate the serial number of the unit (it will either start with
ALFA or BETA). Enter this serial number, including dashes, in the Add new bridge window
5. Click .

4
5

Figure 12-‐15: Bridgetech WebClinical -‐ Add New Bridge

6. Click on Commands and select Configure.

6

Figure 12-‐16: Bridgetech WebClinical -‐ Configure New Bridge

219

7. On the General tab, ensure that the Serial Number and Bridge Type are correct.

7

Figure 12-‐17: Bridgetech WebClinical – Confirm Bridge

For wired setup (Bridge connected to router via Ethernet cable):

8. Click on the Ethernet tab

8
9

Figure 12-‐18: Bridgetech WebClinical – Configure via Ethernet

9. If you are connected to the router provided with the ASL 5000, it will assign an IP address through
DHCP. In this setup, leave Use DHCP checked and the other fields blank. If a network requires fixed
IP addresses (for example in an institutional network), enter proper network settings for Address,
Netmask, and Gateway per instructions from your IT specialist.

220

Alternatively, for wireless setup

10. Click on the “Wireless” tab

10
11
12

Figure 12-‐19: Bridgetech WebClinical -‐ Configure via WiFi

11. If you are connected to the router provided with the ASL 5000, it will assign IP addresses through
DHCP. In this setup, leave Use DHCP checked and the other fields blank. If a network requires fixed
IP addresses (for example in an institutional network), enter proper network settings for Address,
Netmask, and Gateway per instructions from your IT specialist.

12. Enter the network ID in the SSID field and select the proper Authentication Type if applicable. If a
password is required, enter it in the Password box.

221

13. Click .

13

Figure 12-‐20: Bridgetech WebClinical -‐ Save Configuration

222

12.7.2 Ventilator Interface Connections

NOTE
The VIK can be connected to the router in a wireless or hard-‐wired configuration.

Connect Fusion Bridge to ventilator.
1. Connect blue/yellow USB-‐to-‐serial adapter combination to the Fusion Bridge with its USB end.
• Connect Ethernet cable (supplied) to the yellow adapter of the blue/yellow combination.
• Connect the other end of the Ethernet cable into the appropriate ventilator specific adapter
(see list on page 278).
2. Plug ventilator specific adapter into the communications port (Serial / MIB / LTV ports, etc.) on the
ventilator (typically found in the back).

3. Connect power adapter to the Fusion Bridge ALFA (or BETA) and plug in (there is no On/Off switch).

For a hard-‐wired configuration: 
4. Connect the 15 ft Ethernet cable to the back of the router, and then to the Ethernet port of the
Fusion Bridge (ALFA or BETA).

2
4 1 3
1

Figure 12-‐21: Typical Fusion Bridge (ALFA) to Ventilator Connection
(Fusion BETA Bridge shown in insert)

223

12.7.3 Capturing Ventilator Parameters in RespiSim®
The VIK allows to record all parameters that the ventilator makes available

• Create Patient or select an existing patient

NOTE
It is good practice to associate an MRN with the patient name. Patient names should indicate
the type of simulation for later reference to the collected data.

Data collected will be ventilator-‐specific. For this reason, RespiSim® contains a generic ventilator
model, called the Universal Ventilator (Universal Vent).

In RespiSim, Universal Vent is selected by default. When Universal Vent is selected, RespiSim® maps
the parameter names coming from the specific ventilator that is connected into a list of Universal Vent
parameters. Parameters that a ventilator outputs that do not have a mapping assigned are placed at
the end of the list. If there is no mapping, the StandardParamterID is 0. If a user selects the “real” vent,
the Parameter Name is taken from the Vent itself as opposed to the “mapped” name. However, the ID
number will still be the same as above.

The below table shows our mapping:

Parameter Name Standard Parameter Name Standard
Param. ID Param. ID

Mode 1 FiO2 set 15
Rate(f) set 2 FiO2 16

Rate(f) spont 3 PEEP set 17
Rate(f) total 4 Peak Pressure 18
Rate(f) CMV set 5 Press Support set 19
Rate(f) SIMV set 6 PCV Press set 20
Tidal Vol set 7 MAP 21
Tidal Vol exp 8 Insp Time set 22
Tidal Vol spont 9 Insp Time 23
Tidal Vol mand 10 Exp Time set 24
Peak Flow Set 11 Exp Time 25
Peak Flow Insp 12 I:E ratio 26
Minute Vol exp 13 Insp Pause set 27
Min Vol Spont exp 14 Plateau Pressure 28
Parameter Name Standard Parameter Name Standard
Param. ID Param. ID
Trigger Setting 29 Apnea (alarm) 68
224

Bias Flow 30 Expiratory Trigger 69

Press Trigger set 31 Disconnect Alarm 70
Flow Trigger set 32 Elastance 71
Flow Pattern 33 FiO2 (high-‐alarm) 72
Apnea On/Off 34 FiO2 (low-‐alarm) 73
Apnea Interval 35 I:E (set) 74
High Press limit 36 I:E limit (alarm) 75
Low Press limit 37 FiO2 (alarm) 76
High Rate(f) limit 38 MinVol Mand (meas) 77
Low Rate(f) limit 39 O2-‐100% (set) 78
Low Min Vol limit 40 Occlusion (alarm) 79
High Min Vol limit 41 PEEP (low-‐alarm) 80
High Tidal Vol limit 42 PEEP (meas) 81
Low Tidal Vol limit 43 PEEPauto (meas) 82
High O2 limit 44 Power Battery (low-‐a 83
Low O2 limit 45 Power Mains (low-‐ala 84
Low PEEP limit 46 Press (high-‐alarm) 85
High Mand Vt limit 47 Press (low-‐alarm) 86
Low Mand Vt limit 48 Press Air (low-‐alarm 87
RSBI 49 Press O2 (low-‐alarm) 88
Stat Resistance insp 50 Rate (high-‐alarm) 89
Stat Compliance 51 Rate (low-‐alarm) 90
Dyn Resistance insp 52 Support % (set) 91
Dyn Compliance 53 Apnea Tidal Vol set 92
Insp Time % 54 Tidal Vol (exp-‐high-‐ 93
% Min Vol 55 Tidal Vol (exp-‐low-‐a 94
Body weight 56 Tidal Vol Inspired 95
Amp Delta P 57 Vol Leak 96
Wiggle 58 Low Tidal Vol alarm 97
Power 59 FiO2 (range alarm) 98
Frequency 60 Disconnnect (vent-‐al 99
Circuit Temp 61 Disconnect (patient-‐ 100
Ramp Time 62 MinVol (low-‐alarm) 101
aprv p-‐high set 63 Vol (mand-‐low-‐alarm) 102
aprv p-‐low set 64 Vol (spont-‐low-‐alarm 103
Volume Leak % 65 Press Gas (low-‐alarm 104
Rise Time % set 66 Alarm reset 105
Alarm silence 67

NOTE

225

While this list is very comprehensive, typically only a small number of parameters are used for
charting and during RespiSim® scenario simulations.
For the purpose of including ventilator-‐based parameters to the table of numeric parameters of the
Debriefing Screen of RespiSim, or to the real-‐time view of the Instructor Dashboard, simply select
them from the drop-‐down list of available parameters.

• Click on the parameter name in one of the displayed parameter fields.
The parameter list opens.

• Select one of the parameters that is prefaced by (VENT).

12.7.4 Training Students in Patient Charting
Charting is an important aspect of patient care. The Ventilator Interface Kit helps to train respiratory
therapists in this skill with a new browser-‐based tool for recording patient data in a way that emulates
electronic record keeping in a hospital. Patient status, notes, etc. are entered into a coherent form that
also includes the ventilator parameters captured by the VIK. Instructors can use data captured during a
simulation for debriefing and assessing students. Any browser-‐enabled device may be used (tablet,
smartphone, notebook PC).

1. Open a browser and navigate to http://localhost/client
The browser will present a sign-‐in window


Figure 12-‐22: WebClinical -‐ Sign In

2. Log in with your pre-‐assigned credentials to open the Patient Selection window
226

3
4

Figure 12-‐23: WebClinical -‐ Patient Selection

3. Click on the “patient” that you want to use for the current simulation.

4. Click
A window with options for this patient opens

5

Figure 12-‐24: WebClinical – Floor Care/Emergency Response Selection

5. Click Floor Care/Emergency Response.

227

If more than one patient is available and you switch to a different patient, a pop-‐up will ask you to
verify the patient selection.

6

Figure 12-‐25: WebClinical – Floor Care/Emergency Response Menu

6. Confirm that the correct patient is selected.

The Floor Care/Emergency Response Menu window will open.

The Floor Care/Emergency Response is the starting point for recording a patient’s respiratory initial
status and subsequent assessments as well as treatments administered. From here you also access the
Notes/Verify screen used before saving a new chart recording (see Figure 12-‐26 on the next page).

228

7
8

Figure 12-‐26: WebClinical – Floor Care/Emergency Response Overview

7. From the selection that opens, click Setup. Figure 12-‐27 on the next page shows the options that
you have available for charting the initial patient setup

229


Figure 12-‐27: WebClinical – Floor Care Patient Setup Overview

230

You make Patient Assessments in the same way as you would in a real hospital patient record keeping
system. The available options are outlined in Figure 12-‐28.


Figure 12-‐28: WebClinical – Floor Care Patient Assessment Overview

231

From any of the sub-‐menus, clicking will return you to the previous menu. Click to
return directly to the Floor Care Menu.
8. When charting is complete, click , click Review & Exit in the Floor Care Menu to save all entries.
The Notes/Verify window will open.

9


Figure 12-‐29: WebClinical – Saving Charted Notes

9. Click to save the chart. You will be returned to the Patients window.

232

12.7.4.1 Adding Notes

Aside from the charting just described, you may also add notes on a number of patient and therapy
related areas:
• Vent Equipment Monitoring (Humidifier checks) and Vent Orders
• Patient Monitoring (breath sounds, chest assessment, ABGs)
• Airway Management (airway size/type/position, cuff management)
• Weaning (trials, parameters, pulmonary mechanics, assessment)
• Specialty Gases (Heliox, Nitric Oxide)
• Calculations (perfusion ratio, RSBI, O2 index, static and dynamic compliance, resistance,)
• Emergency Response/Productivity (resuscitation, RT standby time)


233

\`.| Mobile Cart Option (Plus Package)


Figure 12-‐30: RespiSim® Plus Package
Frequently, it is easier to move the simulation to a location where the ventilator that students need to
be trained on is available. 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 can be mounted to a tray on the
cart and a notebook computer can be placed on a shelf, with a lockable compartment underneath. The
cart also facilitates mounting a screen (up to a 40” diagonal or 20 lbs., not included with the basic cart
option) and is an ideal platform for in-‐situ training, where the complete training station is brought right
into an ICU or NICU for training staff in small groups or one-‐on-‐one.

234

The version of this cart is as depicted in Figure 12-‐30, available as the RespiSim® Plus package. In this
version, the PC is a touch-‐screen all-‐in-‐one model that comes installed as part of the system instead of
a customer-‐supplied monitor. Such 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
(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 VESA
wall-‐mount standards.

WARNING!
Always observe the load limit of 20 lbs. (9 kg) for a monitor mounted on the cart. An overly
top-‐heavy assembly would present a risk of tipping and bodily injury.

A surge-‐protected, 6-‐outlet power strip for powering all items on the cart is included in the package.
The height adjustability allows for a sitting position with the appropriate height for the notebook
keyboard, or a standing position.
• To adjust the height, press the foot pedal at the front of the cart base.
• Lock the two front casters to prevent an inadvertent roll-‐away when the unit is stationary.

CAUTION!
• Always secure all loose items when moving the loaded cart.  
• Make sure that the simulator is clamped tightly in its tray.  
• Always lower the height adjustable column before moving unit.  
• Use special care when rolling over bumps or uneven surfaces, such as when going through
elevator doors.  

235

13 THEORY OF OPERATION
\k.\ An Introduction to Ventilatory Mechanics5

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 extra-‐pulmonary 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 hand, there are two prime movers that drive the ventilatory system, and its components:
• The first prime mover comprises 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 – pBS). 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

13.1.1.1 Governing Equation
Normal lungs, together, act primarily, as a single, pneumatic, visco-‐elastic compartment. This implies
that 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:

5
This section is authored by Frank P. Primiano, Jr.
236

For the airway:

6
(pAO – pPL) = υL /CL + RAW ·∙ ύ L (1)
For the chest wall:
(pPL – pBS) + pmus = ύL / 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, pES,
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 pmus with the intention of creating more clearly distinguishable
plots.
pAO
RAW
pPL
CW ύ
(+) L
CL
υL Δpmus
pBS

Figure 13-‐1: A one-‐compartment ventilatory system in which...

pAO is the change in pressure at the airway opening
pBS is the change in pressure on the body surface
pPL is the change in pressure within the intrapleural space
Δpmus is the change in the net force produced by the respiratory muscles
expressed as an equivalent pressure difference; often called muscle pressure difference

6
Even in normal lungs, these relations may be more accurately portrayed as non-‐linear. However, a first approximation as a
linear system has been found to be extremely useful, clinically.

237

υL is change in lung volume

ύL is rate of change in lung volume, interchangeably referred to as flow
CL, CW is lung compliance, and chest wall compliance, respectively
CL, CW is lung compliance, and chest wall compliance, respectively
R is resistance of the pulmonary system; sometimes called airway resistance or RAW

Δpmus = – [(pES – pBS) – υL / CW]
(3)
Combining equations (1) and (2), we obtain the governing equation for a single compartment
ventilatory system…:
Δptot = (pAO– pBS) + Δpmus = υL / Ctot + RAW ·∙ ύL 4)

…in which Δp is the total effective pressure difference driving the ventilatory system, and, Ctot, the total
system compliance, is given by
Ctot = CL ·∙ CW /( CL + CW) (5)
Besides the airway resistance, RAW, and the total compliance, Ctot, another mechanical property of
importance is their product, called the time constant, τ tot : t
τtot = RAW ·∙ Ctot (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 ·∙ τtot.)

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 , Ctot and τtot. 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 pressure 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.

238

13.1.1.2 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:

wAB = ∫ Δp dυ
(7)

…where,
• wAB is the work done going from volume A to volume B
• Δp is the pressure difference across the system
• dυ is the differential volume and the integral along the path from A to B on the Δp -‐dυ plane.

For the ventilatory system, for an entire breath numbered N, this can be written as:

Vee(N)
⌠
wBR(N)=| Δptot dυL
(8)
Vee(N-‐1) ⌡

…where, Vee(N) and Vee(N-‐1) are the end-‐expiratory volumes for breaths N and N-‐1, respectively.


239

Figure 13-‐2: Normal ventilatory system responses during assisted inspiration
(with expiratory muscle forcing)
Vei and Vee are end-‐inspiratory, and end-‐expiratory volumes, respectively.

VT is tidal volume.


13.1.1.3 Inspiratory Work
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:

VT
⌠
wI(N)=|[(pAO – pBS) + Δpmus] dυL (8)
Vei ⌡
VT V
⌠ T
⌠
=| (pAO – pBS) dυL + | Δpmus dυL

Vei ⌡ Vei ⌡

= wvent I(N) + wmus I(N) (9)
240

…where Vei is end-‐inspiratory volume, and VT is tidal volume. In this way, we can separately compute
the work of the ventilator, wvent I(N), and the work of the respiratory muscles, wmus I(N), during
inspiration.

We can also substitute the extreme right hand terms of equation 4 (Δptot = (pAO– pBS) + Δpmus = υL /
Ctot + RAW ·∙ ύL) into equation 7 (wAB = ∫ Δp dυ) to yield:

wI(N) = ∫ (υL /CL + RAW υL) dυL

=∫ (υL /CL) dυL + ∫ RAW ύL dυL
= wel I(N) + wres I(N) (10)

Thus, the work stored in the elastic components of the ventilatory system, wel I(N), can be separated
from the work dissipated, or lost, in the resistive components, wres I(N).

These ideas are illustrated graphically on Figure 13-‐3, a Δp-‐υL 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 ventilatory 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,
(pES – pBS), is plotted against lung volume change, υL, along with the static Δp-‐υL characteristic of the
chest wall, the chest wall compliance, CW, curve. These two curves are then used to graphically solve
equation (3) for Δpmus, and depict the components of work given in equation (10).

Cg is the compressibility of the gas in the ventilatory system; PEEP is positive end-‐expiratory pressure.

241

Figure 13-‐3: (a) Δp -‐ υL plot for airway-‐body surface pressure difference versus ventilatory system (lung) volume change
(for data in Figure 13-‐2)

Figure 13-‐3: (b) Δp -‐ υL plot for effective muscle pressure difference versus ventilatory system
(lung) volume change (for data in Figure 13-‐2)

242

Figure 13-‐3: (c) Δp -‐ υL plot for total deriving pressure difference versus ventilatory system
(lung) volume change (for data in Figure 13-‐2)

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 – pBS). This makes visualization of the various
driving pressure differences much clearer.
13.1.1.4 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, Δpmus, and the ventilator,
(pAO – pBS). These two pressure differences can be positive, in which case they retard, or act as a brake
on expiratory flow. Or, they can be negative and compress the system, and assist expiratory flow.
Again, using Figure 13-‐2, we can construct a Δp-‐υL plot for the expiratory portion of the breath,
Figure 13-‐4.
243


Figure 13-‐4: (a -‐ c) Δp -‐ υL plot for data in Figure 13-‐2 with expiration included

244

As the lung volume decreases, the expiratory pathway on the total pressure difference-‐volume plot
continues counterclockwise from the end-‐inspiration (Vei = Vee+VT) point on the total compliance
curve. It eventually meets the υL axis, at which point Δptot is zero and both the ventilator and the
respiratory muscles are passive. The ventilatory system continues 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 (wAB = ∫ Δp dυ) for expiration, we obtain:
Vee
⌠
wE(N)=|(pAO – pBS) dυL + Δpmus dυL
VT ⌡

= wvent E(N) + wmus E(N) (11)

These integrals represent the area between the expiratory curves and the υL-‐axis. In the upper
portions of Figure 4, just below the end-‐tidal volume, the change in υL is negative, i.e., the lung volume
is decreasing, while the Δp is positive. Therefore, the product Δp ·∙ dυL is negative. Negative work
indicates work is being done by the system on its surroundings. In Figure 13-‐4 (a), the work is done on
the ventilator since the (pAO – pPL) component of Δptot is non-‐zero. In Figure 13-‐4 (b), the work is done
on the inspiratory muscles as they lengthen while actively contracting before they completely relax to
Δpmus = 0.
However, further down the expired volume, in this example, the expiratory muscles are momentarily
activated, and Δpmus becomes negative, assisting expiration. Since both Δpmus and υL are negative, s
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 muscles as they shorten while
contracting during expiration.

13.1.1.5 Work of the Breathing Cycle
Figure 13-‐5 shows an alternative way of plotting the Δp -‐υL 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 Vei, the end-‐inspiration point. Thus, the
expiratory curve is the upward reflection of the expiratory portion of Figure 13-‐5.

245

Figure 13-‐5: Δp -‐ υL curve for an entire breath with expiratory volume change
plotted upward from end inspiration on the υL -‐axis

All area to the right of the υL-‐axis in the lower (inspiratory) curve is positive work, done on the system.

In the upper (expiratory) curve, the opposite holds. Area between Δp 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 υL -‐axis is positive, and represents work done on the system.
The same type of plot can be constructed for (pAO – pPL) and Δpmus. 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 work done on or by the respiratory muscles is to be evaluated, then the
Δpmus -‐υL curve is used. If the work done on or by the ventilator is of interest, then the plot of

(pAO – pPL) versus υL is required. If the entire load represented by the ventilatory system is desired,
then Δptot -‐υL 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-‐4 and Figure 13-‐5 is to consider the fate of the work done on
the ventilatory system during inspiration. For expiration to occur, i.e., υL to decrease from Vei toward
Vee, 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
246

inspiration (wel I in Figure 13-‐3). This energy is used to compress the ventilatory system during
expiration.
Figure 13-‐4 (c) shows that the potential (elastic) energy, i.e., the area between the Ctot line and the
υL-‐axis, is divided into two regions by the expiratory Δptot-‐υL curve.
• Area [1], between the Δptot-‐υL curve and the υL-‐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.
• Area [2], between the Δptot-‐υL curve and the Ctot line, is 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.

13.1.2 Abnormal Lungs
13.1.2.1 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
(τ = 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 τ either above or below this range.

247

Figure 13-‐6 (a): Volume and flow responses to the same Δptot forcing function,
for ventilatory systems with different time constants.

The time constant of the restricted system, τR, is less than that of a normal system, τN.
The obstructed system’s time constant, τo, is larger than normal: τR < τN < τo.

248

Figure 13-‐6 (b): The Δp -‐ υL for the three cases

Note that, in the time allotted, the obstructed system’s volume does not return to the same Vee 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 this, it can be appreciated that the intrinsic PEEP that accompanies gas trapping is not seen on a
plot of Δptot versus υL. However, this residual pressure would appear on the plot of (pes–pBS) versus υ .
L
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,

Δptot = (pAO – pBS) + Δ pmus = f1(υL) + f2(ύL)
(13)

249

…where, f1(υL) and f2(ύL) 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.

13.1.2.2 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 well. The minimum number of compartments that will exhibit the essential
responses of such systems is two.

Figure 13-‐7 shows a two-‐compartment pulmonary system within a chest wall compartment.
It is important to 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 similar to one another.


Figure 13-‐7: 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 RAW represents the resistance of
the larger, upper airways leading from the carina, (also called Rt, tracheal resistance).

250

The governing equations for this configuration are:

(pAO – pC) = Rt ·∙ ύ L
a)
(pC – pPL) = υL1 /C L1 + R1 ·∙ ύ L1
b)
(pC – pPL) = υL2 /C L2 + R2 ·∙ ύ L2
c) (14)
(pPL – pBS) + Δpmus = υL / CW
d)
υL = υL1 + υL2
e)
Combining these equations, and collecting terms, yields:
Δptot + K·∙Δptot = γ0·∙υL + γ1·∙ύL + γ2·∙ϋ2 (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)7. 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.
Figure 13-‐8 illustrates the effect of increasing breath rate in a two compartment ventilatory system.


Figure 13-‐8: Δptot -‐ υL relation for a two compartment ventilatory system
as breathing frequency is increased

The same amplitude Δptot is applied at all breathing frequencies, but only during inspiration.

7
Otis AB, McKerrow CB, Bartlett RA, Mead J, McElroy MB, Silverstone NJ and Radford EP Jr.
Mechanical Factors in Distribution of Pulmonary Ventilation. J Appl Physiol 8:427, 1956.

251

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.

13.1.2.3 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, 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 is involved. During 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 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 Δpmus exceeds the decrease in (pAO –pBS) by the amount needed to expand the lungs

and chest wall sufficiently to drop the airway pressure to trip the trigger. Thus, the Δptot -‐υL plot shows

simultaneous increases in lung volume and Δptot that follow the Ctot curve as the lung expands prior to

triggering.
The net or total work, shown on the Δptot -‐υL plot, is just that which is 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 Δpmus -‐υL and (pAO – pBS)-‐υL 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
252

time, T is considered part of inspiration, then the energy required to maintain the static tidal volume
H,
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.
The so-‐called pressure-‐time product (ΔpTH) has been used by various authors as an “index of effort,”
or, interchangeably with work (of breathing). The ΔpTH 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:

1 For the ventilator, is:

Event I = wvent I (+) + Iw vent I (-‐)I + α vent (p AO – pBS)HI THI
(16)

2 For the respiratory muscles, is:

E mus I = wmus I (+) + α mus Δp musHI THI (17)

…where α is a factor that relates the pressure-‐time product to energy for the different components.

Therefore, the total inspiratory energy is:
E tot I = wtot I (+) + Iwtot I (-‐)I + [αvent (pAO – pBS) HI + αmusΔp musHI] THI
(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.)

253

The energy expended during expiration:

1 For the ventilator, is:

Event E = wvent E (+) + Iw vent E (-‐)I + α vent (PEEP) THE (19)

2 For the respiratory muscles, is:

E mus E = Iwmus E (-‐)I + wmus E (+) (20)

Therefore, the total expiratory energy is
E tot E = Iwvent E (-‐) + wmus E (-‐)I + wvent E (+) + wmus E (+) + αvent (PEEP) THE (21)

For the complete breath cycle:
E tot = E tot I + E tot E

(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 Δpmus is available. Even though it is more complicated,
calculation of the various work terms can be obtained by substituting equation 3 for Δpmus. Again, a
simulation can calculate and plot (pes – pBS) versus υL with a superimposed chest wall compliance
curve, if a Campbell-‐type diagram is desired, or if intrinsic PEEP is to be visualized.


254

\k.` Modeling Based on Ventilatory Mechanics

The models of passive and active breathing of the ASL 5000 Breathing Simulator were developed based
on the concepts discussed in the previous chapter (i.e. the lungs, airways, diaphragmatic muscle
activity, and chest wall recoil forces).
A more technical “translation” of the Equation of Motion for the model (as described in the previous
section, Normal Lungs, page 236, and Non-‐uniform Lungs, page 250, is shown below.

Single Compartment Dual Compartment

Figure 13-‐9: Simulation Model Electrical Analog

NOTE
Please remember that in these model configurations no distinction is made between chest wall
compliance and lung compliance, instead they are lumped together. That means that in the
simplified case of the single compartment model, C represents total Compliance Ctot (see also
page 236).
Ctot = CL·∙CW /(CL + CW)
And, similarly, in the case of non-‐uniform lungs,
C1 = CL1·∙CW /(CL1 + CW)

C2 = CL2·∙CW /(CL2 + CW)

NOTE
In the lung model window and graphs, Δpmus is simply called pmus, but it still refers to the

255

muscle pressure difference as discussed in the previous chapter. In the waveform graphs, -‐
Δpmus is plotted, showing a negative (downward) excursion during inspiration.
13.2.1 Limitations of the Model

The model, as implemented in the simulator controller software, does not, by default, take into
account any neural response to external ventilation. The patient backing off feature (see Inspiratory
backing off , page 180) is an exception to this statement. RespiSim® allows pre-‐programmed
physiological responses integrated into simulations, but they are a result of subject matter expert
decisions based on patient characteristics and disease states.

256

\k.k How It Works

The hardware implementation of the models works via a pressure feedback control loop that
determines movement of a piston inside the simulator cylinder in such a fashion that values set for R,
C, and patient effort profiles are executed faithfully according to the
Equation of Motion Δpmus + pvent = ύL ·∙ R + 1/C υL.

The name Active Servo Lung is used to characterize the system as a device that operates on the basis
of such a servo control loop while it can also take active (spontaneous) breaths. The benefit of this
approach is that parameters can change without direct user intervention and that no physical orifice or
springs are needed.

Figure 13-‐10: Simulator Concept
In addition, the system does not feature a flow sensor, an advantage for long-‐term accuracy and
stability of volume measurements. It, instead, calculates flow from the high resolution (14 µL) volume
data.
The only “physical” parameters are volume and airway pressure, all other parameters are direct results
of model calculations. A two-‐compartment model serves as the basis for computing flow, alveolar
(lung) pressures etc. Performing the correct moves of the simulator piston, it is thus possible to make
the system appear from the outside indistinguishable from a physical two-‐compartment configuration
(think of it as a “black box”). A single compartment model, on the other hand, is rendered simply by
making both model compartments of equal size and characteristics.

For further details on model parameters and special enhancements, see 11.1 Advanced Patient
Modeling, page 167 ff.

257

\k.m Schematic Overview

SBLVM
(Simulator Bypass and Leak Valve Module)
One-way
valve
Test lung
Solenoid
valve
2
Mech.
1 3
leak valve 0
Optical limit switches
Brushless DC Motor
w/ encoder
Ventilator
PWM power
Hall signals
Ethernet
COM1
(Host)
Press. cal. Brushless
SIM switch valve Motor motor amplifier
ON Control 5/10 A, 55V
Signal
gr COM2 Differential
(Terminal) press. transducer
-40...110 cm H2O
Barometric
press. transducer

yl
Enc.
signal CAL
ON
Helios CPU with O2 sample
Press. transducer
16-bit A/ D converter pump CAL signal
Simulation ON
Fast signal I/ O
paramagnetic Mod.
2kHz motion
controller O2 transducer Systems
inter-
connect
Thermolinear net- board
work thermistor
Universal input Universal input

switching power supply switching power supply
+ 5V, ± 12 V +48 V
Revision 2, © IngMar Medical 2016

Figure 13-‐11: ASL 5000 Schematic Overview
258

\k.o Patient Model Libraries

There exist two patient model libraries in the ASL 5000 software, one for the Interactive Control Panel
(see 0, page 47) as well as one that is behind the selections for QuickChoice menus of patient/disease
state/severity.

13.5.1 Interactive Control Panel Patient Model Library
1 Compartment Static Models
Inspiration
vr3-‐File Name URC Rin Rout C Effort Rate Pmax Increase Hold Release
Adult Adult_Normal 0.5 6 6 50 Sinusoidal 15 11 30 0 10
Adult_Passive 0.5 6 6 50 Sinusoidal 15 0 30 0 10
Adult_ChBronchitis 0.5 30 30 80 Sinusoidal 18 7 20 0 20
Adult_Emphysema 0.8 6 10 150 Sinusoidal 17 5 10 0 25
Adult_Normal 0.5 6 6 50 Sinusoidal 15 11 30 0 10
Adult_Normal_unassisted 0.5 3 3 80 Sinusoidal 15 7 30 0 10
Adult_Passive 0.5 6 6 50 Sinusoidal 15 0 30 0 10
Adult_ARDS 0.5 11 16 30 Sinusoidal 25 21 27 0 20
Adult_COPD 0.8 21 23 53 Sinusoidal 18 24 35 0 23
Adult_COPD_unassisted 0.8 12 25 66 Sinusoidal 20 25 35 0 23
Adult_Asthma 0.5 30 50 30 Sinusoidal 22 27 20 0 15
Adult_CF 0.5 10 25 45 Sinusoidal 22 17 20 0 20
Pediatric Premature_Neonate 0.2 150 150 0.5 Sinusoidal 45 15.5 23 0 23
Neonate_Normal 0.2 40 40 8 Sinusoidal 32 8 18 0 10
Neonate_Passive 0.2 40 40 8 Sinusoidal 32 0 18 0 10
Neonate_Normal 0.2 40 40 8 Sinusoidal 32 8 18 0 10
Neonate_Passive 0.2 40 40 8 Sinusoidal 32 0 18 0 10
Neonate_BPD 0.2 69 87 2 Sinusoidal 50 30 43 0 20
Neonate_RDS 0.2 125 125 0.5 Sinusoidal 60 16 25 0 25
Infant_Bronchiolitis 0.2 21 25 12 Sinusoidal 29 5 43 0 20
Toddler_Normal 0.375 25 25 15 Sinusoidal 24 10.5 19 0 12
Toddler_Obstructive 0.9 50 50 15 Sinusoidal 24 20 19 0 12
Toddler_Restrictive 0.225 20 20 7.5 Sinusoidal 24 18 19 0 12
Ped_10kg_Normal 0.4 25 25 10 Sinusoidal 30 12 19 0 12
Ped_10kg_Obstructive 0.6 50 50 10 Sinusoidal 30 18 16 0 13
Ped_10kg_Restrictive 0.15 25 25 5 Sinusoidal 30 19 20 0 13
Pediatric5yo_Asthma 0.4 15 75 20 Sinusoidal 28 20 37 0 15
Pediatric5yo_Normal 0.4 15 15 20 Sinusoidal 20 12.5 25 0 10
Pediatric6-‐12yo_Normal 0.5 20 20 30 Sinusoidal 22 14 30 0 10
Adolescent_Normal 0.5 15 15 40 Sinusoidal 15 16 20 0 20
Kussmaul’s Kussmauls_1 0.5 3 3 80 Trapezoidal 18 12 30 0 10
Kussmauls_2 0.5 3 3 80 Trapezoidal 25 20 30 0 10
Kussmauls_3 0.5 3 3 80 Trapezoidal 40 35 30 0 10

259

2 Compartment Static Models
vr3-‐File Name URC Rin Rout C Effort Rate Pmax Increase Hold Release
Adult_Right_Pneumothorax 0.5 Rtin: 75 Rtout: C1: 7 Sinusoidal 20 30 30 0 10

R1in: 15 75 C2: 1
R2in: 3 R1out: 3
R2out: 1

Time-‐Varying Models
(1 Compartment)
Inspiration
vr3-‐File Name Compart URC Rin Rout C Effort Rate Pmax Increa Hol Releas
ment se d e
Adult_Normal_variable 1 0.5 6 6 50 Sinu-‐ Random-‐ Random-‐ 30 0 10
soidal Uniform Uniform
Reps:100 Reps:
0 1000
Mean: Mean: 11
15 Seed: 1
Seed: 1 Ampl:
Ampl: 6 4.4
Adult_Normal_unassisted_vari 1 0.5 3 3 80 Sinu-‐ Random-‐ Random-‐ 30 0 10
able soidal Uniform Uniform
Reps:100 Reps:
0 1000
Mean: Mean: 7
15 Seed: 1
Seed: 1 Ampl:
Ampl: 6 2.8
Improved_Compliance_Adult_ 1 0.5 6 6 Endpoints Sinu-‐ 15 11 30 0 10
1 Reps: 50 soidal
Start: 8
End: 50
Improved_Compliance_Adult_ 1 0.5 6 6 Random-‐ Sinu-‐ 15 11 30 0 10
2 Uniform soidal
Reps: 50
Mean: 50
Seed: 1

Ampl: 20
Improved_Resistance_Adult_1 1 0.5 Endpoints Endpoints 50 Sinu-‐ 15 11 30 0 10
Reps:50 Reps: 50 soidal

Start:30 Start: 50
End:13 End: 15
Improved_Resistance_Adult_2 1 0.5 Random-‐ Random-‐ 50 Sinu-‐ 15 11 30 0 10
Uniform Uniform soidal
Reps:50 Reps: 50
Mean:13 Mean:15
Seed:1 Seed:1
Ampl:5.2 Ampl:6
Anesthetized_Adult 1 0.5 3 3 80 Sinu-‐ 15 Endpoints 30 0 10
soidal Reps: 50
Start: 10
End: 0
Adult_Pneumonia 1 0.5 Random-‐ Random-‐ 31 Sinu-‐ 30 22 31 0 22
Uniform Uniform soidal
Reps: 1000 Reps: 1000
Mean: 12 Mean: 12
Seed: 1 Seed: 1
Ampl: 12 Ampl: 12

260

13.5.2 QuickChoice Patient Model Library

Adult Normal
Compliance Resistance Patient Effort Rise % Release %
Rate
High 50 6 25 18 40% 10%
Medium 50 6 15 11 25% 10%
Low 50 6 8 5 13% 10%
Passive (0)

Adult Asthma
Compliance Insp/Exp Patient Effort Rise % Release
Resistance Rate %
Mild/High 80 30/50 35 30 40% 10%
Moderate/Medium 60 40/70 25 20 35% 10%
Severe/Low 40 50/90 15 10 20% 10%
Passive Passive
(0)

Adult ARDS
Compliance Resistance Patient Effort Rise % Release
Rate %
Mild/High 40 8 25 25 35% 10%
Moderate/Medium 25 15 15 18 20% 10%
Severe/Low 10 22 8 10 13% 10%
Passive Passive (0)
Severe 10 24 35 10 35 15

Adult COPD
Compliance Insp/Exp Patient Effort Rise % Release %
Resistance Rate
Mild/High 50 12/14 30 30 35% 20%
Moderate/Medium 75 21/23 18 20 25% 20%
Severe/Low 100 30/32 10 10 15% 10%
Passive Passive
(0)

261

Ped Normal
Rate
Mild/High 12 20 40 12 40% 10%
Severe/Low 5 40 25 5 25% 10%
Passive Passive (0)

Ped Asthma
Compliance Insp/Exp Patient Effort Rise % Release
Resistance Rate %
Mild 15 20/40 60 20 50% 10%
Moderate 10 30/60 45 15 40% 10%
Severe 5 40/80 30 8 30% 10%
Passive Passive
(0)

Ped ARDS
Rate
Mild/High 10 25 50 15 45% 10%
Severe/Low 4 45 25 5 25% 10%

Passive Passive (0)

Ped CF
Rate %
Mild/High 20 15 40 12 40% 10%
Severe/Low 5 50 20 5 20% 10%
Passive Passive (0)

262

Neo Normal
Rate %
Mild 8 20 50 6 35% 10%
Moderate 4 40 40 4 30% 10%
Severe 2 60 30 2 25% 10%

Neo BPD
Compliance Insp/Exp Patient Effort Rise % Release %
Resistance Rate
Mild 3 50/70 80 15 45% 20%
Moderate 1.5 60/80 70 10 40% 20%
Severe 0.5 70/90 60 5 35% 20%

Neo IRDS
Rate
Mild 1.5 75 80 50 45% 20%
Moderate 1 100 65 35 40% 20%
Severe 0.5 125 50 20 35% 20%


263

\k.s Background to Instructor-‐Driven Multi-‐Stage Clinical

Simulations

RespiSim® employs a specific approach to immersive simulation as 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 usually not left to their own devices to figure 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.

13.6.1 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 the patient vital signs that can be expected
as per the ventilation the 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 is not relegated to a passive role
by 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.”

13.6.2 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 form that can be enhanced by
instructors to include specific quizzes or the like. It is expected that students are exposed to the
264

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 worksheet might also contain suggestions for debriefing questions

Included as part of the module package are also files for x-‐rays as well as lung and heart sounds (where
applicable). Also loaded with 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.


265

14 SUPPORT
\m.\ Support Resources

Recognizing that the ASL 5000 has users from a large number of specialties, 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 this Operating
Manual, there are a number of other resources for 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.

A Virtual Visit (live distance training while the customer shares his/her screen) is a very effective way of
accelerating the learning curve of a novice user. For this training option, you will receive a package of
support materials that includes a webcam for showing your ventilator screen to the trainer. Please
contact Customer Care at 1 (800) 583-‐9910, ext. 107, about this option and other support plans that
you might be interested in purchasing.

\m.` Frequently Asked Questions (FAQs)

For a list of answers to FAQs, please check IngMar Medical’s website. For questions more directly
related to the ASL 5000 only, go to:

http://www.ingmarmed.com/products/asl-‐5000/frequently-‐asked-‐questions-‐asl-‐5000/

For questions that are related to RespiSim® and the use of the ASL 5000 Breathing Simulator in
education, try also:

http://www.ingmarmed.com/products/respisim-‐pvi-‐alternative/faq/

On the IngMar Medical website, we also offer recordings of past webinars:

http://www.ingmarmed.com/site-‐training/live-‐distance-‐training-‐registration/

266

\m.k Troubleshooting
Here are a few conditions (with their solutions) that you can easily identify and troubleshoot:

1. Simulator piston not moving:
• At the simulator power entry module (back of the unit), check that power is switched ON (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 boot up of the system, i.e., after approximately 15-‐20
seconds). The enable/disable switch must be in the depressed position.
• When the light stays ON outside of the boot up process (even while the enable/disable switch is
in the correct, depressed position), it indicates a software motor disable.

Possible reasons: 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.).
The software will also not enable the motor in case of a failed boot procedure.

Solution: In order to reset the ASL 5000 in this case, switch power OFF, wait a few seconds, then
switch power back ON again.

2. Host does not sync up with simulator:
• Check that power is switched ON at the simulator power entry module (green switch lit).
Power cycle the simulator (turn power OFF, then back ON again) and wait until simulator has
initialized (approximately 20 seconds after power-‐up, red light OFF).
Then re-‐try synchronizing the software.
• For Ethernet connection, verify that both the ASL 5000 and the PC are connected to a “live”
network with DHCP service in place or that the ASL 5000 has been issued a fixed IP address
(see 15.1, page 271).
• For serial connection the USB cable must be connected to the COM-‐port labeled Host on the
ASL 5000.
• Also, confirm that the serial port of the host computer is not engaged by another application
(for example, PuTTY, used for maintenance procedures).
• You may also try disabling and re-‐enabling the serial port of the PC in the Windows Device
Manager.
• Then, restart the ASL 5000 application (ASL5000_SW3.6.exe).
• Restart computer, if necessary, to free up a locked serial port.

267

3. Discrepancies between traces for Lung Model and Piston in Run Time Home 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.

4. 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 (dependent on the choice of Chart Length, see page 66). 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.

5. Asynchrony 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.”
However, when a longer profile needs to be downloaded for an upcoming slow rate while the
simulator is still operating at a higher rate, asynchrony is possible.
• Inserting a parameter file segment containing just one breath of an in-‐between rate can be

used to prevent this.
This asynchrony may not occur when operating on a network (Ethernet connection).

6. 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 models. Excessive volumes will exceed the physical capabilities of the
simulator and therefore might cause a motor disable.
• Use values < 2.1 L when operating with a residual volume of 0.5 L
(the default setting for URC).
• Return to model parameters and/or conditions that are within the performance range of the
simulator system (peak flow, acceleration) if 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.

For additional topics on Troubleshooting, go to:
http://www.ingmarmed.com/support/asl-‐5000-‐training-‐support/asl-‐5000-‐troubleshooting/

268

15 MAINTENANCE
When inquiring about maintenance, always have the serial number of your device available. Additional
reference information can be found on the label on the bottom of the instrument a copy of which is
included also in the product binder supplied which each instrument.

Figure 15-‐1: ASL 5000 Component Serial Numbers

CAUTION!
The ASL 5000 does not contain user-‐serviceable components or parts. Unauthorized opening of
the device will void the warranty.

Right-‐click anywhere on the Welcome window (see Figure 5-‐5, page 25) and the Maintenance Menu
opens.

269

Figure 15-‐2: Maintenance Menu

Click on for information that is relevant for determining
the need for calibration as well as maintenance of the piston seals.


Figure 15-‐3: Odometer Readings

270

\o.\ Issuing a Fixed IP Address

The ASL 5000 is, by default, expecting a network where it receives an IP address by a DHCP server
(usually a router or a dedicated server on larger networks). If it is necessary to change this
configuration, for example, because your IT department requires it, you can easily assign the ASL 5000
a fixed IP address.
1. Right-‐click anywhere on the Welcome window (with the switch in Full System Mode to access
the Maintenance Menu (see Figure 15-‐2).

2. Click . The IP Configuration window appears.

Figure 15-‐4: Configuration for Fixed IP Address

3. Select Use IP and enter the desired IP address into the fields. Verify the IP address entered
carefully and click .

After this step, the software will proceed to generate a condition of firmware mismatch, which gets
you to the prompt of firmware update as described in Firmware Upgrade on page 272).
You will use the Upload option.

NOTE
When being asked to restart the software, you should save the User Settings before exiting
because it will save the new, fixed IP address as the new default for communicating with the
ASL 5000.

271

\o.` Manual Software Installation / Software Upgrade

You can easily upgrade an earlier installation of ASL 5000/RespiSim® software to the new version 3.6.
The installer will be supplied to you either as a download link or on a USB flash drive.
\o.k Firmware Upgrade

Whenever the ASL 500 software, upon connecting to the simulator, detects a “mismatch” between the
firmware version of the simulator and the current version of the DLL (direct link library) running on the
PC, you are given the choice to upgrade the firmware. A dialog window will pop up.

Figure 15-‐5: Firmware Upload Dialog
• To perform the firmware upgrade, select Upload new version from host. A new pop-‐up
window gives you the opportunity to verify the upgrade about to be performed.

NOTE
When connected via RS-‐232 (serial connection), the update process will take longer than one
minute. It is therefore recommended to use Ethernet connectivity when attempting a firmware
upgrade.

272

Figure 15-‐6: Firmware Upgrade Verification

• If satisfied with the upgrade information, click .


Figure 15-‐7: Firmware Upload Message

• Click and wait for the message indicating that the upload is complete.

• Acknowledge and restart the ASL 5000 for the new firmware to take effect.

273

\o.m Recommendations for Calibration

Not always will it be necessary to mandate specific calibration intervals for the ASL 5000. However,
depending on the type of use of the device, users in research and development facilities, especially
those operating under some regulatory framework, will find the following guidelines helpful.

What When/How Often
Leak Test every month*
Pressure Calibration IngMar Medical recommends
yearly calibration of the
ASL 5000 Breathing Simulator**
Piston Seal Exchange When leakage rate exceeds
specification (40mL/min at 50
cmH2O)
*more frequently if indicated by continuous
use of the instrument or by good scientific
practice
** Per ISO 17025:2005 guidelines the
recalibration date will not be listed on the
calibration certificate, or be marked on the
instrument itself.

NOTE
Maintenance reminder messages for both calibration and seal replacement at software startup are

implemented in the software. They can be suppressed if not desired.

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

274

16 TECHNICAL DATA
\s.\ Performance Specifications

Modes of Operation Passive
Spontaneous
Interactive (with adjustable response to ventilator breaths)
Flow waveform generator (SmartPump™ mode)
Volumes
(Standard 3 L Cylinder)
Total 3.1
3.1 L
Tidal 2 to 2500 mL
Volume uncertainty ranges
up to 10 mL greater of ± 10% of reading or 1 mL
up to 100 mL greater of ± 2.5% of reading or 2.5 mL

FRC setting 100 ...1500 mL
Deadspace 200 mL

Volumes (6 L Cylinder)
Total 6.9 L
Tidal 2 to 6000 mL
Volume uncertainty
up to 10 mL greater of ± 15% of reading or 1.5 mL

Deadspace 200 mL

Volumes (Preemie Add-‐On Cylinder)
Total 0.4 L
Tidal 0.5 to 200 mL
Volume uncertainty
up to 10 mL greater of ± 2% of reading or 0.2 mL


275

Deadspace 25 mL

Frequencies
Spontaneous breath rate 0 to 150/min (infant Vt)
Small signal bandwidth better than 15 Hz (10 cm passive response to HF ventilation)
3

Flows
Peak flow 270 L/min for units with 4mm,
180 L/min for units with 2.5 mm pitch ball screws
Flow rise t90flow < 50 ms
Low flow < 1 L/min
Uncertainty ± 2% of reading

Passive Model8
Resistance 5 to 500 cmH2O/L/s
linear and parabolic
Uncertainty ± 10 of set value
Compliance 1 or 2 compartment,
0.5 to 250 mL/cmH2O overall
Uncertainty ± 5% of set value
Leak on SBLVM (avail. option),

approx. 4, 9, 15 L/min at 20 cmH2O
leak orifices exchangeable

Active Model
Chestwall pressure profiles Pressure trigger, flow trigger,
sinusoidal, trapezoidal,
user-‐file defined

8
The ASL 5000 complies with the requirements for test lungs of ISO 80601-‐2-‐12 (2011),
“Particular requirements for basic safety and essential performance of critical care ventilators”.
276

Pressure Measurement
Airway uncertainty < than 1% fso
Barometric uncertainty < 1% (1 kPa)

Gas Temperature
uncertainty <0.5°C (20 -‐ 45°C)

Servo System
update rate 2048 Hz

Fast Oxygen Module Part no. 31 00 300
(FOM Option)
Principle Paramagnetic
(partial pressure measurement)
O2 Meas. Range 0 to 100% O2
O2 uncertainty ±0.5% O2
Response time <350 msec
(t90, 21 to 100% O2)

Cylinder Temperature Part no. 31 00 400
Controller
(CTC Option)
Principle PID-‐controlled foil heater on cylinder circumference
Wall temperature setting ambient +5 ºC to 45 ºC

Auxiliary Part no. 31 00 600
Gas Exchange Cylinder
(AGEC Option)
Principle Bag-‐in-‐bottle external cylinder
Volume approximately 3.0 L
(accommodates bags/bellows up to 4.5 inches inflated diameter)

Chest Rise Module Option Part no. 31 00 730

Principle Pneumatic controller for manikin simulator chest rise “pillow“
Compatibility designed for use with Laerdal SimMan (Classic and 3G)
TM

277

RespiSim® VIK Part no. 31 00 765

(Ventilator Interface Kit)
Principle Ventilator data capture via RS-‐232-‐to-‐WiFi interface (Fusion Bridge)
Ventilator Please see table on the next page
Compatibility

\s.` RespiSim® Ventilator interface Kit (VIK) Compatibility and

Configuration


Figure 16-‐1: VIK Configuration
278

\s.k Electrical Specifications

Supply Voltage 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)
Current (120 V) < 1.0 A typical (2.0 A max)
(230 V) < 0.5 A typical (1.0 Amax)
Fuses 3.0 A time delayed (2 x)
(size 5 x 20 mm)

\s.m Physical Specifications

Dimensions
ASL 5000 8.6 x 16.8 x 12.4 inches (219 x 425 x 315 mm)
SBLVM 4.8 x 4.8 x 4.3 inches (123 x 123 x 108 mm)
(not including cable)

Weight
ASL 5000 approx. 22 lbs. (10 kg)
in standard configuration

SBLVM 3.5 lbs. (1.6 kg)

Materials Used
Inside the Simulator
Cylinder anodized aluminum, silicone sealant
Piston plate aluminum, closed cell foam pad
Piston seal Teflon®, Nylon®, rubber
Temperature sensor Nylon, brass

279

\s.o Software Specifications

Interface to PC host via 10/100 MBit Ethernet (units with serial no.’s > 0800),
alternatively USB/RS 232 at 57600 Baud, 8 bit, no parity, 1 checkbit
(built-‐in USB converter beginning serial no. 1400)

Host Software LabVIEW modules for:
modeling
simulation
data analysis

LabVIEW utilities for
breath profile resampling
interface module for remote
control via external LabVIEW
software
TCP/IP Breath Parameter Client
TCP/IP Waveform Client

\s.s Environmental Specifications
Storage Temperature: -‐10 ºC to 50 ºC

(allow device to reach approximate room temperature before use)
Humidity: 10 to 95%, non-‐condensing
Operation Temperature: +10 ºC to 40 ºC
Humidity: 10 to 95%, non-‐condensing

Specifications are subject to change without notice.

280

17 INDEX

A
Active expiration .................................................................... 180 fixed IP address ................................................................. 269
AGEC ....................................................................................... 209 parameter highlighting ..................................................... 139
preference set ................................................................... 123
AICP(Advanced Interactive Control Panel) ............................. 110
relative path ...................................................................... 159
Analysis ..................................................................................... 65 RespiScope ........................................................................ 142
menu ................................................................................... 72 TCP Breath Client .............................................................. 195
Post-‐Run .............................................................................. 71 TCP Broadcast ................................................................... 196
real time .............................................................................. 68 VIK, hard-‐wired ................................................................. 221
Ventilator Performance ...................................................... 85 VIK, Ventilator Adapters ................................................... 276
Analysis Parameters Connection
default ............................................................................... 164 electrical ...................................................................... 20, 153
Anesthetics ............................................................................... 14 Ethernet .............................................................................. 21
Auxiliary Channel serial (USB) ........................................................................ 155
resampling ........................................................................ 189 WiFi ..................................................................................... 21
Auxiliary Gas Exchange Cylinder ............................................. 209 Connector, specification for analog channel .................. 197, 200
Converter
B serial-‐to-‐USB ..................................................................... 155
CTC (Cylinder Temperature Controller) .................................. 203
Backing off electrical specs. ................................................................. 277
expiratory .......................................................................... 180 Curriculum teaching modules .................................................. 40
inspiratory ................................................................. 179, 254
Barometric pressure ........................................................... 65, 67
Breath detection ................................................................ 68, 97
D
settings ................................................................................ 70 Damage .................................................................................... 15
during shipment .................................................................... 3
C excessive voltageon analog inputs .................................... 182
Preemie cylinder threads .................................................. 208
Calibration .............................................................................. 272 Preemie piston seal ........................................................... 208
intervals ............................................................................ 272 Data
Chart Length ............................................................................. 65 raw ................................................................................ 69, 75
Chest wall rwb-‐files ............................................................................ 187
compliance ................................................................ 169, 236 Data file types .......................................................................... 98
Clinical simulations Data files ................................................................................ 187
multi-‐stage ........................................................................ 262 Definitions
Closed Loop of terms used ...................................................................... 12
CO2 Tab ............................................................................... 54 of time marks ...................................................................... 87
MV Tab ................................................................................ 53 of tokens ........................................................................... 160
slider ................................................................................... 50 parameter ........................................................................... 87
Vt Tab .................................................................................. 52 DHCP
Compensations .................................................... 59, 70, 170, 172 IP address from ................................................................. 218
Compliance service ............................................................................... 153
chest wall ............................................................................ 36 Disease state ...................................................................... 35, 37
circuit .................................................................................. 70 from QuickChoice/Interactive ........................................... 107
compounded ..................................................................... 169 RespiSim settings .............................................................. 113
lung ..................................................................................... 36 Disease states ......................................................................... 254
Non-‐linear ................................................................... 59, 171
patient ................................................................................. 70

ventilator ........................................................................... 165
Configuration
analog output .................................................................... 198
Ethernet .............................................................................. 22

281

E H
Electrical supply .......................................................... 15, 20, 267 HF ventilation ......................................................................... 266
Equation of Motion ................................................................ 253 response to ....................................................................... 274
display window ................................................................... 33
Error I
mean squared, inspiratory .................................................. 92
mean squared, expiratory ................................................... 90 Identification
position ............................................................................. 265 network IP address ........................................................... 195
of breaths ............................................................................ 71
Errors
common ............................................................................ 265 Installation
of VIK (Ventilator Interface Kit) ......................................... 214
Ethernet
Preemie cylinder ............................................................... 206
wired setup ......................................................................... 21
software upgrade .............................................................. 270
Ethernet port ............................................................................ 21 software, manual .............................................................. 270
Event Graph ............................................................................ 120 Instructor Dashboard ............................................................. 112
markings ............................................................................ 123 Change Event view ............................................................ 115
Event markers ........................................................................ 121 Initial Settings sub-‐tab ...................................................... 112
Excel ....................................................................................... 188 Instructor Scenario Guide ...................................................... 263
Exit Instructor settings
software .............................................................................. 45 enabling ............................................................................ 115
Virtual Ventilator .............................................................. 105 Intended Use ............................................................................ 13
Explosion hazard ...................................................................... 14 Interactive Control Panel (ICP) ................................................. 47
IP address
F fixed .................................................................................. 269
from DHCP ........................................................................ 218
Fast Oxygen Measurement (FOM) ......................................... 204
Features
lung model, advanced ....................................................... 166 L
of the standard user environment ...................................... 41 Limitation of Liability ................................................................. 4
software .............................................................................. 18
Lung Model
system ................................................................................. 18
parameters in ICP ................................................................ 49

Firmware single compartment .................................................... 58, 166
adjustments for Preemie cylinder ..................................... 207 two compartment ............................................................... 58
Flow pattern generator ............................................................ 18 two-‐compartment ............................................................. 166

FOM ........................................................................................ 204 Lungs
FRC ................................................................................... 59, 167 abnormal ........................................................................... 245
obtructive diseases ........................................................... 247 non-‐uniform ...................................................................... 248
setting ............................................................................... 273 normal ............................................................................... 234
frequency Lungs, uniform ....................................................................... 245
Output sample .................................................................. 189
rate of breathing ............................................................... 249
G
Gain factor
data resampling ................................................................ 191
in User Settings, default analysis parameters ................... 164
multi-‐parameter graph ....................................................... 78
pressure/flow input resampling ........................................ 194
raw data preview ................................................................ 75
setting for analog Pmus input ........................................... 182
Gas temperature ...................................................................... 67
282

M

Maintenance .......................................................................... 272 Patient model
Measurement advanced interactive ......................................................... 110
gas temperature, uncertainty ........................................... 275 Patient modeling ...................................................................... 35
oxygen ............................................................................... 204 advanced ........................................................................... 166
pressure, uncertainty ........................................................ 275
Patient rooms ........................................................................... 14
pressure, with Preemie cylinder ....................................... 208
temperature, with Preemie cylinder ................................. 206 Pausing a simulation ................................................................ 45
volume .............................................................................. 255 Performance
Measurement, fast oxygen ...................................................... 18 thresholds ........................................................................... 39
Model Performance Analysis ............................................................... 85
lung ..................................................................................... 58 Performance verification, ventilator ........................................ 13
lung, interactive .................................................................. 49 Playback mode ....................................................................... 120
lung, single compartment ................................................... 58 Port
lung, two compartment ...................................................... 58 Ethernet .............................................................................. 21
patient effort ............................................................... 59, 193 USB ...................................................................................... 22
Model, limitations of .............................................................. 254 Post-‐Run Analysis ..................................................................... 71
MV Precautions .............................................................................. 15
closed loop .......................................................................... 53
Preferences
desired value ....................................................................... 53
RespiSim ............................................................................ 122
tab ....................................................................................... 53
Pressure feedback
in control loop ................................................................... 255
O off for pump models ......................................................... 193
Odometer readings ................................................................ 268 Pressure filter ........................................................................... 69
Options Pressure trigger ................................................................ 61, 177
hardware ............................................................................. 18 Procedures, ventilator test or calibration ................................ 13
software .............................................................................. 18 Product Warranty ....................................................................... 3
Oscillations, high frequency ..................................................... 71 PuTTY .............................................................................. 201, 207
Over voltage protection ................................................. 197, 200
Overview R
functional ............................................................................ 16
scenario ............................................................................. 136 Ramps
pressure profile ................................................................... 61
schematic .......................................................................... 256
software .............................................................................. 17 Raw Data Preview .................................................................... 75
system ................................................................................. 16 Real time analysis ..................................................................... 68
TAI (Test Automation Interface) ....................................... 202 Resampling
WebClinical ....................................................................... 227 pressure/flow profile ........................................................ 193
Oxygen, use with ...................................................................... 15 Resistance
linear ................................................................................. 168
P mixed ................................................................................ 168
ventilator ........................................................................... 165
Parameter definitions ........................................................ 83, 87
Resistor
Parameters parabolic ........................................................................... 168
auxiliary analog input .......................................................... 67 tracheal ............................................................................. 168
numeric ............................................................................. 120
Resistors
Patents ....................................................................................... 4 independent (in/out) ........................................................ 169
Patient ...................................................................................... 12 lung ................................................................................... 169
Patient charting, training ....................................................... 224 RespiSim ................................................................................. 106
Patient effort model ............................................................... 192 Response, neural, to ventilation ............................................ 254
advanced features ............................................................ 177 Review & Exit (WebClinical) ................................................... 230
sinusoidal .......................................................................... 177
Run Time Home ........................................................................ 41
Patient effort profile
user-‐defined ...................................................................... 193

283

S
Temperature
Safety considerations ............................................................... 12 cylinder wall ...................................................................... 203
Sampling rate, waveform data ............................................... 170 gas ....................................................................................... 67
SBLVM (Simulator Bypass and Leak Valve Module) ............... 211 Terminal program, using ........................................................ 207
Scenario Concept Presentation .............................................. 262 Test Automation Interface (TAI) ............................................. 201
Screen chart, updates ............................................................ 266 Test lung, with SBLVM ............................................................ 211
Serial-‐to-‐USB converter .......................................................... 155 Theory of operation ............................................................... 234
Simulator Bypass and Leak Valve Module ........................ 18, 211 Time-‐varying parameters ....................................................... 172
Sinusoidal patient effort ........................................................... 61 Trademarks ................................................................................ 4
SmartPump Trapezoidal patient effort ........................................................ 61
mode ................................................................................... 14 Trends
models ................................................................................ 36 default analysis parameters .............................................. 164
SmartPump mode .................................................................... 18 multi-‐parameter view ......................................................... 81
Software RespiSim Preferences ........................................................ 124
adjustments for Preemie cylinder ..................................... 207 Trigger response time (time to trigger) .................................... 96
Software License Agreements .................................................... 5 Troubleshooting ..................................................................... 265
Specifications
ASL 5000 ............................................................................ 273 U
electrical ............................................................................ 277
environmental ................................................................... 278 Update
physical ............................................................................. 277 ASL 5000 software ............................................................ 270
software ............................................................................ 278 firmware ........................................................................... 270
Spills ......................................................................................... 15 VIK software ...................................................................... 214
Starting USB cable .......................................................................... 22, 265
ASL 5000 .............................................................................. 23 USB port ................................................................................... 22
simulation ........................................................................... 28 User-‐defined
Switch, emergency OFF ............................................................ 23 patient effort profile ......................................................... 193
Switch, motor enable/disable ................................................ 265
Symmetrical flow profiles, SmartPump mode ........................ 183 V

Synchronization, problems with ............................................. 265
Ventilator ................................................................................. 13
Ventilator Performance Analysis .............................................. 85
T Volume corrections
Target conditions ........................................................................... 73
override ............................................................................... 74 in Post-‐Run Analysis ............................................................ 73
presssure ............................................................................. 74 in Real Time Analysis ........................................................... 68
Vt set value ......................................................................... 52 Volume threshold
TDMS file ................................................................................ 190 breath start ......................................................................... 70
default ................................................................................. 87
Technical data ........................................................................ 273
expiratory start ................................................................... 70

Z
Zoom tool ........................................ 75, 77, 79, 80, 81, 82, 85, 86

284

18 LIST OF FIGURES

Figure 3-‐1 Functional Overview ................................................................................................................................................. 16
Figure 3-‐2 Standard Windows Manager tabs ........................................................................................................................... 17
Figure 3-‐3 RespiSim® Window Manager tabs ........................................................................................................................... 17
Figure 4-‐1: ASL 5000 Line Power Connection ............................................................................................................................ 20
Figure 4-‐2: Ethernet Connection between ASL 5000 and PC ..................................................................................................... 21
Figure 4-‐3: USB Connection between ASL 5000 and PC ............................................................................................................. 22
Figure 5-‐1: Turning On the Device ............................................................................................................................................. 23
Figure 5-‐2: ASL SW 3.6 Icon ....................................................................................................................................................... 23
Figure 5-‐3: IngMar Medical ASL 5000 Welcome window .......................................................................................................... 24
Figure 5-‐4: Welcome window choices ....................................................................................................................................... 24
Figure 5-‐5: Welcome window, Full System Mode ...................................................................................................................... 25
Figure 5-‐6: SWM opened to Run Time Home tab ...................................................................................................................... 26
Figure 5-‐7: Scenario selection .................................................................................................................................................... 27
Figure 5-‐8: Starting the Simulation ........................................................................................................................................... 28
Figure 5-‐9: Running a Simulation from the Run Time Home tab ............................................................................................... 29
Figure 5-‐10: Welcome Window RWM ....................................................................................................................................... 30
Figure 5-‐11: QuickChoice/Interactive Patient Model Selection ................................................................................................. 31
Figure 5-‐12: Selecting an Output Location ................................................................................................................................ 32
Figure 5-‐13: Equation of Motion Waveform View ..................................................................................................................... 33
Figure 5-‐14: Equation of Motion Single Breath View ................................................................................................................ 34
Figure 6-‐1: Types of Lung Models .............................................................................................................................................. 35
Figure 6-‐2: Spontaneous Effort Profile ...................................................................................................................................... 36
Figure 6-‐3: Pump Modes ........................................................................................................................................................... 36
Figure 6-‐4: List of Patient Models .............................................................................................................................................. 37
Figure 6-‐5: Script Editor, Manual Scripting View ....................................................................................................................... 38
Figure 7-‐1: The Run Time Home Tab ......................................................................................................................................... 42
Figure 7-‐2: Graph Area and Options .......................................................................................................................................... 43
Figure 7-‐3: Interactive Control, Debrief, Virtual Vent, Start/Stop Sim., and Set Pause ............................................................. 44
Figure 7-‐4: Fill Bar, Create Report, and Exit Software ............................................................................................................... 46
Figure 7-‐5: Interactive Control Panel ......................................................................................................................................... 48
Figure 7-‐6: Lung Model Parameters tab .................................................................................................................................... 49
Figure 7-‐7: Spontaneous Breathing Parameters Tab ................................................................................................................ 50
Figure 7-‐8: Trends Tab ............................................................................................................................................................... 51
Figure 7-‐9: Closed Loop Vt ......................................................................................................................................................... 52
Figure 7-‐10: Closed Loop MV ..................................................................................................................................................... 53
Figure 7-‐11: Closed Loop CO2 .................................................................................................................................................... 54
Figure 7-‐12: Scenario Scripts Library ......................................................................................................................................... 56
Figure 7-‐13: Manual Scripting ................................................................................................................................................... 57
Figure 7-‐14: Simulation Editor, Step 1 ....................................................................................................................................... 57
Figure 7-‐15: Lung Model Editing, Step 2 .................................................................................................................................... 58

285

Figure 7-‐16: Patient Effort Model, Step 3 .................................................................................................................................. 60

Figure 7-‐17: Patient Model Save As dialog box, Step 4 ............................................................................................................. 62
Figure 7-‐18: Current Patient Model Summary ........................................................................................................................... 63
Figure 7-‐19: Current Script Progress window ............................................................................................................................ 64
Figure 7-‐20: 2-‐Compartment Lung Fill Indicator ....................................................................................................................... 66
Figure 7-‐21: Data Field Real Time Information ......................................................................................................................... 67
Figure 7-‐22: Real Time Analysis Settings ................................................................................................................................... 68
Figure 7-‐23: Real Time Analysis Parameters and Breath Detection .......................................................................................... 69
Figure 7-‐24: Post-‐Run Analysis, Select a Simulation .................................................................................................................. 71
Figure 7-‐25: Post-‐Run Analysis Menu ........................................................................................................................................ 72
Figure 7-‐26: Data Re-‐Processing Window ................................................................................................................................. 73
Figure 7-‐27: Raw Data Preview ................................................................................................................................................. 75
Figure 7-‐28: Breath by Breath Display ....................................................................................................................................... 76
Figure 7-‐29: Multi-‐Parameter Breath-‐by Breath View .............................................................................................................. 78
Figure 7-‐30: Loop View .............................................................................................................................................................. 79
Figure 7-‐31: Multi-‐Parameter Waveforms ................................................................................................................................ 80
Figure 7-‐32: Multi-‐Parameter Trend ......................................................................................................................................... 81
Figure 7-‐33: Work Calculations and PV Loops ........................................................................................................................... 83
Figure 7-‐34: Trigger Analysis ..................................................................................................................................................... 84
Figure 7-‐35: Ventilator Performance Analysis ........................................................................................................................... 87
Figure 7-‐36: Timing of Pressure, Flow, and Volume in a Typical Breath ................................................................................... 88
Figure 8-‐1: Virtual Ventilator in Pressure Control Mode ......................................................................................................... 102
Figure 8-‐2: Virtual Ventilator Button on Run Time Home ....................................................................................................... 103
Figure 8-‐3: Virtual Ventilator Settings for Exp. Dyssynchrony ................................................................................................. 104

Figure 8-‐4: Virtual ventilator Example -‐ Inspiratory Time Mismatch ...................................................................................... 105
Figure 8-‐5: Virtual ventilator Example -‐ Inspiratory Time Mismatch Resolved ....................................................................... 106
Figure 9-‐1: QuickChoice/Interactive Panel .............................................................................................................................. 108

Figure 9-‐2: QuickChoice/Interactive Patient Model Selection ................................................................................................. 109
Figure 9-‐3: QuickChoice/Interactive -‐ Activate ........................................................................................................................ 110
Figure 9-‐4: QuickChoice/Advanced Interactive ....................................................................................................................... 111
Figure 9-‐5: Advanced Interactive Control Panel ...................................................................................................................... 112
Figure 9-‐6: Instructor Dashboard, Initial Settings ................................................................................................................... 114
Figure 9-‐7: Instructor Dashboard, Change Event View ............................................................................................................ 116
Figure 9-‐8: Vital Signs Monitor Window ................................................................................................................................. 117
Figure 9-‐9: Vital Signs Values Fields ........................................................................................................................................ 118
Figure 9-‐10: Vital Signs Monitor with X-‐ray and ABGs ............................................................................................................ 119
Figure 9-‐11: RespiSim® Debriefing Tab ................................................................................................................................... 120
Figure 9-‐12: Debriefing, Playback Mode ................................................................................................................................. 121
Figure 9-‐13: Event Marker Window ........................................................................................................................................ 122
Figure 9-‐14: File Drop-‐Down Menu from Debriefing ............................................................................................................... 123
Figure 9-‐15: RespiSim® Preferences -‐ Module Tab .................................................................................................................. 123
Figure 9-‐16: RespiSim® Preferences -‐ Event Graph Tab ........................................................................................................... 124
286

Figure 9-‐17: RespiSim® Preferences -‐ Parameters Tab ............................................................................................................ 125

Figure 9-‐18: Navigation to RespiSim® Curriculum Modules .................................................................................................... 127
Figure 9-‐19: Initial Settings -‐ NIV2000 ..................................................................................................................................... 128
Figure 9-‐20: NIV2000 -‐ Instructor Guide .................................................................................................................................. 129
Figure 9-‐21: NIV2000 -‐ Initial Assessment ............................................................................................................................... 130
Figure 9-‐22: NIV2000 -‐ Supporting X-‐ray ................................................................................................................................. 131
Figure 9-‐23: NIV2000 -‐ Initial Patient Model ........................................................................................................................... 132
Figure 9-‐24: NIV2000 -‐ Initial Instructor Actions ..................................................................................................................... 132
Figure 9-‐25: NIV 2000 -‐ Change Event 1 .................................................................................................................................. 133
Figure 9-‐26: NIV 2000 -‐ Instructor Actions .............................................................................................................................. 133
Figure 9-‐27: NIV 2000 -‐ Final Assessment ............................................................................................................................... 134
Figure 9-‐28: NIV 2000 -‐ Debriefing .......................................................................................................................................... 135
Figure 9-‐29: Volume Plots with Spont. Breathing, 2 Levels of PEEP ........................................................................................ 135
Figure 9-‐30: Debriefing -‐ Event Graph Details ......................................................................................................................... 136
Figure 9-‐31: Change Event -‐ Vent Reference Settings ............................................................................................................. 138
Figure 9-‐32: Instructor Setting Editing Features ...................................................................................................................... 139
Figure 9-‐33: Parameter Highlight Configuration ..................................................................................................................... 140
Figure 9-‐34: Instructor Actions Example ................................................................................................................................. 141
Figure 9-‐35: View/Edit Lung Sounds Window ......................................................................................................................... 142
Figure 9-‐36: View/Edit Lung Sounds With RespiScope™ ......................................................................................................... 143
Figure 9-‐37: View/Edit X-‐ray ................................................................................................................................................... 145
Figure 9-‐38: Small X-‐ray .......................................................................................................................................................... 145
Figure 9-‐39: Large X-‐ray .......................................................................................................................................................... 146
Figure 9-‐40: View/Edit Lab Results .......................................................................................................................................... 147
Figure 9-‐41: Vital Signs Monitor -‐ Lab Results ......................................................................................................................... 147
Figure 9-‐42: Display ABG Values from Instructor Dashboard .................................................................................................. 148
Figure 9-‐43: Instructor Dashboard Real Time Parameters ...................................................................................................... 149
Figure 9-‐44: RespiSim® Module File Directories ...................................................................................................................... 150
Figure 9-‐45: Support File Notification ..................................................................................................................................... 151
Figure 10-‐1: Welcome Window -‐ User Settings Selection ........................................................................................................ 152
Figure 10-‐2: Help/Customize -‐ User Settings ........................................................................................................................... 153
Figure 10-‐3: ASL User Settings Window .................................................................................................................................. 153
Figure 10-‐4: ASL User Settings Files in ASL User Settings Window .......................................................................................... 154
Figure 10-‐5: Connection Settings -‐ Fixed IP Address ................................................................................................................ 155
Figure 10-‐6: Connection Settings -‐ COM1 ................................................................................................................................ 156
Figure 10-‐7: Output Data Settings ........................................................................................................................................... 157
Figure 10-‐8: Appearance/General Settings ............................................................................................................................. 158
Figure 10-‐9: Help/Customize – Graph Colors .......................................................................................................................... 159
Figure 10-‐10: Customize Graph Colors .................................................................................................................................... 159
Figure 10-‐11: Script Editor Preferences ................................................................................................................................... 160
Figure 10-‐12: Relative Path Configuration Tool ...................................................................................................................... 161
Figure 10-‐13: Add/Edit Relative Path ...................................................................................................................................... 162

287

Figure 10-‐14: Transition Settings ............................................................................................................................................ 163

Figure 10-‐15: Steps per Change Locations .............................................................................................................................. 164
Figure 10-‐16: Default Analysis Parameters Settings ............................................................................................................... 165
Figure 10-‐17: Virtual Ventilator Settings ................................................................................................................................. 166
Figure 11-‐1: Two-‐Compartment Linear Patient Model (1) ...................................................................................................... 168
Figure 11-‐2: Volumes in the ASL 5000 Cylinder ....................................................................................................................... 169
Figure 11-‐3: Pressure/Flow Relationship for Different Resistor Types .................................................................................... 170
Figure 11-‐4: Two-‐Compartment Linear Patient Model (2) ...................................................................................................... 171
Figure 11-‐5: Non-‐Linear Compliance Editor ............................................................................................................................. 172
Figure 11-‐6: Time-‐Varying Parameters Menu ......................................................................................................................... 174
Figure 11-‐7: Time-‐Varying Parameters Editor ......................................................................................................................... 175
Figure 11-‐8: Curve Segment Editor, Curve Types ..................................................................................................................... 175
Figure 11-‐9: Curve Segment Editor, Uniform Distribution ....................................................................................................... 176
Figure 11-‐10: Curve Segment Editor, Gauss Distribution ........................................................................................................ 177
Figure 11-‐11: Technical Trigger Efforts ................................................................................................................................... 178
Figure 11-‐12: Sinusoidal Effort Model ..................................................................................................................................... 179
Figure 11-‐13: Backing-‐off the Patient’s Inspiratory Effort ....................................................................................................... 180
Figure 11-‐14: Backing-‐off the Patient's Expiratory Effort ........................................................................................................ 181
Figure 11-‐15: File-‐based Patient Effort .................................................................................................................................... 182
Figure 11-‐16: Patient Effort Model .......................................................................................................................................... 183
Figure 11-‐17: Flow Pump Model ............................................................................................................................................. 184
Figure 11-‐18: Sine Wave Flow Pump Model ............................................................................................................................ 185
Figure 11-‐19: 500 mL Volume Pump Model ............................................................................................................................ 186
Figure 11-‐20: Utilities Selector Tab ......................................................................................................................................... 187

Figure 11-‐21: File Conversion Selection ................................................................................................................................... 188
Figure 11-‐22: AUX Channel Resampling .................................................................................................................................. 190
Figure 11-‐23: RespiSim® File Conversion Dialog Box ............................................................................................................... 191

Figure 11-‐24: Patient Flow Data Processor ............................................................................................................................. 192
Figure 11-‐25: Recorded Patient Flow Script ............................................................................................................................ 193
Figure 11-‐26: Patient Flow Segment ....................................................................................................................................... 194
Figure 11-‐27: Pressure/Flow Input Resamling ......................................................................................................................... 195
Figure 11-‐28: TCP Breath Client Demo Application ................................................................................................................. 196
Figure 11-‐29: TCP Waveform Client (Raw Data) ..................................................................................................................... 197
Figure 11-‐30: TCP Waveform Client (Processed Data) ............................................................................................................ 197
Figure 11-‐31: TCP Broadcast Configuration ............................................................................................................................ 198
Figure 11-‐32: Analog Data Panel on Run Time Home ............................................................................................................. 199
Figure 11-‐33: ASL 5000 Communication Connections (Back Panel) ........................................................................................ 202
Figure 11-‐34: Test Automation Interface ................................................................................................................................ 204
Figure 12-‐1: Cylinder Temperature Controller Front Panel ..................................................................................................... 205
Figure 12-‐2: Paramagnetic Oxygen Transducer ...................................................................................................................... 206
Figure 12-‐3: ASL 5000 with Preemie Option Installed ............................................................................................................. 207
Figure 12-‐4: Installation of Preemie Cylinder .......................................................................................................................... 208
288

Figure 12-‐5: Preemie Cylinder: Pressure Line Manifold ........................................................................................................... 210

Figure 12-‐6: Auxiliary Gas Exchange Cylinder ......................................................................................................................... 211
Figure 12-‐7: Chest Rise Module ............................................................................................................................................... 212
Figure 12-‐8: Simulator Bypass and Leak Valve Module ........................................................................................................... 213
Figure 12-‐9: SBLVM Schematics .............................................................................................................................................. 213
Figure 12-‐10: SBLVM Orifice Characteristics ........................................................................................................................... 214
Figure 12-‐11: RespiSim® Ventilator Interface Kit (VIK) ............................................................................................................ 215
Figure 12-‐12: Bridgetech WebClinical -‐ Sign In ........................................................................................................................ 217
Figure 12-‐13: Bridgetech WebClinical – Starting Bridge Creation ........................................................................................... 218
Figure 12-‐14: Bridgetech WebClinical -‐ Create Bridge ............................................................................................................ 218
Figure 12-‐15: Bridgetech WebClinical -‐ Add New Bridge ........................................................................................................ 219
Figure 12-‐16: Bridgetech WebClinical -‐ Configure New Bridge ............................................................................................... 219
Figure 12-‐17: Bridgetech WebClinical – Confirm Bridge ......................................................................................................... 220
Figure 12-‐18: Bridgetech WebClinical – Configure via Ethernet .............................................................................................. 220
Figure 12-‐19: Bridgetech WebClinical -‐ Configure via WiFi ..................................................................................................... 221
Figure 12-‐20: Bridgetech WebClinical -‐ Save Configuration .................................................................................................... 222
Figure 12-‐21: Typical Fusion Bridge (ALFA) to Ventilator Connection ..................................................................................... 223
Figure 12-‐22: WebClinical -‐ Sign In .......................................................................................................................................... 226
Figure 12-‐23: WebClinical -‐ Patient Selection .......................................................................................................................... 227
Figure 12-‐24: WebClinical – Floor Care/Emergency Response Selection ................................................................................. 227
Figure 12-‐25: WebClinical – Floor Care/Emergency Response Menu ...................................................................................... 228
Figure 12-‐26: WebClinical – Floor Care/Emergency Response Overview ................................................................................ 229
Figure 12-‐27: WebClinical – Floor Care Patient Setup Overview ............................................................................................. 230
Figure 12-‐28: WebClinical – Floor Care Patient Assessment Overview ................................................................................... 231
Figure 12-‐29: WebClinical – Saving Charted Notes ................................................................................................................. 232
Figure 12-‐30: RespiSim® Plus Package .................................................................................................................................... 234
Figure 13-‐1: A one-‐compartment ventilatory system in which... ............................................................................................ 237
Figure 13-‐2: Normal ventilatory system responses during assisted inspiration ..................................................................... 240
Figure 13-‐3: (a) Δp -‐ υL plot for airway-‐body surface press. diff. versus..(lung) volume change (for data in Figure 13-‐2) .. Error!
Bookmark not defined.
Figure 13-‐4: (a -‐ c) Δp -‐ υL plot for data in Figure 13-‐2 with expiration included .......................... Error! Bookmark not defined.
Figure 13-‐5: Δp -‐ υL curve for an entire breath with expiratory volume change ........................... Error! Bookmark not defined.
Figure 13-‐6 (a): Vol. and flow responses to the same Δptot forcing function, for vent. systems with diff. time constants. . Error!
Figure 13-‐7: Two compartment pulmonary system within the chest wall .................................... Error! Bookmark not defined.
Figure 13-‐8: Δptot -‐ υL relation for a two compartment ventilatory system as breathing frequency is increased .............. Error!
Figure 13-‐9: Simulation Model Electrical Analog .................................................................................................................... 255
Figure 13-‐10: Simulator Concept ............................................................................................................................................. 257
Figure 13-‐11: ASL 5000 Schematic Overview .......................................................................................................................... 258
Figure 15-‐1: ASL 5000 Component Serial Numbers ................................................................................................................. 269
Figure 15-‐2: Maintenance Menu ............................................................................................................................................. 270
Figure 15-‐3: Odometer Readings ............................................................................................................................................. 270

289

Figure 15-‐4: Configuration for Fixed IP Address ...................................................................................................................... 271

Figure 15-‐5: Firmware Upload Dialog ..................................................................................................................................... 272
Figure 15-‐6: Firmware Upgrade Verification ........................................................................................................................... 273
Figure 15-‐7: Firmware Upload Message ................................................................................................................................. 273
Figure 16-‐1: VIK Configuration ................................................................................................................................................ 278

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Table of Contents

7.2.3 Trends ..................................................................................................................................... 51

8 The Virtual Ventilator ............................................................................................... 101

9.2 QUICKCHOICE/INTERACTIVE .......................................................................................... 108

9.9.6 Lung and Heart Sounds ......................................................................................................... 142

10 Customizing the User Environment ........................................................................... 152

11.5 TEST AUTOMATION INTERFACE ...................................................................................... 203

12 Advanced Hardware Options .................................................................................... 205

13.1.1 Normal Lungs ........................................................................................................................ 236

13.6 BACKGROUND TO INSTRUCTOR-­‐DRIVEN MULTI-­‐STAGE CLINICAL SIMULATIONS .......................... 264

14 Support ..................................................................................................................... 266

1 ABOUT THE USER MANUAL

\.\ Conventions Used in This Manual

Use of the word “Patient”

`.\ Operator Safety

2.1.1 Intended Use

2.1.2 Smart Pump™ Mode

`.` Summary of General Precautions

3 AN INTRODUCTION TO THE ASL 5000

k.\ System Overview

k.` Software Overview

k.k System Features and Options

4 ASL 5000 SETUP

m.\ Electrical Connections

o.\ Running a Simulation from the Standard Window Manager

The view switches to the Manual Scripting sub-­‐tab.

o.` Running a Simulation from the RespiSim® Window Manager

6 UNDERSTANDING THE PATIENT MODELING PROCESS

s.\ Structure of an ASL ottt Patient Model

or two-­‐compartment lung model.

s.` Patient Model Library

s.k Scripted Modeling

s.m Interactive Modeling

s.o QuickChoice Modeling in the RespiSim® Environment

s.s RespiSim® Patient Models in Curriculum Teaching Modules

7 FEATURES AND FUNCTIONS OF THE STANDARD USER ENVIRONMENT

u.\ Run Time Home

Sim. when the simulation is running.

u.` Interactive Simulations

7.2.1 Lung Model Parameters Tab

7.2.2 Spontaneous Breathing Parameters Tab

7.2.4 Closed Loop Vt Tab

7.2.5 Closed Loop MV Tab

7.2.6 Closed Loop CO2 Tab

u.k Scripted Simulations

u.m Data View and Analysis

7.4.2 Real Time Analysis

7.4.3.1 Data Re-­‐Processing

7.4.3.2 Raw Data Preview

7.4.3.4 Multi-­‐Parameter Graph (Breath-­‐by-­‐Breath)

Figure 7-­‐29: Multi-­‐Parameter Breath-­‐by Breath View

7.4.3.6 Multi-­‐Parameter Waveforms

7.4.3.7 Multi-­‐Parameter Trend (Breath Parameters)

1. To determine the validity of the assumed target:

7.4.4 Parameter Definitions

Start Insp [SoE] End of Expiration (of Point A

the inspiratory pressure effort is detected, Start of Patient

Parameter Label/Unit Definition Comment

Parameter Unit Definition Comment

between peak volumes Added parameter in sw 3.3

Parameter Unit Definition Comment

13.6 BACKGROUND TO INSTRUCTOR-‐DRIVEN MULTI-‐STAGE CLINICAL SIMULATIONS .......................... 264

The view switches to the Manual Scripting sub-‐tab.

or two-‐compartment lung model.

7.4.3.1 Data Re-‐Processing

7.4.3.4 Multi-‐Parameter Graph (Breath-‐by-‐Breath)

Figure 7-‐29: Multi-‐Parameter Breath-‐by Breath View

7.4.3.6 Multi-‐Parameter Waveforms

7.4.3.7 Multi-‐Parameter Trend (Breath Parameters)

P_aw_TP500 cmH2O*ms ∫ (Pairway -‐ PEEP) dt from

Figure 9-‐30: Debriefing -‐ Event Graph Details

During a simulation, you can right-‐click or on a Change

! "##$

wall. They can be either linear or non-‐linear.

11.1.1.1 Non-‐Linear Compliance