common_2system_2physiology_2_respiratory_model_8h_source.html

/* Distributed under the Apache License, Version 2.0.

   See accompanying NOTICE file for details.*/


#pragma once


#include "engine/common/system/Model.h"

#include "engine/common/system/Systems.h"

#include "cdm/circuit/fluid/SEFluidCircuitCalculator.h"

#include "cdm/compartment/fluid/SEGasCompartmentGraph.h"

#include "cdm/compartment/fluid/SELiquidCompartmentGraph.h"


class SEPatient;

class SEPatientActionCollection;

class SEGasCompartment;

class SEGasSubstanceQuantity;

class SELiquidCompartment;

class SELiquidSubstanceQuantity;

class SEFluidCircuit;

class SEFluidCircuitNode;

class SEFluidCircuitPath;

class SEConsciousRespirationCommand;

class SERespiratoryMechanicsModifiers;


namespace pulse

{

  class PBPhysiology;

  class EngineTest;

  class PULSE_DECL RespiratoryModel : public RespiratorySystem, public Model

  {

    friend PBPhysiology;//friend the serialization class

    friend EngineTest;

  public:

    RespiratoryModel(Data& data);

    virtual ~RespiratoryModel();


    virtual void Clear() override;


    // Set members to a stable homeostatic state

    virtual void Initialize() override;

    // Set pointers and other member varialbes common to both homeostatic initialization and loading a state

    virtual void SetUp() override;


    virtual void AtSteadyState() override;

    virtual void PreProcess() override;

    virtual void Process(bool solve_and_transport=true) override;

    virtual void PostProcess(bool solve_and_transport=true) override;


  protected:

    void ComputeExposedModelParameters() override;/*TODO ExpandedLungs*/

    eLungCompartment GetLungCompartment(const std::string& cmpt);

    std::string GetCompartmentName(eLungCompartment m);


    //Tuning

    void TuneCircuit();


    //PreProcess

    void CalculateWork();

    void CalculateFatigue();

    void UpdateChestWallCompliances();/*TODO ExpandedLungs*/

    SESegment* GetSegement(const std::vector<SESegment*>& segments, double volume_L);

    void UpdateAlveolarCompliances();

    void UpdateVolumes();

    void UpdateResistances();/*TODO ExpandedLungs*/

    double CalculateSuctioningPattern(double baseResistance_cmH2O_s_Per_L, double flow_L_Per_s);

    void UpdateInspiratoryExpiratoryRatio();

    void UpdateDiffusion();

    // If Cardiovascular

    void UpdatePulmonaryCapillary();

    void UpdatePulmonaryShunt();

    // Aerosol Deposition and various Effects

    void ProcessAerosolSubstances();

    //Actions

    void Pneumothorax();

    void Hemothorax();

    void MechanicalVentilation();

    void SupplementalOxygen();

    // Driver

    void CalculateDriver();

    void ApplyDriver();

    void SetBreathCycleFractions();

    void ConsciousRespiration();

    double VolumeToDriverPressure(double TargetVolume);/*TODO ExpandedLungs*/

    void UpdateDriverPressure();

    /****/void CalculateMechanoreceptors();

    void UpdateDriverPeriod();

    double UpdateTargetVentilation(double targetAlveolarVentilation_L_Per_min);

    //Overrides

    void SetRespiratoryResistance();

    void SetRespiratoryCompliance();


    //Process

    void CalculateVitalSigns();

    void Debugging();


    // Serializable member variables (Set in Initialize and in schema)


    // CalculateVitalSigns()

    bool   m_BreathingCycle;

    bool   m_NotBreathing;

    double m_TopBreathTotalVolume_L;

    double m_TopCarinaO2;

    double m_TopBreathElapsedTime_min;

    double m_BottomBreathElapsedTime_min;

    double m_BottomBreathTotalVolume_L;

    double m_BottomBreathAlveoliPressure_cmH2O;

    double m_BottomBreathAirwayPressure_cmH2O;

    double m_PeakAlveolarPressure_cmH2O;

    double m_MaximalAlveolarPressure_cmH2O;

    double m_LastCardiacCycleBloodPH;

    SERunningAverage* m_BloodPHRunningAverage;

    SERunningAverage* m_MeanAirwayPressure_cmH2O;

    // Compliances

    double m_PreviousLeftLungPressureDiff_cmH2O;

    double m_PreviousRightLungPressureDiff_cmH2O;

    double m_PreviousLeftLungVolume_L;

    double m_PreviousRightLungVolume_L;

    double m_PreviousLeftPleuralPressureDiff_cmH2O;

    double m_PreviousRightPleuralPressureDiff_cmH2O;

    double m_PreviousLeftPleuralVolume_L;

    double m_PreviousRightPleuralVolume_L;


    // Expanded pulmonary methodology

    std::vector<double> m_AlveoliVolumeIncrement_L;

    std::vector<double> m_TopBreathAcinarZoneVolumes_L;

    std::vector<double> m_BottomBreathAcinarZoneVolumes_L;

    std::vector<double> m_PreviousShuntScalingFactor;


    // Respiratory Driver

    double m_ArterialO2PartialPressure_mmHg;

    double m_ArterialCO2PartialPressure_mmHg;

    double m_BreathingCycleTime_s;

    double m_DriverPressure_cmH2O;

    double m_ElapsedBreathingCycleTime_min;

    double m_IERatioScaleFactor;

    double m_PeakInspiratoryPressure_cmH2O;

    double m_PeakExpiratoryPressure_cmH2O;

    double m_PreviousTargetAlveolarVentilation_L_Per_min;

    double m_VentilationFrequency_Per_min;

    double m_VentilationPeriod_s;

    double m_VentilationToTidalVolumeSlope;

    SERunningAverage* m_ArterialO2RunningAverage_mmHg;

    SERunningAverage* m_ArterialCO2RunningAverage_mmHg;

    SERunningAverage* m_MixedExpiredCO2RunningAverage_mmHg;


    // Muscle Pressure Waveform

    double m_ExpiratoryHoldFraction;

    double m_ExpiratoryReleaseFraction;

    double m_ExpiratoryRiseFraction;

    double m_InspiratoryHoldFraction;

    double m_InspiratoryReleaseFraction;

    double m_InspiratoryRiseFraction;

    double m_InspiratoryToExpiratoryPauseFraction;

    double m_ResidueFraction;

    double m_PreviousDyspneaSeverity;

    double m_MechanoreceptorsDyspneaFactor;

    double m_AppliedMechanoreceptorsDyspneaFactor;


    // Positive Pressure Ventilation

    bool m_PositivePressureVentilation;


    // Conscious Respiration

    bool m_ActiveConsciousRespirationCommand;


    // Disease States

    double m_LeftAlveoliDecrease_L;

    double m_RightAlveoliDecrease_L;


    // Overrides

    double m_RespiratoryResistanceOverride_cmH2O_s_Per_L;

    double m_RespiratoryComplianceOverride_L_Per_cmH2O;


    // Stateless member variable (Set in SetUp())

    SERespiratoryMechanicsModifiers* m_MechanicsModifiers;

    // Respiratory Driver

    double m_MaxDriverPressure_cmH2O;

    // Configuration parameters

    double m_CentralControlGainConstant;

    double m_DefaultOpenResistance_cmH2O_s_Per_L;

    double m_DefaultClosedResistance_cmH2O_s_Per_L;

    double m_PeripheralControlGainConstant;

    double m_RespOpenResistance_cmH2O_s_Per_L;

    double m_RespClosedResistance_cmH2O_s_Per_L;

    double m_VentilationTidalVolumeIntercept;

    double m_VentilatoryOcclusionPressure_cmH2O;

    double m_MinimumAllowableTidalVolume_L;

    double m_MinimumAllowableInspiratoryAndExpiratoryPeriod_s;

    // State between functions (i.e. shared between methods in preprocess, set to a default value at the start of preprocess)

    double m_AverageLocalTissueBronchodilationEffects;


    // Patient

    SEPatientActionCollection* m_PatientActions;


    // Variables independent of how the lungs are modelled

    SEFluidCircuit* m_RespiratoryCircuit;

    SEFluidCircuitCalculator* m_Calculator;

    SEGasTransporter* m_GasTransporter;

    SELiquidTransporter* m_AerosolTransporter;

    // Nodes

    SEFluidCircuitNode* m_PharynxNode;

    SEFluidCircuitNode* m_RespiratoryMuscleNode;

    SEFluidCircuitNode* m_LeftPleuralNode;

    SEFluidCircuitNode* m_RightPleuralNode;

    SEFluidCircuitNode* m_AmbientNode;

    SEFluidCircuitNode* m_StomachNode;

    // Paths

    SEFluidCircuitPath* m_LeftPleuralToRespiratoryMuscle;

    SEFluidCircuitPath* m_RightPleuralToRespiratoryMuscle;

    SEFluidCircuitPath* m_DriverPressurePath;

    SEFluidCircuitPath* m_NasalCavityToPharynx;

    SEFluidCircuitPath* m_MouthToPharynx;

    SEFluidCircuitPath* m_PharynxToEnvironment;

    SEFluidCircuitPath* m_LarynxToTrachea;

    SEFluidCircuitPath* m_MouthToStomach;

    // Compartments

    SEGasCompartment* m_Environment;

    SEGasCompartment* m_Trachea;

    SEGasSubstanceQuantity* m_TracheaO2;

    SEGasCompartment* m_Lungs;

    SEGasCompartment* m_LeftLung;

    SEGasCompartment* m_RightLung;

    SEGasCompartment* m_PleuralCavity;

    SEGasCompartment* m_LeftPleuralCavity;

    SEGasCompartment* m_RightPleuralCavity;

    SEGasCompartment* m_AnatomicDeadSpace;

    SEGasCompartment* m_AlveolarDeadSpace;

    SEGasCompartment* m_RightAlveolarDeadSpace;

    SEGasCompartment* m_LeftAlveolarDeadSpace;

    SEGasCompartment* m_Alveoli;

    SEGasCompartment* m_LeftAlveoli;

    SEGasCompartment* m_RightAlveoli;

    SEGasSubstanceQuantity* m_LeftAlveoliO2;

    SEGasSubstanceQuantity* m_RightAlveoliO2;

    // Mechanical Ventilation

    SEGasCompartment* m_MechanicalVentilationConnection;

    SEFluidCircuitNode* m_MechanicalVentilationDeadSpace;

    SELiquidCompartment* m_MechanicalVentilationAerosolConnection;

    SEFluidCircuitPath* m_ConnectionToDeadSpace;

    SEFluidCircuitPath* m_GroundToConnection;

    // Cardiovascular

    SELiquidSubstanceQuantity* m_AortaO2;

    SELiquidSubstanceQuantity* m_AortaCO2;

    // Substance

    SESubstance* m_Oversedation;


    // Lung Configuration Specific Variables //


    // These are the lung components we will iterate on for actions

    struct LungComponent

    {

      eSide                    Side;

      SEFluidCircuitNode*      AlveoliNode;

      SEFluidCircuitNode*      DeadSpaceNode;

      SEFluidCircuitPath*      ResistancePath;

      SEFluidCircuitPath*      CompliancePath;

      SEFluidCircuitPath*      ShuntPath;

      SEFluidCircuitPath*      ArteriesPath;

      SEFluidCircuitPath*      VeinsPath;

      SEGasCompartment*        AlveoliCompartment;

      SELiquidCompartment*     CapillaryCompartment;

      SELiquidCompartmentLink* ShuntLink;

      SELiquidCompartmentLink* ArteriesLink;

      SELiquidCompartmentLink* VeinsLink;

      SELiquidCompartment*     AerosolDeadSpace;

      SELiquidCompartment*     AerosolAlveoli;

    };

    std::map<eLungCompartment, LungComponent> m_LungComponents;

    // Paths

    SEFluidCircuitPath* m_TracheaToRightLung;

    SEFluidCircuitPath* m_TracheaToLeftLung;


    // Currently only for default lung configuration //


    // Aerosol

    SELiquidCompartment* m_AerosolMouth;

    SELiquidCompartment* m_AerosolTrachea;

    SELiquidCompartment* m_AerosolNasalCavity;

    SELiquidCompartment* m_AerosolPharynx;

    SELiquidCompartment* m_AerosolLarynx;

    std::vector<SELiquidCompartment*> m_AerosolUpperAirwayInlets;

    SELiquidCompartment* m_AerosolLeftConductingAirways;

    SELiquidCompartment* m_AerosolLeftAlveolarDeadSpace;

    SELiquidCompartment* m_AerosolLeftAlveoli;

    SELiquidCompartment* m_AerosolRightConductingAirways;

    SELiquidCompartment* m_AerosolRightAlveolarDeadSpace;

    SELiquidCompartment* m_AerosolRightAlveoli;

    std::vector<SELiquidCompartment*> m_AerosolEffects;

    SELiquidCompartment* m_LeftLungExtravascular;

    SELiquidCompartment* m_RightLungExtravascular;


    SEFluidCircuitPath* m_TracheaToLeftConductingAirways;

    SEFluidCircuitPath* m_TracheaToRightConductingAirways;

    SEFluidCircuitPath* m_LeftConductingAirwaysToLeftAlveolarDeadSpace;

    SEFluidCircuitPath* m_RightConductingAirwaysToRightAlveolarDeadSpace;

    SEFluidCircuitPath* m_LeftAlveolarDeadSpaceToLeftAlveoli;

    SEFluidCircuitPath* m_RightAlveolarDeadSpaceToRightAlveoli;


    SEFluidCircuitPath* m_EnvironmentToLeftChestLeak;

    SEFluidCircuitPath* m_EnvironmentToRightChestLeak;

    SEFluidCircuitPath* m_LeftAlveoliLeakToLeftPleural;

    SEFluidCircuitPath* m_RightAlveoliLeakToRightPleural;

    SEFluidCircuitPath* m_LeftNeedleToLeftPleural;

    SEFluidCircuitPath* m_RightNeedleToRightPleural;


    SEFluidCircuitPath* m_LeftCardiovascularLeak;

    SEFluidCircuitPath* m_RightCardiovascularLeak;

    SEFluidCircuitPath* m_LeftRespirtoryLeak;

    SEFluidCircuitPath* m_RightRespirtoryLeak;


    SEFluidCircuitPath* m_LeftAlveoliToLeftPleuralConnection;

    SEFluidCircuitPath* m_RightAlveoliToRightPleuralConnection;

  };

END_NAMESPACE

PBPhysiology
Definition: PBPhysiology.h:25

SECircuitCalculator
Definition: SECircuitCalculator.h:24

SEConsciousRespirationCommand
Definition: SEConsciousRespirationCommand.h:8

SEFluidCircuit
Definition: SEFluidCircuit.h:12

SEFluidCircuitNode
Definition: SEFluidCircuitNode.h:10

SEFluidCircuitPath
Definition: SEFluidCircuitPath.h:9

SEGasCompartment
Definition: SEGasCompartment.h:14

SEGasSubstanceQuantity
Definition: SEGasSubstanceQuantity.h:10

SELiquidCompartment
Definition: SELiquidCompartment.h:11

SELiquidCompartmentLink
Definition: SELiquidCompartmentLink.h:11

SELiquidSubstanceQuantity
Definition: SELiquidSubstanceQuantity.h:12

SEPatientActionCollection
Definition: SEPatientActionCollection.h:54

SEPatient
Definition: SEPatient.h:13

SERespiratoryMechanicsModifiers
Definition: SERespiratoryMechanicsModifiers.h:9

SERunningAverage
Definition: SERunningAverage.h:8

SESegment
Definition: SESegment.h:7

SESubstance
Definition: SESubstance.h:16

SESubstanceTransporter
Definition: SESubstanceTransport.h:86

pulse
Definition: Logger.h:14