Flight Simulator for Intensive Care Clinicians

O r g a n i s T e s T C h e s T ®

The equipment and devices intended for the care of critically ill patients make the ICU one of the most technologically sophisticated environment in any hospital. The aim of this technology is to facilitate everyday practice by decreasing workload but it may become a source of dilemma as it is difficult to handle and often not totally trustworthy. ICU is likely the most error prone environment in the hospital.

Mechanical Ventilation is a life-saving method used to assist the patient partially or totally re-garding the severity of the respiratory failure. It is more a supportive intervention than a therapeutic one with considerable side effects and unwanted

Critical Care challengesO r g a n i s T e s T C h e s T ®

Training on ventilation modes with simulation is crucial for patient safety

1. Tobin, M.J., Advances in mechanical ventilation. N Engl J Med, 2001. 344(26): p. 1986-96.

complications if not properly and timely used [1].Given the abovementioned issues, specific training of physicians and nurses on mechanical venti-lation is crucial for optimal outcomes. To date, most common ways for training include animal experiments to achieve realistic physiological and pathological conditions for advanced respiratory education.

With TestChest®, Organis GmbH created an inno-vative full physiologic artificial lung that provides a breakthrough in mechanical ventilation training. TestChest® promotes a safe and controlled envi-ronment free from risks of the clinical environment and eliminates the necessity of training on animals.

Self-contained TestChest® dimensi-ons fit on any bed and it is fully self-contai-ned. It is a stand-alone skill training station and can be easily connected with an intubation head. The latter adds more re-alistic features to the respiratory simulation (NIV, intubation).

Intuitive The high-end lung simulator is an easy tool to use for training on ventilation ma-nagement. It supports any kind of artificial respiration in anest-hesia, intensive care, emergency medicine and home care.

Respiratory Flight Simulator for IntensivistsO r g a n i s T e s T C h e s T ®

TestChest can easily be combined with

all existing full scale patient simulators

Programmable TestChest® is program-mable and can be remotely operated to simulate in an unprece-dented way the evolu-tion of diseases as well as the recovery process. It allows the operator to control respiratory rate and depth to simula-te complex breathing patterns and thus allows the evaluation of specific pathological alterations.

Active Learning TestChest® is the key to modern learning concepts like Prob-lem Based Learning. It facilitates active application of learning concepts of care and promotes a deeper assimilation in a cont-rolled environment.

Realistic TestChest® combines the simplicity of a physical model with the sophistication of advanced mathematical modelling to provide a complete solution for a real patient’s conditions. TestChest® is capable of replicating pulmonary mechanics, gas ex-change and hemodyna-mic responses of healthy and pathological adult.

Key featuresO r g a n i s T e s T C h e s T ®

TestChest® has unique features in terms of representing complex breathing patterns. Physiological equations realize two modes of spontaneous activity: The driving pressure (p0.1) for ventilator triggering and the loading of respiratory rate. Muscular activity, important criteria for weaning, can be easily simulated.

In contrast to mechanically lungs, TestChest® inspiratory compliance is a non-linear function that can be represented as S-shape curve. TestChest® allows the simulation of lung collapse and recruitment as well as hysteresis of the pressure-volume loop.

A variety of scenarios including ARDS, COPD and ALI are programmed for teaching. A mass flow controller for the regulation of CO2 production as well as dead space allows the generation of realistic capnograms. TestChest® is compatible with humidified breathing gas mixtures. The internal bellows can be washed or even replaced if necessary.

TestChest® is not only limited to training as it is further intended to check the functionalities of ventilators, CPAP devices and other respiratory support devices in laboratories facilities.

An artificial finger allows the simula-tion of oxygen saturation (SpO2). The variation of pulse amplitude according to different intravascular fillings allows the modeling of heart-lung interactions supporting the testing of the latest Smart ventilation modes.

TestChest® consists of two bellows driven by a linear motor. The large volume ensures a realistic replication of vital capacity and FRC of an ICU adult patient. TestChest® contains alveolar, airway, and ambient pressure sensors as well as a temperature sensor.

Technical SpecificationsO r g a n i s T e s T C h e s T ®

TestChest® features a detachable calibration module, which makes it accurate for years of use.

Options including intrapulmonary oxygen sensor, mass flow controller for CO2 production, pulse oxi-meter simulator in form of an “artificial finger”, varia-ble dead space and variable leakage are available.

Pa r a m e t e r U n i tLength 685 mmWidth 292 mmHeight 202 mmWeight 16 kgVoltage 110/230 VACFrequency 50/60 HzWattage 520 W

CO2 Max. 4 bar

D i m e n s i o n s

g a z s U P P ly

TestChest®consists of three modules: Active elements, Calboard and Housing.

TestChest® is loaded with highly accurate sensors which make it a refe-rence to test ventilators, anaesthesia machines home care ventilators, sleep apnea devices, and CPAP systems.

Wide range of parameters and functionalities for a realistic simulationO r g a n i s T e s T C h e s T ®

The physiological model built into TestChest® was designed to simulate the human cardio-respiratory system for teaching and training purposes.

Pa r a m e t e r m i n m a x U n i tChest wall Compliance 3 200 ml/mbarTotal Compliance 8 60 ml/mbar BTPSFunctional Residual Capacity (Predicted) 100 4000 mlAirway Resistance RP5, RP20, RP50, RP200 mbar/(L/s)Spontaneous Breathing Activity (P0.1) 0 15 mbar/100msSpontaneous Respiratory Rate 0 100 /minlower Inflection Point 0 100 mbarUpper Inflection Point 1 100 mbar

Functional Residual Capacity 300 4000 mlAlveolar Pressure -30 75 mbarAirway Pressure -250 250 mbarAirway Temperature 0 50 °CBarometric Pressure 800 1100 mbarEnd-expiratory Lung Volume ~500 4000 mlTidal volume 1 2500 ml BTPS

CO2 Production 0 600 ml/min STPDDead Space small 175, medium 190, large 205 mlFiO2 0 100 vol %SpO2 50 100 %Pulse Rate 20 300 bpmPlethysmograph -30 100 %Cardiac Output 500 10000 ml/minShunt Fraction 0 97.5 %Leakage 3 leak sizes, manually adjustable

s e t t i n g s

m e a s U r e m e n t s

m o r e o P t i o n s

Wide range of parameters and functionalities for a realistic simulation

TestChest® interfaces•CO2connector,tubeØ4mm•Manuallyadjustablevalveforleakage•Airwayconnector,connectiontotheventilator•Leakageoutlet•DB9connectorforpulseoximetersimulator•USB-Bconnectorforservice•J45connectorforEthernet•DB9connectorforanalogoutput

User InterfaceO r g a n i s T e s T C h e s T ®

The communication between the user inter-face and TestChest® is effectuated via stan-dard TCP/IP network connections. The communication status is continuously dis-played via colored indicators in order to draw the attention of the user about it.

User Interface features

•Selectionofpreconfigures patients scenarios.•Selectionofpreconfigured spontaneous breaths.•Calibrationprocedure.

•Settingofparametersfor advanced users•Storingnewpatients’ scenarios and saving the records in a CSV file.

Organis GmbH has developed a new cockpit that controls the TestChest® and runs on any window PC.

AQAI Simulation Center is a cooperative partner of Organis and has developed a PC based software “Basic Control”

SimulationSet respiratory drive [P0.1] and spontaneous breathing rate [f(spont)] according to table below. Then adjust CO2 produc-tion [V’CO2] to reflect the work of breathing and the concomitant change in metabolic rate. Adjust chest wall compliance [Cw] to reflect reduced compliance due to increased tension of respiratory muscles.

Simulation ScenariosO r g a n i s T e s T C h e s T ®

s c e n a r i o s

CW [ml/hPa] 120 100 90 80V’CO2 [mlSTPD] 150 200 250 350P0.1 [hPa/100ms] 0 3 5 8f [/min] 0 5 12 25

Strong Respiratory Activity

Passive (no Respiratory Effort)

Weak Respiratory Activity

Normal Respiratory Activity

BackgroundRespiratory drive, spontaneous breathing rates, respiratory musc-le tension and oxygen consumption may vary considerably with the patient´s breathing efforts. Therefore, a systematic simulation of these conditions in a stepwise fashion might be highly instructive.

ExampleTransition from a passive to an actively breathing patient.

ORGANIS GmbHSchulstrasse 76, 7302 Landquart, SwitzerlandTel.: +41 (0)81 300 65 80 Email: info@organis-gmbh.chWeb: www.organis-gmbh.ch

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