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Commit 88875da5 authored by Jeff Webb's avatar Jeff Webb
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Added dead space increase and increased shunting with positive pressure ventilation. 

Tweaks to respiratory disease mapping.
Added intrathoracici pressure effects to show up during ventilation - commented out for now.
parent 7560e08d
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data/human/adult/scenarios/equipment/MechanicalVentilator_PC-CMV_Healthy.json
View file @ 88875da5
......@@ -100,18 +100,18 @@
"EquipmentAction": {
"MechanicalVentilatorConfiguration": {
"MechanicalVentilatorAction": { "EquipmentAction": { "Action": {
"Comment": "Attach the mechanical ventilator - RR = 16 bpm, I:E = 0.6, TV = 7 mL/kg(ideal)" }}},
"Comment": "Attach the mechanical ventilator - RR = 17 bpm, I:E = 0.6, TV = 8 mL/kg(ideal)" }}},
"Configuration":
{
"Connection": "Tube",
"InspirationWaveform": "Square",
"ExpirationWaveform": "Square",
"PeakInspiratoryPressure": { "ScalarPressure": { "Value": 16.5, "Unit": "cmH2O" } },
"PeakInspiratoryPressure": { "ScalarPressure": { "Value": 18.5, "Unit": "cmH2O" } },
"PositiveEndExpiredPressure": { "ScalarPressure": { "Value": 5.0, "Unit": "cmH2O" } },
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 2.344, "Unit": "s" } },
"ExpirationCycleTime": { "ScalarTime": { "Value": 1.406, "Unit": "s" } },
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 2.206, "Unit": "s" } },
"ExpirationCycleTime": { "ScalarTime": { "Value": 1.324, "Unit": "s" } },
"FractionInspiredGas": [
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.21, "Unit": "" } } }
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.3, "Unit": "" } } }
]
}
}
......
data/human/adult/scenarios/equipment/MechanicalVentilator_PC-CMV_Moderate_ARDS.json
View file @ 88875da5
......@@ -119,7 +119,7 @@
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 1.974, "Unit": "s" } },
"ExpirationCycleTime": { "ScalarTime": { "Value": 1.776, "Unit": "s" } },
"FractionInspiredGas": [
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.35, "Unit": "" } } }
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.47, "Unit": "" } } }
]
}
}
......
data/human/adult/scenarios/equipment/MechanicalVentilator_PC-CMV_Severe_ARDS.json
View file @ 88875da5
......@@ -114,12 +114,12 @@
"Connection": "Tube",
"InspirationWaveform": "Square",
"ExpirationWaveform": "Square",
"PeakInspiratoryPressure": { "ScalarPressure": { "Value": 25.5, "Unit": "cmH2O" } },
"PeakInspiratoryPressure": { "ScalarPressure": { "Value": 30.0, "Unit": "cmH2O" } },
"PositiveEndExpiredPressure": { "ScalarPressure": { "Value": 11.0, "Unit": "cmH2O" } },
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 1.974, "Unit": "s" } },
"ExpirationCycleTime": { "ScalarTime": { "Value": 1.776, "Unit": "s" } },
"FractionInspiredGas": [
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.35, "Unit": "" } } }
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.47, "Unit": "" } } }
]
}
}
......
data/human/adult/scenarios/equipment/MechanicalVentilator_PC-CMV_Severe_COPD.json
View file @ 88875da5
......@@ -129,7 +129,7 @@
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 3.228, "Unit": "s" } },
"ExpirationCycleTime": { "ScalarTime": { "Value": 1.388, "Unit": "s" } },
"FractionInspiredGas": [
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.31, "Unit": "" } } }
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.38, "Unit": "" } } }
]
}
}
......
data/human/adult/scenarios/equipment/MechanicalVentilator_VC-AC_Healthy.json
View file @ 88875da5
......@@ -98,19 +98,19 @@
"EquipmentAction": {
"MechanicalVentilatorConfiguration": {
"MechanicalVentilatorAction": { "EquipmentAction": { "Action": {
"Comment": "Attach the mechanical ventilator - TV = 7 mL/kg(ideal)" }}},
"Comment": "Attach the mechanical ventilator - TV = 8 mL/kg(ideal)" }}},
"Configuration":
{
"Connection": "Tube",
"InspirationWaveform": "Square",
"ExpirationWaveform": "Square",
"InspirationTargetFlow": { "ScalarVolumePerTime": { "Value": 0.375, "Unit": "L/s" } },
"InspirationTargetFlow": { "ScalarVolumePerTime": { "Value": 0.455, "Unit": "L/s" } },
"PositiveEndExpiredPressure": { "ScalarPressure": { "Value": 5.0, "Unit": "cmH2O" } },
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 10.0, "Unit": "s" } },
"InspirationPatientTriggerPressure": { "ScalarPressure": { "Value": -0.000001, "Unit": "cmH2O" } },
"ExpirationCycleVolume": { "ScalarVolume": { "Value": 0.527, "Unit": "L" } },
"ExpirationCycleVolume": { "ScalarVolume": { "Value": 0.602, "Unit": "L" } },
"FractionInspiredGas": [
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.21, "Unit": "" } } }
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.3, "Unit": "" } } }
]
}
}
......
data/human/adult/scenarios/equipment/MechanicalVentilator_VC-CMV_Healthy.json
View file @ 88875da5
......@@ -100,18 +100,18 @@
"EquipmentAction": {
"MechanicalVentilatorConfiguration": {
"MechanicalVentilatorAction": { "EquipmentAction": { "Action": {
"Comment": "Attach the mechanical ventilator - RR = 16 bpm, I:E = 0.6, TV = 7 mL/kg(ideal)" }}},
"Comment": "Attach the mechanical ventilator - RR = 17 bpm, I:E = 0.6, TV = 8 mL/kg(ideal)" }}},
"Configuration":
{
"Connection": "Tube",
"InspirationWaveform": "Square",
"ExpirationWaveform": "Square",
"InspirationTargetFlow": { "ScalarVolumePerTime": { "Value": 0.375, "Unit": "L/s" } },
"InspirationTargetFlow": { "ScalarVolumePerTime": { "Value": 0.455, "Unit": "L/s" } },
"PositiveEndExpiredPressure": { "ScalarPressure": { "Value": 5.0, "Unit": "cmH2O" } },
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 2.344, "Unit": "s" } },
"ExpirationCycleVolume": { "ScalarVolume": { "Value": 0.527, "Unit": "L" } },
"InspirationMachineTriggerTime": { "ScalarTime": { "Value": 2.206, "Unit": "s" } },
"ExpirationCycleVolume": { "ScalarVolume": { "Value": 0.602, "Unit": "L" } },
"FractionInspiredGas": [
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.21, "Unit": "" } } }
{ "Name": "Oxygen", "Amount": { "Scalar0To1": { "Value": 0.3, "Unit": "" } } }
]
}
}
......
docs/Sources.bib
View file @ 88875da5
......@@ -7086,3 +7086,26 @@ title = {{Sympathetic nerve activity and heart rate variability during severe he
url = {www.elsevier.com/locate/autneu},
year = {2007}
}
@article{verhoeff2017cardiopulmonary,
title={Cardiopulmonary physiology: why the heart and lungs are inextricably linked},
author={Verhoeff, Kevin and Mitchell, Jamie R},
journal={Advances in physiology education},
volume={41},
number={3},
pages={348--353},
year={2017},
publisher={American Physiological Society Bethesda, MD}
}
@article{luecke2005clinical,
title={Clinical review: positive end-expiratory pressure and cardiac output},
author={Luecke, Thomas and Pelosi, Paolo},
journal={Critical Care},
volume={9},
number={6},
pages={607},
year={2005},
publisher={BioMed Central}
}
src/cpp/cpm/physiology/Cardiovascular.cpp
View file @ 88875da5
......@@ -160,6 +160,8 @@ void Cardiovascular::Clear()
m_leftPleuralCavity = nullptr;
m_rightPleuralCavity = nullptr;
m_PleuralCavity = nullptr;
m_Ambient = nullptr;
m_CardiacCycleArterialPressure_mmHg->Clear();
m_CardiacCycleArterialCO2PartialPressure_mmHg->Clear();
......@@ -296,6 +298,8 @@ void Cardiovascular::SetUp()
//Respiratory Compartments
m_leftPleuralCavity = m_data.GetCompartments().GetGasCompartment(pulse::PulmonaryCompartment::LeftPleuralCavity);
m_rightPleuralCavity = m_data.GetCompartments().GetGasCompartment(pulse::PulmonaryCompartment::RightPleuralCavity);
m_PleuralCavity = m_data.GetCompartments().GetGasCompartment(pulse::PulmonaryCompartment::PleuralCavity);
m_Ambient = m_data.GetCompartments().GetGasCompartment(pulse::EnvironmentCompartment::Ambient);
//Nodes
m_MainPulmonaryArteries = m_CirculatoryCircuit->GetNode(pulse::CardiovascularNode::MainPulmonaryArteries);
m_LeftHeart2 = m_CirculatoryCircuit->GetNode(pulse::CardiovascularNode::LeftHeart2);
......@@ -1846,14 +1850,47 @@ void Cardiovascular::UpdateHeartRhythm()
/// When a lung collapses (as with pneumothorax), increased pleural cavity pressure pushes on the
/// mediastinum and great veins. As an effect, the mediastinum is displaced and the great veins
/// become kinked, leading to decreased venous return to the heart. This leads to increasing cardiac
/// and respiratory embarrasment. http://medind.nic.in/jac/t08/i1/jact08i1p42.pdf
/// and respiratory embarrasment. @cite jain2008understanding
//--------------------------------------------------------------------------------------------------
void Cardiovascular::CalculatePleuralCavityVenousEffects()
{
//The left and right pleural pressures are likely to have large differences only due to a pneumothorax
//Pressure difference causes a mediastinum shift
double rightHeartResistance_mmHg_s_Per_mL = m_RightHeartResistance->GetNextResistance(PressureTimePerVolumeUnit::mmHg_s_Per_mL);
//-----------------------------------------------------------------------------------------------------
//\\\todo Add this and test/tune
////Lung volume/pressure has a direct effect on cardiac output ///\cite verhoeff2017cardiopulmonary
////Decreased venous return occurs in disease states and with mechanical ventilation through an increased PEEP ///\cite luecke2005clinical
////Get the current pleural cavity pressure (reletive to ambient)
//double baselineIntrapleuralPressure_cmH2O = -5.0; /// \cite Levitzky2013pulmonary
//double pleuralCavityPressureBaselineDiff_cmH2O = m_PleuralCavity->GetPressure(PressureUnit::cmH2O) - m_Ambient->GetPressure(PressureUnit::cmH2O) - baselineIntrapleuralPressure_cmH2O;
////Increase resistance if it's above healthy PEEP
////Healthy PEEP is always zero and pleural cavity pressure is negative during inhalation
//if (pleuralCavityPressureBaselineDiff_cmH2O > 0.0)
//{
// double maxPressure_cmH2O = 5.0;
// double maxResistanceMultiplier = 10.0;
// pleuralCavityPressureBaselineDiff_cmH2O = MIN(pleuralCavityPressureBaselineDiff_cmH2O, maxPressure_cmH2O);
// //Interpolate into a parabola to effect things much more at larger differences
// double min = 1.0;
// double max = maxResistanceMultiplier;
// double a = max - min;
// double factor = pleuralCavityPressureBaselineDiff_cmH2O / maxPressure_cmH2O;
// double resistanceMultiplier = a * factor * factor + min;
// rightHeartResistance_mmHg_s_Per_mL *= resistanceMultiplier;
//}
//-----------------------------------------------------------------------------------------------------
//Pressure difference causes a mediastinum shift, which also effects the venous return
//The left and right pleural pressures are likely to have large differences only due to a pneumothorax
double pleuralCavityPressureDiff_cmH2O = std::abs(m_leftPleuralCavity->GetPressure(PressureUnit::cmH2O) - m_rightPleuralCavity->GetPressure(PressureUnit::cmH2O));
double maxPressureDiff_cmH2O = 20.0;
double maxResistanceMultiplier = 10.0;
pleuralCavityPressureDiff_cmH2O = MIN(pleuralCavityPressureDiff_cmH2O, maxPressureDiff_cmH2O);
......@@ -1865,20 +1902,23 @@ void Cardiovascular::CalculatePleuralCavityVenousEffects()
double factor = pleuralCavityPressureDiff_cmH2O / maxPressureDiff_cmH2O;
double resistanceMultiplier = a * factor * factor + min;
double rightHeartResistance_mmHg_s_Per_mL = m_RightHeartResistance->GetNextResistance(PressureTimePerVolumeUnit::mmHg_s_Per_mL);
rightHeartResistance_mmHg_s_Per_mL *= resistanceMultiplier;
//-----------------------------------------------------------------------------------------------------
//Dampen the change to prevent potential craziness
//It will only change half as much as it wants to each time step to ensure it's critically damped and doesn't overshoot
//It will only change a fraction as much as it wants to each time step to ensure it's critically damped and doesn't overshoot
double dampenFraction_perSec = 0.001 * 50.0;
double previousRightHeartResistance_mmHg_s_Per_mL = m_RightHeartResistance->GetResistance(PressureTimePerVolumeUnit::mmHg_s_Per_mL);
double resistanceChange_L_Per_mmHg_s_Per_mL = (rightHeartResistance_mmHg_s_Per_mL - previousRightHeartResistance_mmHg_s_Per_mL) * dampenFraction_perSec * m_dT_s;
rightHeartResistance_mmHg_s_Per_mL = previousRightHeartResistance_mmHg_s_Per_mL + resistanceChange_L_Per_mmHg_s_Per_mL;
m_RightHeartResistance->GetNextResistance().SetValue(rightHeartResistance_mmHg_s_Per_mL, PressureTimePerVolumeUnit::mmHg_s_Per_mL);
//For tuning
//m_data.GetDataTrack().Probe("pleuralCavityPressureBaselineDiff_cmH2O", pleuralCavityPressureBaselineDiff_cmH2O);
//m_data.GetDataTrack().Probe("pleuralCavityPressureDiff_cmH2O", pleuralCavityPressureDiff_cmH2O);
//m_data.GetDataTrack().Probe("resistanceMultiplier", resistanceMultiplier);
//m_data.GetDataTrack().Probe("rightHeartResistance_mmHg_s_Per_mL", rightHeartResistance_mmHg_s_Per_mL);
......
src/cpp/cpm/physiology/Cardiovascular.h
View file @ 88875da5
......@@ -211,6 +211,8 @@ protected:
SEGasCompartment* m_leftPleuralCavity;
SEGasCompartment* m_rightPleuralCavity;
SEGasCompartment* m_PleuralCavity;
SEGasCompartment* m_Ambient;
std::vector<SEFluidCircuitPath*> m_systemicResistancePaths;
std::vector<SEFluidCircuitPath*> m_systemicCompliancePaths;
......
src/cpp/cpm/physiology/Respiratory.cpp
View file @ 88875da5
......@@ -1308,7 +1308,8 @@ void Respiratory::RespiratoryDriver()
m_data.GetEvents().SetEvent(eEvent::StartOfExhale, true, m_data.GetSimulationTime());
}
//double pi = 3.14159265359;
//jbw - updated expiration to new waveforms
double pi = 3.14159265359;
if (m_BreathingCycleTime_s >= ResidueFractionTimeStart_s)
{
m_DriverPressure_cmH2O = 0.0;
......@@ -1333,11 +1334,11 @@ void Respiratory::RespiratoryDriver()
}
else if (m_BreathingCycleTime_s >= InspiratoryReleaseTimeStart_s)
{
double ventilationFrequency_Per_min = 60.0 / (m_InspiratoryReleaseFraction * TotalBreathingCycleTime_s);
m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * (exp(-((ventilationFrequency_Per_min + m_VentilatoryOcclusionPressure_cmH2O / 2.0) / 10.0) * (m_BreathingCycleTime_s - InspiratoryReleaseTimeStart_s)));
//double ventilationFrequency_Per_min = 60.0 / (m_InspiratoryReleaseFraction * TotalBreathingCycleTime_s);
//m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * (exp(-((ventilationFrequency_Per_min + m_VentilatoryOcclusionPressure_cmH2O / 2.0) / 10.0) * (m_BreathingCycleTime_s - InspiratoryReleaseTimeStart_s)));
//double segmentTime_s = InspiratoryToExpiratoryPauseTimeStart_s - InspiratoryReleaseTimeStart_s;
//m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * sin(pi / 2.0 * (m_BreathingCycleTime_s + segmentTime_s - InspiratoryReleaseTimeStart_s) / (segmentTime_s));
double segmentTime_s = InspiratoryToExpiratoryPauseTimeStart_s - InspiratoryReleaseTimeStart_s;
m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * sin(pi / 2.0 * (m_BreathingCycleTime_s + segmentTime_s - InspiratoryReleaseTimeStart_s) / (segmentTime_s));
}
else if (m_BreathingCycleTime_s >= InspiratoryHoldTimeStart_s)
{
......@@ -1345,10 +1346,10 @@ void Respiratory::RespiratoryDriver()
}
else //(m_BreathingCycleTime_s >= InspiratoryRiseTimeStart_s)
{
double ventilationFrequency_Per_min = 60.0 / (m_InspiratoryRiseFraction * TotalBreathingCycleTime_s);
m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * (1.0 - exp(-((ventilationFrequency_Per_min + 4.0 * m_VentilatoryOcclusionPressure_cmH2O) / 10.0) * m_BreathingCycleTime_s));
//double ventilationFrequency_Per_min = 60.0 / (m_InspiratoryRiseFraction * TotalBreathingCycleTime_s);
//m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * (1.0 - exp(-((ventilationFrequency_Per_min + 4.0 * m_VentilatoryOcclusionPressure_cmH2O) / 10.0) * m_BreathingCycleTime_s));
//m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * sin(pi / 2.0 * m_BreathingCycleTime_s / InspiratoryHoldTimeStart_s);
m_DriverPressure_cmH2O = m_PeakInspiratoryPressure_cmH2O * sin(pi / 2.0 * m_BreathingCycleTime_s / InspiratoryHoldTimeStart_s);
}
if (!m_PatientActions->HasConsciousRespiration())
......@@ -1393,11 +1394,14 @@ void Respiratory::SetBreathCycleFractions()
//Healthy = ~1:2 IE Ratio = 0.33 inpiration and 0.67 expiration
///\cite Fresnel2014musclePressure
//Adjust for standard 12 bpm giving ~0.33 instead of 16 bpm by adding 4
m_InspiratoryRiseFraction = (0.0125 * (m_VentilationFrequency_Per_min + 4.0) + 0.125) * m_IERatioScaleFactor;
m_InspiratoryRiseFraction = LIMIT(m_InspiratoryRiseFraction, 0.1, 0.9);
double inspiratoryFraction = (0.0125 * (m_VentilationFrequency_Per_min + 4.0) + 0.125) * m_IERatioScaleFactor;
inspiratoryFraction = LIMIT(inspiratoryFraction, 0.1, 0.9);
double expiratoryFraction = 1.0 - inspiratoryFraction;
m_InspiratoryRiseFraction = inspiratoryFraction;
m_InspiratoryHoldFraction = 0.0;
m_InspiratoryReleaseFraction = 1.0 - m_InspiratoryRiseFraction;
m_InspiratoryToExpiratoryPauseFraction = 0.0;
m_InspiratoryReleaseFraction = 0.5 * expiratoryFraction;
m_InspiratoryToExpiratoryPauseFraction = 0.5 * expiratoryFraction;
m_ExpiratoryRiseFraction = 0.0;
m_ExpiratoryHoldFraction = 0.0;
m_ExpiratoryReleaseFraction = 0.0;
......@@ -2318,6 +2322,17 @@ void Respiratory::UpdateVolumes()
double leftAlveolarDeadSpaceIncrease_L = 0.0;
double rightAlveolarDeadSpaceIncrease_L = 0.0;
//------------------------------------------------------------------------------------------------------
//Positive Pressure Ventilation
if (m_data.GetAirwayMode() == eAirwayMode::AnesthesiaMachine ||
m_data.GetAirwayMode() == eAirwayMode::MechanicalVentilation ||
m_data.GetAirwayMode() == eAirwayMode::MechanicalVentilator)
{
double ventilatorIncrease_L = 0.05;
leftAlveolarDeadSpaceIncrease_L += ventilatorIncrease_L;
rightAlveolarDeadSpaceIncrease_L += ventilatorIncrease_L;
}
//------------------------------------------------------------------------------------------------------
//COPD
//Exacerbation will overwrite the condition, even if it means improvement
......@@ -2623,8 +2638,8 @@ void Respiratory::UpdateAlveolarCompliances()
emphysemaSeverity = m_data.GetConditions().GetChronicObstructivePulmonaryDisease().GetEmphysemaSeverity().GetValue();
}
double complianceScalingFactor = GeneralMath::LinearInterpolator(0.0, 1.0, 1.0, 1.2, emphysemaSeverity);
double complianceScalingFactor = GeneralMath::LinearInterpolator(0.0, 1.0, 1.0, 1.1, emphysemaSeverity);
leftObstructiveComplianceScalingFactor = MAX(leftObstructiveComplianceScalingFactor, complianceScalingFactor);
rightObstructiveComplianceScalingFactor = MAX(rightObstructiveComplianceScalingFactor, complianceScalingFactor);
}
......@@ -3134,6 +3149,17 @@ void Respiratory::UpdatePulmonaryShunt()
double rightSeverity = 0.0;
double leftSeverity = 0.0;
//------------------------------------------------------------------------------------------------------
//Positive Pressure Ventilation
if (m_data.GetAirwayMode() == eAirwayMode::AnesthesiaMachine ||
m_data.GetAirwayMode() == eAirwayMode::MechanicalVentilation ||
m_data.GetAirwayMode() == eAirwayMode::MechanicalVentilator)
{
double shuntResistanceFactor = 0.3;
m_RightPulmonaryArteriesToVeins->GetNextResistance().MultiplyValue(shuntResistanceFactor, PressureTimePerVolumeUnit::mmHg_s_Per_mL);
m_LeftPulmonaryArteriesToVeins->GetNextResistance().MultiplyValue(shuntResistanceFactor, PressureTimePerVolumeUnit::mmHg_s_Per_mL);
}
//------------------------------------------------------------------------------------------------------
//PulmonaryShunt
//Exacerbation will overwrite the condition, even if it means improvement
......@@ -3208,8 +3234,8 @@ void Respiratory::UpdatePulmonaryShunt()
leftSeverity = MAX(leftSeverity, leftScaledSeverity);
}
double rightPulmonaryShuntScalingFactor = GeneralMath::ExponentialDecayFunction(10, 0.01, 1.0, rightSeverity);
double leftPulmonaryShuntScalingFactor = GeneralMath::ExponentialDecayFunction(10, 0.01, 1.0, leftSeverity);
double rightPulmonaryShuntScalingFactor = GeneralMath::ExponentialDecayFunction(10, 0.05, 1.0, rightSeverity);
double leftPulmonaryShuntScalingFactor = GeneralMath::ExponentialDecayFunction(10, 0.05, 1.0, leftSeverity);
double rightPulmonaryShuntResistance = m_RightPulmonaryArteriesToVeins->GetNextResistance().GetValue(PressureTimePerVolumeUnit::mmHg_s_Per_mL);
double leftPulmonaryShuntResistance = m_LeftPulmonaryArteriesToVeins->GetNextResistance().GetValue(PressureTimePerVolumeUnit::mmHg_s_Per_mL);
......
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