Commit d4d9b506 authored by Rachel Clipp's avatar Rachel Clipp
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Respiration rate only goes to zero with a sedative for "over sedation' or when...

Respiration rate only goes to zero with a sedative for "over sedation' or when sedation = 1.0 and stays there. The CO2 setpoints that trigger respiration changes are modified by sedation level now. Need to update drug methodology still.
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Methodology Sources and References
@article{Kanaya2003differential,
author = {Kanaya, Noriaki and Hirata, Naoyuki and Kurosawa, Saori and Nakayama, Masayasu and Namiki, Akiyoshi},
doi = {10.1097/00000542-200301000-00009},
issn = {0003-3022},
journal = {Anesthesiology},
month = {jan},
number = {1},
pages = {34--40},
publisher = {American Society of Anesthesiologists},
title = {{Differential Effects of Propofol and Sevoflurane on Heart Rate Variability}},
url = {http://pubs.asahq.org/anesthesiology/article-pdf/98/1/34/407321/0000542-200301000-00009.pdf},
volume = {98},
year = {2003}
}
@article{Lee2011effect,
author = {Lee, Mi Hyeon and Yang, Ki-Hwan and Lee, Choon Soo and Lee, Hong Sik and Moon, Sin Yeong and Hwang, Sung-Il and Song, Jang-Ho},
journal = {Korean Journal of Anesthesiology},
number = {2},
pages = {122},
pmid = {21927681},
publisher = {Korean Society of Anesthesiologists},
title = {{The effect-site concentration of propofol producing respiratory depression during spinal anesthesia}},
url = {/pmc/articles/PMC3167130/ /pmc/articles/PMC3167130/?report=abstract https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3167130/},
volume = {61},
year = {2011}
}
@article{Tulen1991dose,
author = {Tulen, Johanna H.M. and Moleman, Peter and Boomsma, Frans and van Steenis, Huibert G. and van den Heuij, Venantius J.H.M.},
isbn = {0033315891001},
journal = {Psychopharmacology},
pages = {77--83},
title = {{Dose-dependent effects of intravenous lorazepam on cardiovascular activity, plasma catecholamines and psychological function during rest and mental stress}},
volume = {105},
year = {1991}
}
@article{Ghiasi2021lorazepam,
author = {Ghiasi, Noman and Bhansali, Rakesh Kumar and Marwaha, Raman},
journal = {xPharm: The Comprehensive Pharmacology Reference},
......
......@@ -574,7 +574,7 @@ namespace pulse
deltaTubularPermeability += (pd.GetTubularPermeabilityModifier()) * concentrationEffects_unitless;
if (sedationLevel > 0.15)
if (sedationLevel > 0.999)//0.15)
{
deltaRespirationRate_Per_min += patient.GetRespirationRateBaseline(FrequencyUnit::Per_min) * pd.GetRespirationRateModifier();
deltaTidalVolume_mL += patient.GetTidalVolumeBaseline(VolumeUnit::mL) * pd.GetTidalVolumeModifier();
......
......@@ -1237,8 +1237,16 @@ namespace pulse
}
//Calculate the target Alveolar Ventilation based on the Arterial O2 and CO2 concentrations
double dTargetAlveolarVentilation_L_Per_min = m_PeripheralControlGainConstant * exp(-0.05 * m_ArterialO2PartialPressure_mmHg) * MAX(0., m_ArterialCO2PartialPressure_mmHg - PeripheralCO2PartialPressureSetPoint); //Peripheral portion
dTargetAlveolarVentilation_L_Per_min += m_CentralControlGainConstant * MAX(0., m_ArterialCO2PartialPressure_mmHg - CentralCO2PartialPressureSetPoint); //Central portion
double peripheralCO2SetPoint = PeripheralCO2PartialPressureSetPoint;
double centralCO2SetPoint = CentralCO2PartialPressureSetPoint;
if (Drugs.GetSedationLevel().GetValue() > 0)
{
peripheralCO2SetPoint = PeripheralCO2PartialPressureSetPoint / (1.0 - 0.15*Drugs.GetSedationLevel().GetValue());
centralCO2SetPoint = CentralCO2PartialPressureSetPoint / (1.0 - 0.15*Drugs.GetSedationLevel().GetValue());
}
double dTargetAlveolarVentilation_L_Per_min = m_PeripheralControlGainConstant * exp(-0.05 * m_ArterialO2PartialPressure_mmHg) * MAX(0., m_ArterialCO2PartialPressure_mmHg - peripheralCO2SetPoint); //Peripheral portion
dTargetAlveolarVentilation_L_Per_min += m_CentralControlGainConstant * MAX(0., m_ArterialCO2PartialPressure_mmHg - centralCO2SetPoint); //Central portion
//Metabolic modifier is used to drive the system to reasonable levels achievable during increased metabolic exertion
//The modifier is tuned to achieve the correct respiratory response for near maximal exercise. A linear relationship is assumed
......@@ -1320,11 +1328,11 @@ namespace pulse
}
else
{
m_VentilationFrequency_Per_min = dTargetPulmonaryVentilation_L_Per_min / dTargetTidalVolume_L; //breaths/min
m_VentilationFrequency_Per_min = dTargetPulmonaryVentilation_L_Per_min / (dTargetTidalVolume_L - DrugsTVChange_L); //breaths/min
m_VentilationFrequency_Per_min *= NMBModifier * SedationModifier;
m_VentilationFrequency_Per_min += DrugRRChange_Per_min;
m_NotBreathing = false;
}
}
m_VentilationFrequency_Per_min = LIMIT(m_VentilationFrequency_Per_min, 0.0, dMaximumPulmonaryVentilationRate / dHalfVitalCapacity_L);
......
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