2 nd Jan Beneken Conference on Modeling and

2 nd Jan Beneken Conference on Modeling and Simulation of Human Physiology 23 rd April, 2015 Construction Requirements for Full-term Newborn Simulation Manikin Lúcia Fonseca and Mark Thielen

Newborn Intensive Care Unit (NICU) 4500 Newborns per year at NL NICUs[1] → Newborn maladaptation • Foetus • Airway-Breathing-Circulation emergencies Complex/High Risk Interventions[2] • Opening airway • Aerating lung • Rescue breathing • Chest compressions • Drugs [1] Planningsbesluit bijzondere perinatologishe zorg (2001) Staatscourant CSZ/ZT/2192014 [2] Resuscitation Council UK. Newborn Life Support (2010) Resuscitation Guidelines 118 -127 / Eindhoven University of Technology Slide 1

NICU Educative Simulation Very demanding… Trainees practicing Supervisors Manikin Response Let’s automatize manikin response! Debriefing How will it help? How to do it? Manually control physiological variables / Eindhoven University of Technology Slide 2

Automatize manikin response COMPUTER MODEL Interventions Trainees practicing Physiological Response MANIKIN INTERFACE / Eindhoven University of Technology Slide 3

1 st Goal: Define Construction Requirements Requirement Assessment Methods: 1. Oriented scientific-literature review 2. Product-market research 3. In-situ observations NICU, delivery rooms and simulation centers 4. Interviews obstetricians, neonatologists, pediatricians, nurses, educative simulation trainers and developers Special thanks to Sidarto Bambang Oetomo MD / Eindhoven University of Technology Slide 4

Requirements Physiology Model Scenarios Submodels Lumped-element model exterior environment Gas Transport Gas Exchange O 2 Hemodynamics - airways, - breathing, Regulation - and circulation …maladaptation. / Eindhoven University of Technology CO 2 tissues Slide 5

Requirements Physiology Model Pathologies Lumped elements Input Output Gas Transport Alveolar collapse Airway obstruction Airway leakage Upper airways Lower airways Alveoli Pleura Thorax Breathing rate Lung volumes Anatomic dead space Atmospheric partial pressures Compliance, Resistance Inspiratory muscle pressure Air flow Alveolar partial pressures Gas Exchange Perinatal asphyxia Ventilation/Perfusion mismatches Alveoli Pulmonary microcirculation Systemic microcirculation Ventilation/Perfusion Diffusion Constants Hb Concentration Dissociation Curves Metabolic Rate Alveolar partial pressures Blood gases concentrations Oxygen saturation Blood p. H Hemodynamics Persistent pulmonary hypertension Congenital heart diseases Myocardial depression Ventricle (L, R) Atria (L, R) Aorta Pulmonary arteries Vena Cava (Sup, Inf) Pulmonary veins Systemic microcirculation Pulmonary microcirculation Heart rate Heart unstressed volume Compliance Resistance Inductance Elastance Blood flow Blood pressure Cardiac output Heart rate Oxygen and metabolites distribution Weighting factors Set-points Time delays Low pass filters Gains Regulation / Eindhoven University of Technology Slide 6

Requirements Manikin Interface COMPUTER MODEL Interventions Trainees practicing Physiological Response MANIKIN INTERFACE / Eindhoven University of Technology Slide 7

Requirements Manikin Interface Automated physiological response also calls for new manikin design Artificial in vivo environment Manikin design which closely relates to human anatomy and histology Data gathering Manikin whith embedded sensor systems in the artificial in vivo environment / Eindhoven University of Technology Slide 8

Requirements Manikin Interface What can this offer? Artificial in vivo environment Can account for improving tactile experience and gas, fluid, and structure interactions Data gathering Can generate input parameters for physiologic models / Eindhoven University of Technology Slide 9

Requirements Manikin Interface System overview manikin components Respiratory System Thorax Upper respiratory tract Rib cage Lower respiratory tract Diaphragm Pleural Cavity Cardiovascular System Embedded sensor systems Heart Measuring flow Blood vessels Measuring pressure Measuring position / Eindhoven University of Technology Slide 10

Requirements Manikin Interface Respiratory System Upper respiratory tract / Eindhoven University of Technology Slide 11

Requirements Manikin Interface Thorax Rib cage / Eindhoven University of Technology Slide 12

Requirements Manikin Interface Cardiovascular System Heart / Eindhoven University of Technology Slide 13

Requirements Manikin Interface Embedded sensor systems Measuring flow / Eindhoven University of Technology Slide 14

Requirements Manikin Interface Measuring flow Trachea Left Ventricle V(ml/ml/cl) Right Ventricle 1 2 3 4 5 t(s) / Eindhoven University of Technology Slide 15 6 7 8 9 10

Discussion and Conclusion How can an automatized manikin response improve simulation? Provide more time to focus on instructing and debriefing. Provide more detailed information during debriefing. A “human” manikin can provide more realistic tactile experience. / Eindhoven University of Technology Slide 16

Acknowledgments P. H. M. Bovendeerd, F. L. M. Delbressine, F. N. van de Vosse, L. M. G. Feijs M. B. van der Hout-van der Jagt, P. Andriessen, P. J. van Runnard Heimel, S. Bambang Oetomo, S. G. Oei, C. van Pul N. Hijnen T. Antonius and all the medical members of the MMC NICU, MMC Skills Lab, Kraamsuites, Medsim, and the simulation center of Radboud UMC which welcomed us in our visits. / Eindhoven University of Technology

2 nd Jan Beneken Conference on Modeling and Simulation of Human Physiology 23 rd April, 2015 Construction Requirements for Full-term Newborn Simulation Manikin Thank you for your attention! Lúcia Fonseca and Mark Thielen L. T. Neto. Fonseca@tue. nl M. W. H. Thielen@tue. nl