Pulse Physiology Engine: an Open-Source Software Platform for Computational Modeling of Human Medical Simulation

Bray, Aaron; Webb, Jeff; Enquobahrie, Andinet; Vicory, Jared; Heneghan, Jerry; Hubal, Robert; TerMaath, Stephanie C.; Asare, Philip; Clipp, Rachel B.

doi:10.1007/s42399-019-00053-w

Cited by 26 publications

(22 citation statements)

References 42 publications

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“…The Pulse Physiology Engine (pulse.kitware.com) models are built on the pioneering work of Ty Smith [26], further developed by the Department of Defense as BioGears (W81XWH-13-2-0068), and finally forked, continually developed, and supported for diverging uses as Pulse. Pulse is comprised of lumped-parameter models, which use electrical circuit analogues (e.g., resistors and capacitors) to represent the behavior of physiological regions or systems of the human body [25]. Feedback mechanisms and interactions of systems are accomplished through circuit connections or scalable circuit elements [27].…”

Section: Methodsmentioning

confidence: 99%

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Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine

Webb

Bray

Asare

et al. 2020

Preprint

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Background: The COVID-19 pandemic is stretching medical resources internationally, including creating ventilator shortages that complicate clinical and ethical situations. The possibility of needing to ventilate multiple patients with a single ventilator raises patient health and safety concerns. This simulation study explores patient compatibility and ventilator settings during multi-patient ventilation without the use of flow compensating resistances. Methods: A whole-body computational physiology model was used to simulate each patient on a ventilator. The primary model of a single patient with a dedicated ventilator was augmented to model two patients sharing a single ventilator. A range of ventilator settings and patient characteristics were simulated for paired patients. In addition to mechanical ventilation parameters, the full physiological simulation provides estimates of additional values for oxyhemoglobin saturation, arterial oxygen tension, and other patient parameters. Findings: These simulations show patient outcome during multi-patient ventilation is most closely correlated to lung compliance, oxygenation index, oxygen saturation index, and endtidal carbon dioxide of individual patients. The simulated patient outcome metrics were satisfactory when the lung compliance difference between two patients was less than 12 cmH2O/mL, and the oxygen saturation index difference was less than 2 mmHg. Interpretation: In resource-limited regions of the world, the COVID-19 pandemic will result in equipment shortages. While single-patient ventilation is preferable, if unavailable, these simulations provide a conceptual framework for clinical patient selection guidelines if ventilator sharing is the only available alternative.

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Section: Methodsmentioning

confidence: 99%

“…The Pulse Physiology Engine (Kitware, Inc., Clifton Park, NY) open source software was previously designed and validated to model a single patient-ventilator pairing [22]. We modified and employed this model to simulate two or more patients sharing a single ventilator resource.…”

Section: Introductionmentioning

confidence: 99%

Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine

Webb

Bray

Asare

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The Pulse Physiology Engine (Kitware, Inc., Clifton Park, NY) open source software was previously designed and validated to model a single patient-ventilator pairing [25]. We modified and employed this model to simulate two or more patients sharing a single ventilator resource.…”

Section: Plos Onementioning

confidence: 99%

“…The open source Pulse Physiology Engine (pulse.kitware.com) models are built on the pioneering work of Ty Smith [26], further developed by the Department of Defense as BioGears (W81XWH-13-2-0068), and finally forked, continually developed, and supported for diverging uses as Pulse. Pulse is comprised of lumped-parameter models, which use electrical circuit analogues (e.g., resistors and capacitors) to represent the behavior of physiological regions or systems of the human body [25]. Feedback mechanisms and interactions of systems are accomplished through circuit connections or scalable circuit elements [27].…”

Section: Pulse Overviewmentioning

confidence: 99%

Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine

et al. 2020

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Background The COVID-19 pandemic is stretching medical resources internationally, sometimes creating ventilator shortages that complicate clinical and ethical situations. The possibility of needing to ventilate multiple patients with a single ventilator raises patient health and safety concerns in addition to clinical conditions needing treatment. Wherever ventilators are employed, additional tubing and splitting adaptors may be available. Adjustable flow-compensating resistance for differences in lung compliance on individual limbs may not be readily implementable. By exploring a number and range of possible contributing factors using computational simulation without risk of patient harm, this paper attempts to define useful bounds for ventilation parameters when compensatory resistance in limbs of a shared breathing circuit is not possible. This desperate approach to shared ventilation support would be a last resort when alternatives have been exhausted. Methods A whole-body computational physiology model (using lumped parameters) was used to simulate each patient being ventilated. The primary model of a single patient with a dedicated ventilator was augmented to model two patients sharing a single ventilator. In addition to lung mechanics or estimation of CO2 and pH expected for set ventilation parameters (considerations of lung physiology alone), full physiological simulation provides estimates of additional values for oxyhemoglobin saturation, arterial oxygen tension, and other patient parameters. A range of ventilator settings and patient characteristics were simulated for paired patients. Findings To be useful for clinicians, attention has been directed to clinically available parameters. These simulations show patient outcome during multi-patient ventilation is most closely correlated to lung compliance, oxygenation index, oxygen saturation index, and end-tidal carbon dioxide of individual patients. The simulated patient outcome metrics were satisfactory when the lung compliance difference between two patients was less than 12 mL/cmH2O, and the oxygen saturation index difference was less than 2 mmHg. Interpretation In resource-limited regions of the world, the COVID-19 pandemic will result in equipment shortages. While single-patient ventilation is preferable, if that option is unavailable and ventilator sharing using limbs without flow resistance compensation is the only available alternative, these simulations provide a conceptual framework and guidelines for clinical patient selection.

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“…Pulse Physiology Engine [17] is a comprehensive open-source human physiology model. It is implemented including a solver in C++ and it integrates many physiological systems [18].…”

Section: Introductionmentioning

confidence: 99%

Development of In-Browser Simulators for Medical Education: Introduction of a Novel Software Toolchain

Šilar¹,

Polák²,

Mládek³

et al. 2019

J Med Internet Res

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BackgroundSimulators used in teaching are interactive applications comprising a mathematical model of the system under study and a graphical user interface (GUI) that allows the user to control the model inputs and visualize the model results in an intuitive and educational way. Well-designed simulators promote active learning, enhance problem-solving skills, and encourage collaboration and small group discussion. However, creating simulators for teaching purposes is a challenging process that requires many contributors including educators, modelers, graphic designers, and programmers. The availability of a toolchain of user-friendly software tools for building simulators can facilitate this complex task.ObjectiveThis paper aimed to describe an open-source software toolchain termed Bodylight.js that facilitates the creation of browser-based client-side simulators for teaching purposes, which are platform independent, do not require any installation, and can work offline. The toolchain interconnects state-of-the-art modeling tools with current Web technologies and is designed to be resilient to future changes in the software ecosystem.MethodsWe used several open-source Web technologies, namely, WebAssembly and JavaScript, combined with the power of the Modelica modeling language and deployed them on the internet with interactive animations built using Adobe Animate.ResultsModels are implemented in the Modelica language using either OpenModelica or Dassault Systèmes Dymola and exported to a standardized Functional Mock-up Unit (FMU) to ensure future compatibility. The C code from the FMU is further compiled to WebAssembly using Emscripten. Industry-standard Adobe Animate is used to create interactive animations. A new tool called Bodylight.js Composer was developed for the toolchain that enables one to create the final simulator by composing the GUI using animations, plots, and control elements in a drag-and-drop style and binding them to the model variables. The resulting simulators are stand-alone HyperText Markup Language files including JavaScript and WebAssembly. Several simulators for physiology education were created using the Bodylight.js toolchain and have been received with general acclaim by teachers and students alike, thus validating our approach. The Nephron, Circulation, and Pressure-Volume Loop simulators are presented in this paper. Bodylight.js is licensed under General Public License 3.0 and is free for anyone to use.ConclusionsBodylight.js enables us to effectively develop teaching simulators. Armed with this technology, we intend to focus on the development of new simulators and interactive textbooks for medical education. Bodylight.js usage is not limited to developing simulators for medical education and can facilitate the development of simulators for teaching complex topics in a variety of different fields.

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Pulse Physiology Engine: an Open-Source Software Platform for Computational Modeling of Human Medical Simulation

Cited by 26 publications

References 42 publications

Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine

Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine

Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine

Development of In-Browser Simulators for Medical Education: Introduction of a Novel Software Toolchain

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