Ventilator Modality - Systematic Name (SN) - OO Ontology - FSM perspective Ventilator Nomenclature Standards JWG d4jw

Introduction “Formal” definition of Ventilator Mode “names” involves developing a systematic syntax, or “Systematic Name (SN)”, based on a formal methodology, in this case, Object-Oriented Ontology (OOO). Terminology is based on the related “Handbook” and “Glossary” definitions being co-developed in the Vent Nomenclature JWG. This document describes derivation of the SN syntax through the OOO model, chief components of which include a “Finite State Model” (FSM), which is based on an OO “Class Model”. A common Ventilator Modality-- “Volume-targeted, Bi-Level Pressure Control (PC) with Pressure Support (PS) and Continuous Positive Airway Pressure (CPAP)/Positive End Expiratory Pressure (PEEP)”-- is derived according to the [VSN derivation methodology. Contents include: TopicPage Topology PC-related3 PC-related VC-related4 VC-related Methodology [OO] Ontology Finite State Model (FSM)5 Finite State Model (FSM Object Class Model 6 Object Class Model Applications – Ventilator Modality Profiling (VMP) Tool7 Profiling (VMP) Tool Synthesizer8 Synthesizer Vent Nomen Stds JWG2

Vent Modality SN - Topology – PC-related Derivation of several major Modality SN’s is shown in the following diagram, which reflects the nature of OO “generalization/specialization”. In the diagram, the same [classical] BT, e.g. PC/CBAP, is reused in different Modal contexts, ranging among several [classical, continuously positive airway] Pressure gradations, e.g. i-iii, which are also commonly known in general by the “_aka” construct. See next slide for volume-controlled/-targeted (VC, VT) adjuncts and the slide following that for FSM derivation. Vent Nomen Stds JWG3 I _PCa _CBAP i-A _PC _CBAP Iii _[PCa-] PS _CBAP ii- [ S ] _PCa _CBAP Example: ii-S_PCa_CBAP_PS

Mode Gradient Typical Volumetric adjuncts Tidal VolumeMinute Volume Intra-BTFeedbackCapabilityFeedback “_VC”“_VT”“_VM”“- ” iii ii-S * i-A i Vent Modality SN - Topology – VC-related From a naming point of view, Tidal and Minute “Volume”-related as qualifiers, or “adjuncts”, related to attainment of “Volume Control (VC)”, “Volume Target (VT)”, and “Minute Volume [VM]” metrological objectives. The distinction between “VC” and “VT” in this context is that VC implies achieving Tidal Volume object intra-breath, while “VT” implies “Breath-to-Breath” (Br2Br, or inter-breath). See previous slide for example SN derivation and subsequent slides for FSM and SN derivation methodology. Vent Nomen Stds JWG4 Volumetric Grammar: [ [_VC | _VT] [_VM [-<type] ] ] Example: ii-S_PCa_CBAP_PS_VT

Vent Modality SN - Methodology – Finite State Model (FSM) VMP finite state topology is based on recurring traversals of a graph representing several fundamental breath type (BT) variations w.r.t. Inspiration (Initiation, Delivery, Termination) and Expiration. In general, “Mode” Classes (i-iii) progress from left-to-right, and BT elevated [airway] Pressure “gradations” progress from bottom-to-top; particular “b-tree” graphs are “Modalities”, abstractly “Vent Modality Profiles (VMP). Vent Nomen Stds JWG5

Vent Modality SN - Methodology – Class Model – BT variations Vent Nomen Stds JWG6 N br Phasic Inh  exh A BR Activity Breath Phasic BT [Selec’n] Conduction Compens’n Term’n Insp  exp Mode MT [Selec’n] Continuation Instigation Sync’z’n Modality Selection Instigation Class Property Attribute Method Containment Inheritance Natural Artificial Legend: PC PCa FC FCh FCl FCd S Synchronization ATC Si St [ETT] Compensation PCa Exp Insp Rel’nship PS Insp MT i ii iii BT’s are classified as a series of heritable (reusable) “Transfer Functions”, as shown in the upper-right part of the following OO “Class” diagram. Other objects are included for heuristic purposes; see next slides. BT OO “Class” variations

Vent Modality SN - Methodology – Applications – VMP Tool In the VMP “Template Tool”, a SN string is generated by doing a b-tree traversal (left-hand for MT, right- hand for BT)). “Global” (/transitive) properties/attributes, such as “CBAP” and “Volume Targeted [Control]” are post-fixed. Two variations of a pragmatically synonymous Modality are shown below. Vent Nomen Stds JWG7 PC [a] PS CBAP Si ii aka-VolTarg BiLevel PC/PS CPAP/PEEP MMV1 ≈ ii[-S]_PCa[_CBAP]_PS_VT_VM Related settings require clarification in user documentation or related DIM, e.g. f==BR Pinsp CBAP ∆P Vt Vm [Ti]

CBAP Vent Modality SN - Methodology – Applications – Synthesizer A [Vent Modality[SN]] pattern synthesizer generating a variety of constructs, including the “Compressed Spectral Array (CSA) at right) and related annotative or interpretive terminology. Vent Nomen Stds JWG8 Si ii PC [a] PS Compressed Spectral Array