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Multi-objective optimization of Mechanical ventilation with the aid of purifiers in two scenarios:Regular operation and mitigating the spread of respiratory infectious diseases

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Building Simulation 2023年第5期16卷 795-811页

作者： Yiqun Li Yujie Fan Chengqiang Zhi Wei Ye Xu Zhang School of mechanical Engineering Tongji UniversityShanghai 201804China Department of Building Science Tsinghua UniversityBeijing 100084China Key Laboratory of Engineering Structure Performance Evolution and Control Ministry of EducationTongji UniversityShanghai 200092China

COVID-19 and its impact on society have raised concerns about scaling up Mechanical ventilation(MV)systems and the energy consequences.This paper attempted to combine MV and portable air cleaners(PACs)to achieve acceptable indoor air quality(IAQ)and energy reduction in two scenarios:regular operation and mitigating the spread of respiratory infectious diseases(RIDs).We proposed a multi-objective optimization method that combined the NSGA-II and TOPSIS techniques to determine the total equivalent ventilation rate of the MV-PAC system in both scenarios.The concentrations of PM_(2.5) and CO_(2) were primary indicators for IAQ.The modified Wells-Riley equation was adopted to predict RID transmissions.An open office with an MV-PAC system was used to demonstrate the method’s applicability.Meanwhile,a field study was conducted to validate the method and evaluate occupants’perceptions of the MV-PAC system.Results showed that optimal solutions of the combined system can be obtained based on various IAQ requirements,seasons,outdoor conditions,etc.For regular operation,PACs were generally prioritized to maintain IAQ while reducing energy consumption even when outdoor PM_(2.5) concentration was high.MV can remain constant or be reduced at low occupancies.In RID scenarios,it is possible to mitigate transmissions when the quanta were<48 h^(−1).No significant difference was found in the subjective perception of the MV and PACs.Moreover,the effects of infiltration on the optimal solution can be substantial.Nonetheless,our results suggested that an MV-PAC system can replace the MV system for offices for daily use and RID mitigation.

关键词： Mechanical ventilation portable air cleaners infiltration multi-objective open office

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Safety and efficacy of ciprofol vs.propofol for sedation in intensive care unit patients with Mechanical ventilation:a multi-center,open label,randomized,phase 2 trial

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Chinese Medical Journal 2022年第9期135卷 1043-1051页

作者： Yongjun Liu Xiangyou Yu Duming Zhu Jun Zeng Qinhan Lin Bin Zang Chuanxi Chen Ning Liu Xiao Liu Wei Gao Xiangdong Guan Department of Critical Care Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhou 510080China Department of Critical Care Medicine The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830011China Department of Critical Care Medicine Zhongshan HospitalFudan UniversityShanghai 200032China Department of Critical Care Medicine Guangzhou First People's HospitalGuangzhou 510180China Department of Critical Care Medicine Qingyuan People's HospitalThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuan 511518China Department of Critical Care Medicine Shengjing Hospital of China Medical UniversityShenyang 110022China Department of Research and Development Haisco Pharmaceutical Group Co.LtdShanghai 201203China.

Background:Ciprofol(HSK3486;Haisco Pharmaceutical Group Co.,Ltd.,Chengdu,China),developed as a novel 2,6-disubstituted phenol derivative showed similar tolerability and efficacy characteristics as propofol when applicated as continuous intravenous infusion for 12 h maintenance sedation in a previous phase 1 trial.The phase 2 trial was designed to investigate the safety,efficacy,and pharmacokinetic characteristics of ciprofol for sedation of patients undergoing Mechanical ventilation.Methods:In this multicenter,open label,randomized,propofol positive-controlled,phase 2 trial,39 Chinese intensive care unit patients receiving Mechanical ventilation were enrolled and randomly assigned to a ciprofol or propofol group in a 2:1 ratio.The ciprofol infusion was started with a loading infusion of 0.1-0.2 mg/kg for 0.5-5.0 min,followed by an initial maintenance infusion rate of 0.30 mg·kg^(-1)·h^(-1),which could be adjusted to an infusion rate of 0.06 to 0.80 mg·kg^(-1)·h^(-1),whereas for propofol the loading infusion dose was 0.5-1.0 mg/kg for 0.5-5.0 min,followed by an initial maintenance infusion rate of 1.50 mg·kg^(-1)·h^(-1),which could be adjusted to 0.30-4.00 mg·kg^(-1)·h^(-1)to achieve-2 to+1 Richmond Agitation-Sedation Scale sedation within 6-24 h of drug administration.Results:Of the 39 enrolled patients,36 completed the trial.The median(min,max)of the average time to sedation compliance values for ciprofol and propofol were 60.0(52.6,60.0)min and 60.0(55.2,60.0)min,with median difference of 0.00(95%confidence interval:0.00,0.00).In total,29(74.4%)patients comprising 18(69.2%)in the ciprofol and 11(84.6%)in the propofol group experienced 86 treatment emergent adverse events(TEAEs),the majority being of severity grade 1 or 2.Drug-and sedation-related TEAEs were hypotension(7.7%vs.23.1%,P=0.310)and sinus bradycardia(3.8%vs.7.7%,P=1.000)in the ciprofol and propofol groups,respectively.The plasma concentration-time curves for ciprofol and propofol were similar.Conclusions:ciprofol is comparable to propofol with good t

关键词： HSK3486 Ciprofol Propofol Sedation Mechanical ventilation

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Effects of Tanreqing Injection on ICU Mortality among ICU Patients Receiving Mechanical ventilation: Time-Dependent Cox Regression Analysis of A Large Registry

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Chinese Journal of Integrative Medicine 2023年第9期29卷 782-790页

作者： WANG Wen HE Qiao WANG Ming-qi XU Jia-yue JI Peng ZHANG Rui ZOU Kang SUN Xin Chinese Evidence-Based Medicine Center West China HospitalSichuan UniversityChengdu610041China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan Chengdu610041China Sichuan Center of Technology Innovation for Real World Data Chengdu610041China Intensive Care Unit West China HospitalSichuan UniversityChengdu610041China Information Center West China HospitalSichuan UniversityChengdu610041China

Objective To assess whether the use of Tanreqing(TRQ)Injection could show improvements in time to extubation,intensive care unit(ICU)mortality,ventilator-associated events(VAEs)and infection-related ventilator associated complication(IVAC)among patients receiving Mechanical ventilation(MV).Methods A time-dependent cox-regression analysis was conducted using data from a well-established registry of healthcare-associated infections at ICUs in China.Patients receiving continuous MV for 3 days or more were included.A time-varying exposure definition was used for TRQ Injection,which were recorded on daily basis.The outcomes included time to extubation,ICU mortality,VAEs and IVAC.Time-dependent Cox models were used to compare the clinical outcomes between TRQ Injection and non-use,after controlling for the influence of comorbidities/conditions and other medications with both fixed and time-varying covariates.For the analyses of time to extubation and ICU mortality,Fine-Gray competing risk models were also used to measure competing risks and outcomes of interest.Results Overall,7,685 patients were included for the analyses of MV duration,and 7,273 patients for the analysis of ICU mortality.Compared to non-use,patients with TRQ Injection had a lower risk of ICU mortality(Hazards ratios(HR)0.761,95%CI,0.581–0.997),and was associated with a higher hazard for time to extubation(HR 1.105,95%CI,1.005–1.216),suggesting a beneficial effect on shortened time to extubation.No significant differences were observed between TRQ Injection and non-use regarding VAEs(HR 1.057,95%CI,0.912–1.225)and IVAC(HR 1.177,95%CI,0.929–1.491).The effect estimates were robust when using alternative statistic models,applying alternative inclusion and exclusion criteria,and handling missing data by alternative approaches.Conclusion Our findings suggested that the use of TRQ Injection might lower mortality and improve time to extubation among patients receiving MV,even after controlling for the factor that the use of TRQ changed over time.

关键词： Tanreqing critical care Mechanical ventilation mortality ventilator-associated events

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Predictive performance of the variation rate of the driving pressure on the outcome of invasive Mechanical ventilation in patients with acute respiratory distress syndrome

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Chinese Journal of Traumatology 2024年第2期27卷 107-113页

作者： Hui-Dan Jing Jun-Ying Tian Wei Li Bing-Ling He Hong-Chao Li Fu-Xia Jian Cui Shang Feng Shen Department of Intensive Care Unit The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China Department of Intensive Care Unit Army Medical Center of PLAChongqing400042China College of Foreign Languges Chongqing Medical UniversityChongqing400016China

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive Mechanical ventilation in patients with acute respiratory distress syndrome.Methods:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive Mechanical ventilation for at least 48 h were enrolled.Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days.Outcome measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,etc.were assessed every 24 h from day 0 to day 14 until successful weaning was achieved.The measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum test.And categorical data use the Chi-square test or Fisher's exact test to compare.The predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.Results:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of Mechanical ventilation.The cut-off values of the medianΔP%measured by Operator 1 vs.Operator 2 in the first 4 days were≥4.17%and 4.55%,respectively(pMechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these 2 groups in the 28-day mortality(11.8%vs.66.7%,

关键词： Driving pressure Driving pressure variation rate Acute respiratory distress syndrome Mechanical ventilation

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Prediction of Mechanical ventilation outcome by early abdominal-visceral-blood-flow-and-function score in critically ill patients after cardiopulmonary bypass in the ICU: A prospective observational study

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Journal of Intensive Medicine 2024年第1期4卷 101-107页

作者： Chaofu Yue Longxiang Su Jun Wang Na Cui Yuankai Zhou Wei Cheng Bo Tang Xi Rui Huaiwu He Yun Long Department of Intensive Care Unit Peking Union Medical College HospitalBeijingChina Department of Intensive Care Unit Qujing First People’s HospitalQujingYunnanChina Department of Intensive Care Unit Shiyan People’s Hospital of Bao’an DistrictShenzhenGuangdongChina

Background:Abdominal organs are important organs that sense and respond to ischemia and hypoxia,but there are few evaluation methods.We use ultrasonography to evaluate abdominal organ function and blood flow in patients with Mechanical ventilation(MV)after cardiopulmonary bypass and to obtain a semiquantitative score for abdominal organ function and blood flow.Methods:Patients with cardiopulmonary bypass in the Critical Care Department of Peking Union Medical College Hospital in China from March to July 2021 were enrolled in this prospective observational study.The correlation of the abdominal-visceral-blood-flow-and-function score(AVBFS)with the duration of MV,number of days spent in the intensive care unit(ICU),acute physiology and chronic health evaluation II(APACHE-II),sequential organ failure assessment(SOFA),lactate,epinephrine,and norepinephrine use was analyzed,and the results were used to assess the predictive value of the receiver operating characteristic curve(ROC)regression analysis score for the duration of MV.Results:Of the 92 patients who underwent cardiopulmonary bypass,41 were finally included.The AVBFS were significantly correlated with the duration of MV,number of days spent in the ICU,APACHE-II score,SOFA score,and norepinephrine use time.The AVBFS in a group of patients using ventilators≥36 h were significantly higher than those obtained for a group of patients using ventilators<36 h(P<0.05).The evaluation results for the AVBFS at 0-12 h after ICU admission were as follows:area under the ROC curve(AUC)=0.876(95%confidence interval[CI]:0.767 to 0.984),cut-off value=2.5,specificity=0.842,and sensitivity=0.773.Conclusions:Abdominal visceral organ function and blood perfusion can be used to evaluate gastrointestinal function.It is related to early and late extubation after cardiac surgery.

关键词： Ultrasonic evaluation Abdominal-visceral-blood-flow-and-function score(AVBFS) Gastrointestinal dysfunction Mechanical ventilation Cardiopulmonary bypass

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Structured Graded Lung Rehabilitation for Children with Mechanical ventilation

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Computer Systems Science & Engineering 2022年第1期40卷 139-150页

作者： Lei Ren Jing Hu Mei Li Ling Zhang Jinyue Xia Department of Nursing Children’s Hospital of Nanjing Medical UniversityNanjing210008China Department of rehabilitation medicine Children’s Hospital of Nanjing Medical UniversityNanjing210008China International Business Machines Corporation(IBM) NYUSA

Lung rehabilitation is safe and feasible,and it has positive benefits in weaning the machine as soon as possible,shortening the time of hospitalization and improving the prognosis of children with Mechanical ventilation.However,at present,the traditional medical concept is deep-rooted,and doctors'understanding of early rehabilitation is inadequate.It is necessary to make in-depth exploration in the relevant guidelines and expert consensus to formulate standardized early rehabilitation diagnosis and treatment procedures and standards for mechanically ventilated children.In the paper,a structured graded lung rehabilitation program is constructed for children with Mechanical ventilation to improve their respiratory function,shorten the time of Mechanical ventilation and pediatric intensive care unit(PICU)hospitalization,and reduce their anxiety,based on the principal component analysis of functional pneumonia data.Scientific evaluation and dynamic monitoring ensure the safety of the implementation of the program and promote the prognosis and prognosis of the disease.The proposed lung reha-bilitation program provides a reference basis for the formulation of lung rehabilitation guidelines for children with Mechanical ventilation.And It has important reference significance for clinical pulmonary rehabilitation to alleviate the concerns of clinicians and lay the foundation for the large-scale promotion of early lung rehabilitation.

关键词： Lung rehabilitation Mechanical ventilation principal component analysis

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Mechanical ventilation strategy for pulmonary rehabilitation based on patient-ventilator interaction

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Science China(Technological Sciences) 2021年第4期64卷 869-878页

作者： HAO LiMing LI Xiao SHI Yan CAI MaoLin REN Shuai XIE Fei LI YaNa WANG Na WANG YiXuan LUO ZuJin XU Meng School of Automation Science and Electrical Engineering Beihang UniversityBeijing 100191China Department of Rehabilitation The Fouth Medical Center of PLA General HospitalBeijing 100048China Department of Pulmonary and Critical Care Medicine Chinese PLA General HospitalBeijing 100039China Department of Respiratory and Critical Care Medicine Beijing Engineering Research Center of Respiratory and Critical Care MedicineBeijing Institute of Respiratory MedicineBeijing Chao-Yang HospitalCapital Medical UniversityBeijing 100043China Department of Orthopedics Chinese PLA General HospitalBeijing 100039China State Key Laboratory of Fluid Power and Mechatronic Systems Zhejiang UniversityHangzhou 310027China

Mechanical ventilation is an effective medical means in the treatment of patients with critically ill,COVID-19 and other pulmonary diseases.During the Mechanical ventilation and the weaning process,the conduct of pulmonary rehabilitation is essential for the patients to improve the spontaneous breathing ability and to avoid the weakness of respiratory muscles and other pulmonary functional trauma.However,inappropriate Mechanical ventilation strategies for pulmonary rehabilitation often result in weaning difficulties and other ventilator complications.In this article,the Mechanical ventilation strategies for pulmonary rehabilitation are studied based on the analysis of patient-ventilator interaction.A pneumatic model of the Mechanical ventilation system is established to determine the mathematical relationship among the pressure,the volumetric flow,and the tidal volume.Each ventilation cycle is divided into four phases according to the different respiratory characteristics of patients,namely,the triggering phase,the inhalation phase,the switching phase,and the exhalation phase.The control parameters of the ventilator are adjusted by analyzing the interaction between the patient and the ventilator at different phases.A novel fuzzy control method of the ventilator support pressure is proposed in the pressure support ventilation mode.According to the fuzzy rules in this research,the plateau pressure can be obtained by the trigger sensitivity and the patient’s inspiratory effort.An experiment prototype of the ventilator is established to verify the accuracy of the pneumatic model and the validity of the Mechanical ventilation strategies proposed in this article.In addition,through the discussion of the patient-ventilator asynchrony,the strategies for Mechanical ventilation can be adjusted accordingly.The results of this research are meaningful for the clinical operation of Mechanical ventilation.Besides,these results provide a theoretical basis for the future research on the intelligent control of ventilator and the a

关键词： Mechanical ventilation pulmonary rehabilitation phases division fuzzy control patient-ventilator interaction

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Intensivists’response to hyperoxemia in Mechanical ventilation patients:The status quo and related factors

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World Journal of Emergency Medicine 2021年第3期12卷 202-206页

作者： Zi-wei Ke Yue Jiang Ya-ping Bao Ye-qin Yang Xiao-mei Zong Min Liu Xiang-yun Guan Zhong-qiu Lu Department of Emergency Medicine the First Affi liated Hospital of Wenzhou Medical UniversityWenzhou 325000China Department of Nursing Taizhou Hospital of Zhejiang ProvinceTaizhou 317000China Operating Room the First Affi liated Hospital of Wenzhou Medical UniversityWenzhou 325000China Faculty of Nursing Wenzhou Medical UniversityWenzhou 325000China Yiwu Hospital Affi liated to Wenzhou Medical University Yiwu 322000China

BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required Mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients

关键词： Mechanical ventilation Hyperoxemia Fraction of inspired oxygen Arterial blood gas Intensive care unit

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Assessment of 1-year Outcomes in Survivors of Severe Acute Respiratory Distress Syndrome Receiving Extracorporealembrane Oxygenation or Mechanical ventilation： A Prospective Observational Study

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Chinese Medical Journal 2017年第10期130卷 1161-1168页

作者： Zhi-Yong Wang Tong Li Chun-Ting Wang Lei Xu Xin-Jing Gao Department of Critical Care Medicine Tianjin Third Central Hospital Artificial Cells Key Laboratory of Tianjin Tianjin 300170 China Heart Center Tianjin Third Central Hospital Tianjin 300170 China Department of Critical Care Medicine Shandong Provincial Hospital Jinan Shandong 250021 China

Background： Little is known about the long-term outcomes of severe acute respiratory distress syndrome （ARDS） patients requiring extracorporeal membrane oxygeuation （ ECMO）. This study aimed Io investigate the 1 -year outcomes of these patients or patients receiving Mechanical ventilation （MV） and compare their health-related quality of lili：（HRQoL） to the general population. Methods： Severe ARDS survivors admitted to two ICUs in China between .lanuary 2012 and .lanuary 2014 were enrolled. Of the severe ARDS survivors enrolled, 1-year postdischarge, HRQoL assessment using the Short-Forna 36 （SF-36） and EuroQol questionnaire dimensions, 6-rain walking distance, chest computed tomography scan, pulmonary limction, and arterial blood gas analysis were compared lbrARDS patients with or without ECMO. Rcsulls： ARDS patients receiving ECMO had a significantly higher Acute Physiology and Chronic Health Evaluation 11 score （30.3 ± 6.7 vs. 26.5 ± 7.3, P = 0.036）, lung injury score （3.3 ± 0.4 vs. 2.8 ± 0.5, P = 0.000）, Sequential Organ Failure Assessment score （ 10.8 ± 3.5 vs. 7.9 ＋ 3.1, P = 0.000）, lower PaO,/FiO, ratio （[mmHg, 1 namHg = 0.133 kPa], 68.3 ± 16.1 vs. 84.8 ± 16.5, P = 0.000）, and increased extrapuhnonary organ Iiailure （2 [1, 3] vs. 1 [1, 1], P - 0.025） compared with patients not receiving ECMO. ECMO and non-ECMO survivors showed similar pulmonary fimction, morphological abnormalities, resting arterial blood gas wflues, and 6-rain walking distance. Mild pulmonary dyslimction and abnormal morphology were observed in a few survivors. In addition, ECMO and non-ECMO survivors showed a similar quality of life. ECMO survivors showed lower SF-36 physical functioning and role-physical domain scores （minimum clinically significant difference at least 5 points）, and non-ECMO survivors had similar outcome. Conclusions： One-year posthospital discharge, severe ARDS survivors receiving ECMO or MV demonstrated comparable outcomes. Compared with the general population, ARDS survivors showed reduced HRQoL. Pulmonary function

关键词： Acute Respiratory Distress Syndrome Extracorporeal Membrane Oxygenation Mechanical ventilation Outcome

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An aviation oxygen supply system based on a Mechanical ventilation model

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Chinese Journal of Aeronautics 2018年第1期31卷 197-204页

作者： Yan SHI Yixuan WANG Maolin CAI Bolun ZHANG Jian ZHU School of Automation Science and Electrical Engineering Beihang University Beijing 100191 China Beijing Chao Yang Hospital Beijing 100043 China

At high altitudes, an Aviation Oxygen Supply System （AOSS） protects pilots from low pressure and hypoxia by continuously providing oxygen corresponding to the pilots＇ dynamic respiratory properties. An AOSS mainly consists of oxygen supercharging machines which are used in a high-altitude flight cabin to supply pressurized oxygen to pilots. Therefore, it is of great significance to study the airflow dynamic characteristics of an AOSS for safe, continuous, and efficient oxygen supply. In this paper, an AOSS is firstly simplified and considered as a Mechanical ventilation system. Then, its corresponding mathematical model is constructed. Next, to verify the mathematical model, a prototype AOSS with a lung simulator is proposed for an experimental study. Afterwards, to build a foundation for the optimization of the AOSS, the airflow dynamic characteristics of an aircraft are analyzed, and the effects of key parameters on the respiration system are researched. Through experimental and simulation studies, it can be concluded that the mathematical model is effective. Subsequently, for stability during the respiration process, we consider setting the equivalent throttling areas of the inspiration and expiration pipelines smaller within certain limits; additionally, an excessively high oxygen supply pressure will disturb smooth airflow, and in a low-pressure environment, the pressure can be 84 cmH20 lower than the standard atmospheric pressure. This research can be referred to in the design of an oxygen supply system and the study on optimization of airflow dynamic characteristics.

关键词： Aviation Dynamic characteristics Mathematical modeling Mechanical ventilation Oxygen supply system

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