Principles and M­odeling of C­ontinuous P­ositive Airway P­ressure (CPAP



Ahmed M. Al-Jumaily Institute of Biomedical Technologies Auckland University of Technology

Contributing Author
Prasika I. Reddy Institute of Biomedical Technologies Auckland University of Technology

the assistance of an appropriate professional should be sought.     p.   Includes bibliographical references. Ahmed.  2. Danvers.  Sleep Apnea. Requests for special permission or bulk reproduction should be addressed to the ASME Publishing Department. Information contained in this work has been obtained by the American Society of Mechanical Engineers from sources believed to be reliable. Respiration Disorders--therapy.  4.© 2012. ASME.copyright. Prasika I.cfm ASME Press books are available at special quantity discounts to use as premiums or for use in corporate training programs. 222 Rosewood Drive.  Continuous Positive Airway Pressure--instrumentation. Statement from the Bylaws. contributing author. The work is published with the understanding that ASME and its authors and editors are supplying information but are not attempting to render engineering or other professional services. NY 10016. contact the Copyright Clearance Center (CCC). All rights reserved. MA 01923.asme. USA (www. Reddy. For more information. Obstructive--therapy. no part of this publication may be reproduced or distributed in any form or by any means. or damages arising out of the use of this information. omissions. printed in its publications (B7. Prasika I.   [DNLM:  1.   Medical devices for respiratory dysfunction : principles and modeling of continuous positive airway pressure (CPAP) devices / Ahmed M. .20028’4--dc23 2011035639 . contact Special Sales at infocentral@asme.asme. For authorization to photocopy material for internal or personal use under those circumstances not falling within the fair use provisions of the Copyright Act. Printed in the United States of America.  3. If such engineering or professional services are required. cm. 3 Park Avenue. Title.1. tel: 978-750-8400. without the prior written permission of the publisher. or submitted online at: http://www. . II. Neither ASME nor its authors and editors shall be responsible for any errors. WF 145] 616. Biomedical Engineering--methods. New York. neither ASME nor its authors or editors guarantee the accuracy or completeness of any information published in this work. ASME shall not be responsible for statements or opinions advanced in papers or .org/Publications/ Books/Administration/ Library of Congress Cataloging-in-Publication Data Al-Jumaily.   ISBN 978-0-7918-5977-3   I. . Except as permitted under the United States Copyright Act of 1976. Reddy.3). or stored in a database or retrieval system. Al-Jumaily .

2 Surgical Treatment 2.5 Closure 3 3 5 7 8 13 Part 1: Obstructive Sleep Apnea (OSA) 15 Chapter 2: Obstructive Sleep Apnea: Basic Principles and Current Treatments 2.3.3 Clinical Management and Treatment of OSA 2.3.2 Diagnosis 2.1 Mathematical Modeling 1.3.3 CPAP Therapy 2.TABLE OF CONTENTS About the Author Preface Author’s Introduction ix x xiii Introduction 1 Chapter 1: Modeling Concepts 1.4 Modeling Procedure 1.1 Obstructive Sleep Apnea (OSA) 2.2 Talkative Models 1.3 Parameter/Model Requirements 1.1 Oral Devices 2.4 Closure References 17 17 19 20 20 21 22 25 25 iii .

2.2.1 Air Delivery Unit 3.1 The Need for Humidification 4.1 Heated Humidifiers 4.6.1 Compressor Analysis 3.3 Simulink™ Model 3.3 Exhaled Air Re-breathing 3.2 Lumped Parameter Modeling of Components 3.6 Reversed Flow 3.2 Effect of Flow Direction on Air Properties 3.4 Delivery Tube Model Utility 3.4 Air Delivery Unit 4.3 Reservoir 3.3 Modeling with Humidification 4.2.7 Closure References 29 29 30 31 31 32 33 37 39 41 44 45 47 49 54 56 56 57 59 63 63 Chapter 4: Modeling CPAP Humidification 4.1 Principles of Operation and System Components      Table of Contents Chapter 3: Modeling of Continuous Positive Airway Pressure (CPAP) 3.6 Mass Transfer 4.6.5 Humidification Process 4.5.7 Humidifier Heat Transfer 4.2 Water Reservoir 4.4 Model Validation 3.2 System Model Summary 3.3 Hygroscopic Condenser Humidifiers 4.4 Modeling Outcomes 3.1 Transport Delay 3.2.2 Types of Humidifiers 4.2 Passive Humidifiers 4.6.2 Connecting Duct 3.7.1 Heater Plate 4.5 Mask 3.3 Simulation Results 3.2.3 Air Chamber 65 65 66 67 69 69 71 72 74 76 79 79 82 86 .6.

2 Nasal Mask 4.3.1 Physical System 5.3 Simulink™ Model 5.6 Flow Sensors 5.9 Interface 4.2 Continuous Cycling Method 5.3.3 Modeling Condensation 6.11 Closure References     89 93 94 95 99 100 100 Chapter 5: Control Systems for CPAP Basic Principles of Condensation and Carbon Dioxide 6.9.1 Flexible Tube 4.7 Closure References 103 103 106 106 107 108 108 108 108 109 111 112 114 116 117 117 119 122 123 Chapter 6: Mask Design 6.2 Mathematical Models to Determine Design Parameters 6.4.1 Reaction Curve Method 5.1 Fluid Modeling 6.8 Heated Air Delivery Tube (HADT) 4.2 Mathematical Modeling 5.2.10 Simulink™ Model 4.Table of Contents     4.4.2 Calculation of condensation rate 125 125 128 128 131 132 132 133 .2 Open Loop Response 5.5 Controller Tuning 5.2 Time Delay Compensation 5.1 Time Constant Compensation 5.4 Appropriate Control Scheme 5.2 Pressure Transducer 5.3 Controller Condensation Physics 6.2.4 Breathing 5.3.1 Model Components Available Control Schemes 5.2 Design Considerations of Pressure and Area Effects 6. The CPAP Generator 8.4 Expiratory Line Humidification Chamber 8.2.1 Principles of Operation and System Components 8.2 Lumped Parameter Modeling of Components 8.6 Simplified Lung Model 8.1 Respiratory Distress Syndrome (RDS) 7.1.5  Patient Interface .2.5 Closure References 137 139 139 Part 2: Respiratory Distress Syndrome (RDS) 141 Chapter 7: Basic Principles and Current Treatments 7.2 Biologically Variable Ventilation (BVV) 7. Nasal Prongs.4 CPAP Generator 8.3 Traditional Ventilation Therapies 7.1.1 Humidification Chamber 8.1.2 Single-Heated Breathing Circuit 8.2. and Infant Bonnet 8.2 Ventilation Techniques using Pressure Oscillations 7.3 Pressure Manifold      Table of Contents 6.2.7 Complete System Simulation Model 155 155 156 156 157 157 158 158 159 160 162 163 166 166 167 .1 Pathophysiology 7.2.4 Computational Fluid Dynamic (CFD) Simulations 6.3 Patient Interface 8.1.2 Surfactant Therapies 7.3 Closure References 143 143 144 145 145 147 147 150 150 152 152 Chapter 8: Modeling of Bubble CPAP 8.2.1.Nasal Tubing.3  Continuous Positive Airway Pressure (CPAP) with Pressure Oscillations 7.2 The Inspiratory Line 8.1 High Frequency Ventilation (HFV) 7. Model Assumptions 9.3 Model Validation  Predictions of Pressure Oscillation Transmission Through the Tracheobronchial Tree 9.4.2 Respiratory Mechanics Anatomy 9.5 Closure References    vii 168 169 169 170 170 171 Chapter 9: Modeling Device Interaction with the Neonatal Lung 9. Expiration.1 Morphometric Models 9.5 Simulink™ Model 9.3.2 Model Derivation 9.4.3 Modeling Respiratory System Dynamics 9.3 Mass Flow Rate Expressions 9.1  Effect of Design Parameters on Pressure Transmission 8.1.1 Respiratory System Structure and Function 9.4 Model Development 9.2 Compliance 9.3 Summary 9.4 Alveolar Surface Tension Interaction with Neonatal Lung 8.6 Model Validation 9.5 The Pleural Compartment and Chest Wall 9.3 Impedance Mechanical Models 9.1 Airway Resistance 9.8 Closure References 173 173 173 177 179 180 180 181 182 182 185 186 186 187 189 190 191 194 195 196 198 200 204 207 209 209 .3 Respiratory Volumes and Capacities  Inspiration. and the Respiratory Muscles 9.4 Lobe Dynamics 9.4 Model Utility 8.5 Work of Breath 9.Table of Contents     8.

1 Digital Propeller Anemometer B.4 Hot Wire/Film Anemometer B.5 Ultrasonic Anemometer B.1 Positive Type Air Compressors A.3 Laser Doppler Anemometry (LDA) B.viii      Table of Contents Appendix A: CPAP Air Delivery A.6 Summary References 215 215 216 216 217 219 219 221 .2 Non-Positive Type Air Compressors References 211 211 211 214 Appendix B: Sensors Used in CPAP B.2 Electromagnetic Flow Meter B.

and a B.Sc. he has established very strong industrial research links with many major medical device companies in New Zealand and the United States. and has acted as a reviewer for several international journals. He has published more than 250 papers in international journals and conference proceedings.Sc. As the director of the Engineering Research Institute and then the Institute of Biomedical Technologies of AUT for the last 12 years. He is also a registered professional engineer. from the University of Baghdad. and the Auckland University of Technology (AUT). and system dynamics and control. International Institute of Acoustics and Vibration.ABOUT THE AUTHOR Professor Ahmed Al-Jumaily holds a Ph. Iraq (all in Mechanical Engineering). OH. He is a Fellow member of the American Society of Mechanical Engineers. acoustics. Al-Jumaily’s perspective of academic engineering research is that industrial research is a “must” to minimize the gap between academia and the industry. Also. International Society of Optical Engineering. as well as a member of the Acoustical Society of America. medical devices. ix . from Ohio State University. four Middle Eastern universities. smart polymers.D. mechanical vibrations. and Institute of Professional Engineers New Zealand. and M. American Engineering Education. He has 33 years of teaching and research experience at two American universities. he has edited two ASME books on vibration and acoustics in biomedical applications. Columbus. He has supervised more than 90 postgraduate students in biomechanic­s.

The manner in which the governing equations can be detailed through the use of block diagrams within Simulink™ is demonstrated. The book consists of an introductory chapter and two sections. Chapter 3 demonstrates how modeling techniques can be applied to predict the performance of a prototype CPAP system. It includes updated literature reviews on the state of the art of these devices. The introductory chapter presents some modeling concepts and their pros and cons.PREFACE This book introduces the reader to the basic principles of operation. The chapter also introduces a new concept of “Talkative Models. Chapter 2 in the book. and improvement using electromechanical engineering principles to serve the medical community. Dynamic testing for the purpose of model verification is then illustrated to the reader. It presents definitions and an overview of OSA and the related literature. and then modeled in Simulink™ within the Matlab™ environment.e.” which can be used to assess medical device performance as these devices are applied during a therapy process. Section One consists of six chapters. The system is described in terms of governing equations of the individual components using a lumped parameter approach. Each one of the chapters in these sections is designed to be a stand-alone chapter that can potentially be used in an engineering modeling course. covers basic principles and current treatments of OSA. and modeling of positive airway pressure therapy devices with an emphasis on Continuous Positive Airway Pressure (CPAP) devices. modeling. The first chapter in this section. with emphasis on medical therapy device applications. The book elaborates on two of the most prevalent respiratory dysfunctions. as well as elaborates on various methods of treatment. including functionality and modeling. It reflects more than 10 years of development. The need for modeling humidification and the types of humidifiers using a lumped parameter approach with model validation  .. i. Obstructive Sleep Apnea (OSA) and Respiratory Distress Syndrome (RDS). which focus on CPAP devices for OSA treatment. design. development. with an emphasis on the use of CPAP systems to manage these respiratory disorders. An example of how such a model can then be used for further product development is given by using it to evaluate the specifications of an improved air delivery unit.

and its implementation in the Simulink™ environment is also elaborated on. Chapter 6 presents a brief overview of the different types of masks used in CPAP delivery and an introduction to the importance of controlling carbon dioxide and condensation levels in the mask. The first chapter is Chapter 7 in the book. along with clinical studies from the literature that outline the benefits of its use to treat RDS. and describes traditional surfactant and ventilation therapies. function. The content and format of this book have been designed to benefit a variety of audiences. including: 1. The procedure of developing a validated lumped parameter mathematical model of a non-linear biological system such as the lung is described. While Chapter 5 covers the development of a control scheme to enable the regulation of a constant nasal mask pressure during CPAP therapy throughout a patient’s breathing cycle. along with more current techniques that use pressure oscillations. the manner in which such a model can be integrated with a model of a respiratory device to determine the effect of device operation on respiratory performance is illustrated. before embarking on a lumped parameter modeling approach. electrical. Using the “Talkative Models” concept introduced in Chapter 1. It also presents a description of how to create an overall computational model of the system in Simulink™ within the Matlab™ environment. flow direction. and mechanics of the respiratory system before proceeding to discuss existing models in the literature that have been developed to answer a variety of questions on respiratory performance. . Chapter 9. A computation fluid dynamics (CFD) approach to modeling condensation in the mask is also described when there is a need to take into account geometric complexity.Preface        xi is presented in Chapter 4. It provides an introduction and overview of RDS. Graduate and undergraduate students in biomedical. This chapter also shows how fluid mechanics and thermodynamics can be used to model flow and condensation in a typical nasal mask. In particular. and temperature distribution.  Academic educators teaching upper-level graduate courses in Biomedical Engineering. Section Two consists of three chapters on RDS. The process of validating the model with experimental data is elaborated on with the aim of producing a model that can be used for clinical and engineering trials. Chapter 8 provides a description of the various components of a Bubble CPAP system. The last chapter. the Bubble CPAP system is elaborated on. provides an introduction to the structure. 2. and mechanical engineering wanting to learn about modeling therapeutic devices and techniques and how those models can be used to assess the performance of these devices. where basic laws of physics and empirical relationships are applied to generate mathematical models of individual components.

experimental. 5. The author’s main contributions have been to the ways in which these methods are fine-tuned for uses related to medical therapy devices. 6. This book presents well-established modeling methods as applied to medical devices. modeling. 4. theory.  Industrial professionals wishing to understand the fundamentals and applications of lung therapy devices with a focus on CPAP devices. Researchers interested in learning relevant significant principles. .  Medical practitioners who are involved in using therapeutic techniques.xii      Preface 3. I am thus indebted to the authors and postgraduate students whose works were gleaned (with appropriate references to the original publications) for this book to be developed. and clinical applications of biomedical systems.  Medical device manufacturing companies interested in expedient procedures for device analyses and development.

which is further detailed in the thesis cited as the main reference for that chapter. and students of engineering and medicine as well as to medical device industry personnel. This book summarizes more than 10 years of research and development that I have conducted with my postgraduate students. This book will appeal not only to fellow researchers. Prasika I. This makes it difficult for the reader to access lung therapy devices in one ready-made volume. and optimize these devices. xiii . this book provides updated material on the subject: It gives the basic principles of these devices and explains how engineering modeling is used to improve. In this way.AUTHOR’S INTRODUCTION Applications of engineering principles for therapy devices are not available under one umbrella. Each chapter stands alone and summarizes a complete project. It compiles experimental. The author’s wish is that this book will interest and intrigue its readers to promote further useful modeling applications for medical devices. develop. as well as an ex-­colleague and friend David Dodd for the final proof-reading of the book. I would like to extend my thanks to my student and assistant Meha Mathur for helping to revise parts of the book. Reddy. Further. I would like to acknowledge the contributions of all students whose theses are used as the main reference materials for this book. and computational methods applied to the medical devices under one roof. Information from the classroom and the industry are brought together to the expanding field of biomedical devices. theoretical. who has helped in putting together parts of the book. co-author Dr. The author hopes that the readers will find this book a valuable asset in keeping themselves abreast of the latest techniques in the beneficial system modeling approach applications for lung supportive devices. This is the first book that brings together engineering principles as applied to Lung Therapy Devices. To achieve this goal. but also to practitioners. they are scattered in various research articles and limited book chapters. This book bridges the gap between academia and the industry in the area of biomedical devices and methodologies. I would also like to acknowledge the effort of my student and colleague. lecturers.

New Zealand . which can be the base for a “Virtual Lab” to test the performance of those devices.xiv      Author’s Introduction and render those modeling techniques as tools for computer simulations. This is a very powerful and economic approach to improvin­g and developing those devices. Ahmed Al-Jumaily Institute of Biomedical Technologies Auckland University of Technology Auckland. It will minimize the trial-and-error p­rocesses that are currently used by many industries and reduce the risk of costly design changes.

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