Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention that is complex and risky, which makes effective training essential. Traditional ECMO training is resource-intensive, requiring clinical equipment, an intensive care unit (ICU), and qualified instructors. To address this gap, the LAIXR research group developed a virtual reality (VR)-based ECMO simulator. This thesis extends that work by implementing dynamic patient-physiology modelling and one clinical training scenario to improve realism and educational value.

The project was split into three stages: 1) development of a virtual patient monitor to display physiology modelling, 2) scenario scripting and development of a predictive physiology model, and 3) a pilot usability study to assess feasibility and realism.

The virtual monitor generates four synchronised signals, the electrocardiogram (ECG), arterial blood pressure (ABP), photoplethysmogram (PPG), and capnogram, in real time. Models combine literature-based methods with ICU data: a Gaussian ECG, Fourier-series reconstructions for ABP and PPG, and a piecewise capnogram model. Clinically relevant behaviours are included, for example, pulse pressure variation during mechanical ventilation and physiologic delays between signals. The patient monitor layout and logic were based on the Philips IntelliVue MX750 to ensure familiarity and realism.

A predictive model was developed to generate the physiological inputs required by the patient monitor. Using data from 82 VA-ECMO patients, the first stage predicts ECMO pressures and flow from device settings such as pump speed and cannula size. The second stage estimates vital signs from pump speed and the predicted ECMO parameters.

A VA-ECMO console-failure scenario was implemented to train recognition of abrupt pump stop and the restoration of flow with the hand crank. All required interactions were included, and the physiological response to console failure was modelled using fitted functions derived from clinical data and expert review.

The pilot usability study explored the feasibility and perceived realism of the simulated ECMO and vital parameters. Participants indicated that the prototype was usable and realistic, and they identified priorities for richer interactions, broader scenarios, and expanded model coverage.

Overall, this work delivers a VR-ECMO simulator that integrates data-driven, dynamic physiology modelling. The prototype demonstrates feasibility and provides a foundation for future development toward scalable, immersive ECMO education.

Rationale | | High flow nasal cannula (HFNC) is a non-invasive oxygen therapy using humidified high flow to support patients with respiratory failure. This study aimed to compare the physiological effects on respiratory effort and aeration between patients receiving high flow oxygen therapy or conventional oxygen therapy (COT) in the first twenty-four hours after extubation.

Methods | Post-extubation patients were randomized to receive either HFNC or COT. Esophageal pressure measurements and Electrical Impedance Tomography were used to evaluate the physiological effects. Measurements were taken at baseline (during mechanical ventilation just before extubation) and at 2, 4, and 24 hours post-extubation. Linear mixed model analyses were applied to assess changes over time.

Results | No statistically significant differences in respiratory effort were observed, although trends emerged in the linear mixed model analyses. In terms of aeration, the COT group showed increasing inhomogeneity over time, while the HFNC group maintained stable aeration with a progressive increase in dorsal ventilation. No changes in tidal volume were observed.

Conclusions | While statistically significant differences were limited, HFNC showed clinically relevant and important trends in stabilizing respiratory effort and lung aeration, suggesting it may provide better support for weaning and reduce re-intubation risk.

Background: The diaphragm is poorly monitored in the Intensive care unit (ICU), despite its evident importance in respiration. Ultrasound (US) is frequently employed to evaluate diaphragm thickness (DT) and diaphragm thickening factor (DTF) but requires expertise and only covers a small diaphragm area. Therefore, advanced US (post-)processing techniques are being investigated for diaphragm applications, including speckle tracking methods.
Objective: The primary aim of this pilot study was to develop an algorithm enabling DT quantification. Second, both an existing Fourier-based (FBST) and intensity-based speckle tracking (IBST) algorithm were modified to determine their feasibility in diaphragm strain quantification.
Results: Minimal (DTmin, mm) and maximal DT (DTmax, mm), and DTF (%) values were 1.9 ± 0.4, 2.3 ± 0.5, and 22.6 ± 10.9 in the MV patient group, and 2.2 ± 0.4, 3.7 ± 1.5 and 66.5 ± 45.0 in the volunteer group (all p > 0.05). Correlation of DT algorithm variables and manual expert grading were allsignificant, with a good correlation in DTmax (ICC 0.9, r or ρ 0.7, p < 0.001) and a moderate correlation in DTmin and DTF (ICC 0.7, r or ρ 0.7, p < 0.001 and p = 0.001, respectively). Inter- and intra-rater reproducibility of manual DT assessment was poor (ICC < 0.4 and r or ρ < 0.2). GLS (%) and GLSR (%/s) values were -32.0 ± 19.8 and -6.6 ± 3.8 in the patient group and -40.3 ± 17.3 and -10.4 ± 6.8 in the volunteer group, respectively (all p > 0.05). IBST scores were 26.2 ± 17.6 in the patient group and 68.1 ± 32.5 in the volunteer group (p = 0.009). IBST score values showed a good correlation with DTF (r or ρ 0.7, p = 0.003), and a moderate, negative correlation with DTmin (r or ρ -0.5, p = 0.043). No significant correlations were seen between the remaining manual expert DT assessment and algorithm-derived FBST and IBST variables.Conclusion: DT quantification using the algorithm developed during this study correlated to conventional US expert assessment. Poor reproducibility of current diaphragm function quantification supports the need for such an automated assessment. The clinical value of diaphragm strain assessment using the modified FBST and IBST algorithms remains unclear. Further research involving a widely defined gold standard technique in diaphragm function quantification is warranted.