Mechanical ventilation is a very effective therapy, but with many complications. Simulators are used in many fields, including medicine, to enhance safety issues. In the intensive care unit, they are used for teaching cardiorespiratory physiology and ventilation, for testing ventilator performance, for forecasting the effect of ventilatory support, and to determine optimal ventilatory management. They are also used in research and development of clinical decision support systems (CDSSs) and explicit computerized protocols in closed loop. For all those reasons, cardiorespiratory simulators are one of the tools that help to decrease mechanical ventilation duration and complications. This paper describes the different types of simulators described in the literature for physiologic simulation and modeling of the respiratory system, including a new simulator (SimulResp), and proposes a validation process for these simulators. 1. Introduction Mechanical ventilation is a lifesaving therapy which is associated with complications such as baro-, volo-, and biotrauma, ventilation-induced pneumonia and laryngeal stenosis [1–3]. These complications can be decreased through the use of a protective ventilation strategy for acute lung injury [4] and the use of protocols to reduce the duration of weaning [5]. These protocols include a set of patient-specific therapy instructions that change according to the patient’s cardiorespiratory condition. Because it is difficult to test each modification/improvement that is made to the protocol on real patients, there is an increasing interest in the development of physiologic models that simulate cardiorespiratory responses to modifications of mechanical ventilation settings. We reviewed the literature and report our experience on physiologic simulation and modeling of the respiratory system. 2. Simulators of Mechanical Ventilation in the Literature Simulation is a strategy to replace or amplify real experiences with another experience that evokes certain aspects of the real world in constant interaction with the user [6]. Three categories of simulation have been described: simulation of patient signs and symptoms, anatomic simulation of the lung, and physiologic simulation. For each of these categories, there are several types of simulators with different goals, each of them with their advantages and disadvantages. Currently, the different types of simulators are as follows: (1) simulators to assess ventilator performance; (2) simulators used to teach physiology and ventilation management; (3) simulators for ventilation
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