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Fix/rec36/set-lowest-FiO2-0.21 #44

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Feb 17, 2024
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Fix/rec36/set-lowest-FiO2-0.21 #44

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7791c13
feat: set lowest FiO2 from 0.3 to 0.2
glichtner Feb 17, 2024
82701a2
feat: set lowest FiO2 from 0.3 to 0.2
glichtner Feb 17, 2024
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9 changes: 5 additions & 4 deletions docs/36a_PEEP.md
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Expand Up @@ -35,27 +35,28 @@ Management of analgesia and sedation in ICU-treated patients should be targeted
Population
==========

* For each FiO2 value (0.3, 0.4 etc) we have defined a different population
* For each FiO2 value (0.2, 0.4 etc) we have defined a different population
* The selection works via "valueRange", i.e. the range datatype, with valueRange.low and valueRange.high
* According to the FHIR specicfication for the Range datatype, these values (low/high) are inclusive, and there is no possibility to change that behaviour (because low and high use the SimpleQuantity datatype, which disallows the use of the comparator field, which could have  been used otherwise to specify inclusive or exclusive)
* There is apparently no real way to define an [exact cover](https://en.wikipedia.org/wiki/Exact_cover) using the Range datatype in FHIR

| Name | Description | Criteria |
| --- | --- | --- |
| | | Inclusion / Exclusion | Name | Type | definition.type | definition.value |
| PopulationVentilatedCOVID19patientsWithARDS-fio2-[0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] | Ventilated Patients suffering from COVID-19 induced ARDS | | COVID-19 | Condition | SCT [404684003 "Clinical finding (finding)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=404684003&edition=MAIN/2022-04-30&release=&languages=en)" | $sct#840539006 "Disease caused by severe acute respiratory syndrome coronavirus 2 (disorder)" |
| PopulationVentilatedCOVID19patientsWithARDS-fio2-[0.2, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] | Ventilated Patients suffering from COVID-19 induced ARDS | | COVID-19 | Condition | SCT [404684003 "Clinical finding (finding)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=404684003&edition=MAIN/2022-04-30&release=&languages=en)" | $sct#840539006 "Disease caused by severe acute respiratory syndrome coronavirus 2 (disorder)" |
| | ventilated | Procedure | SCT [71388002 "Procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=71388002&edition=MAIN/2022-05-31&release=&languages=en)" | $sct#40617009 "Artificial ventilation (regime/therapy)" |
| | FiO2 | ventilationObservableLOINC | $loinc#3150-0 "Inhaled oxygen concentration"* as used in [GECCO FiO2](https://simplifier.net/guide/GermanCoronaConsensusDataSet-ImplementationGuide-1.0.5/Home/GECCOCore/Vitalsigns/FiO2.guide.md?version=current)
* Alternative (as decimal, without % unit): [71835-3 Oxygen/Gas total [Pure volume fraction] Inhaled gas](https://loinc.org/71835-3/)
| FiO2 [0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] |
| FiO2 [0.2, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] |

Intervention
============

| Name | Description | Criteria |
| --- | --- | --- |
| | | Name (Goal ID) | Action Category | Goal target measure | Goal target detail |
| VentilatedCOVID19patientsWithARDSInterventionPlan-fio2-[0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] | PEEP Intervention Plan for Ventilated COVID-19 Patients with ARDS, inspiratory oxygen fraction currently -[0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] | ventilator-management-fio2-0.3-goal | ventilatorManagement | $loinc#76248-4 "PEEP Respiratory system --on ventilator" | >5 cm[H2O] |
| VentilatedCOVID19patientsWithARDSInterventionPlan-fio2-[0.2, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9] | PEEP Intervention Plan for Ventilated COVID-19 Patients with ARDS, inspiratory oxygen fraction currently -[0.2, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9]
| ventilator-management-fio2-0.2-goal | ventilatorManagement | $loinc#76248-4 "PEEP Respiratory system --on ventilator" | >5 cm[H2O] |
| ventilator-management-fio2-0.4-goal | ventilatorManagement | $loinc#76248-4 "PEEP Respiratory system --on ventilator" | >5 cm[H2O] |
| ventilator-management-fio2-0.5-goal | ventilatorManagement | $loinc#76248-4 "PEEP Respiratory system --on ventilator" | >8 cm[H2O] |
| ventilator-management-fio2-0.6-goal | ventilatorManagement | $loinc#76248-4 "PEEP Respiratory system --on ventilator" | >10 cm[H2O] |
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6 changes: 3 additions & 3 deletions input/fsh/covid19-inpatient-therapy/36a-peep/recommendation_36a.fsh
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Expand Up @@ -17,10 +17,10 @@ Description: "Recommendation Collection for Ventilated COVID-19 Patients"
* publisher = "Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN)"
* insert rs-combination-exactly(1)
* action[+]
* title = "PEEP_Intervention_Plan_FiO2_0.3"
* title = "PEEP_Intervention_Plan_FiO2_0.2"
* code = $cs-common-process#guideline-based-care
* description = "PEEP Intervention plan for COVID-19 patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* definitionCanonical = Canonical(VentilatedCOVID19patientsInterventionPlan-fio2-point3)
* description = "PEEP Intervention plan for COVID-19 patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* definitionCanonical = Canonical(VentilatedCOVID19patientsInterventionPlan-fio2-point2)
* action[+]
* title = "PEEP_Intervention_Plan_FiO2_0.4"
* code = $cs-common-process#guideline-based-care
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26 changes: 13 additions & 13 deletions input/fsh/covid19-inpatient-therapy/36a-peep/recommendation_36a_intervention.fsh
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@@ -1,29 +1,29 @@
/*********************/
/* Intervention Plan */
/*********************/
Instance: VentilatedCOVID19patientsInterventionPlan-fio2-point3
Instance: VentilatedCOVID19patientsInterventionPlan-fio2-point2
InstanceOf: recommendation-plan
Usage: #definition
Title: "PEEP Intervention Plan for Population: Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.3"
Description: "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* insert canonical-url(covid19-inpatient-therapy, intervention-plan/peep-fio2-point3)
Title: "PEEP Intervention Plan for Population: Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.2"
Description: "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* insert canonical-url(covid19-inpatient-therapy, intervention-plan/peep-fio2-point2)
* insert publisher-experimental-version(7.0)
* name = "PEEP_Intervention_Plan_FiO2_0.3"
* title = "PEEP Intervention plan for COVID-19 patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* identifier.value = "PEEPPlanCOVIDPatients_OxygenFraction-0.3"
* title = "PEEP Intervention plan for COVID-19 patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* identifier.value = "PEEPPlanCOVIDPatients_OxygenFraction-0.2"
* date = "2022-02"
* status = #active
* description = "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* subjectCanonical = Canonical(PopulationVentilatedCOVID19patients-fio2-point3)
* description = "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* subjectCanonical = Canonical(PopulationVentilatedCOVID19patients-fio2-point2)
* extension[partOf].valueCanonical = Canonical(RecommendationCollectionVentilatedCOVID19patients)
* insert rs-combination-all
* action[ventilatorManagement][+]
* code = $sct#410210009 "Ventilator care management (procedure)"
* goalId[+] = "ventilator-management-fio2-0.3-goal"
* goalId[+] = "ventilator-management-fio2-0.2-goal"
* goal[ventilatorManagement][+]
* category = $sct#385857005 "Ventilator care and adjustment (regime/therapy)"
* id = "ventilator-management-fio2-0.3-goal"
* description.text = "Positive end-expiratory pressure (PEEP) minimal value setting for COVID-19 Patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* id = "ventilator-management-fio2-0.2-goal"
* description.text = "Positive end-expiratory pressure (PEEP) minimal value setting for COVID-19 Patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* target
* measure = $loinc#76248-4 "PEEP Respiratory system --on ventilator"
* detailRange
Expand All @@ -32,8 +32,8 @@ Description: "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspirato
Instance: VentilatedCOVID19patientsInterventionPlan-fio2-point4
InstanceOf: recommendation-plan
Usage: #definition
Title: "PEEP Intervention Plan for Population: Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.3"
Description: "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.3 - 0.39"
Title: "PEEP Intervention Plan for Population: Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.4"
Description: "PEEP Intervention Plan for Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 043 - 0.49"
* insert canonical-url(covid19-inpatient-therapy, intervention-plan/peep-fio2-point4)
* insert publisher-experimental-version(7.0)
* name = "PEEP_Intervention_Plan_FiO2_0.4"
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14 changes: 7 additions & 7 deletions input/fsh/covid19-inpatient-therapy/36a-peep/recommendation_36a_population.fsh
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@@ -1,15 +1,15 @@
/**************/
/* Population */
/**************/
Instance: PopulationVentilatedCOVID19patients-fio2-point3
Instance: PopulationVentilatedCOVID19patients-fio2-point2
InstanceOf: recommendation-eligibility-criteria
Usage: #definition
Title: "Population: Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.3"
Description: "Ventilated COVID-19 patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* insert canonical-url(covid19-inpatient-therapy, population/ventilated-covid19-patients-fio2-point3)
Title: "Population: Ventilated COVID-19 Patients, inspiratory oxygen fraction currently 0.2"
Description: "Ventilated COVID-19 patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* insert canonical-url(covid19-inpatient-therapy, population/ventilated-covid19-patients-fio2-point2)
* status = #active
* name = "Population_COVID19_Ventilated_FiO2_0.3"
* description = "Ventilated COVID-19 patients, inspiratory oxygen fraction currently 0.3 - 0.39"
* name = "Population_COVID19_Ventilated_FiO2_0.2"
* description = "Ventilated COVID-19 patients, inspiratory oxygen fraction currently 0.2 - 0.39"
* characteristic[+].definitionByCombination
* code = #all-of
* characteristic[condition][+]
Expand All @@ -29,7 +29,7 @@ Description: "Ventilated COVID-19 patients, inspiratory oxygen fraction currentl
* definitionByTypeAndValue
* type = $loinc#3150-0 "Inhaled oxygen concentration"
* valueRange
* low = 30 '%' "%"
* low = 20 '%' "%"
* high = 39.9999999999999 '%' "%"
* characteristic[ventilationObservableLOINC][=].exclude = false
* characteristic[=].exclude = false
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