Using NICU Autonomous Lung Simulators for Simulated Training

LuSi is a lung simulator used for NICU (neonatal intensive care unit) medical training and teaching. LuSi is suitable for all simulation-based training for NICU staff, from crisis resource management, high-fidelity skills training and best-practices training, to knobology drills, error recognition, and error reduction.

What does LuSi include?

LuSi is comprised of a mechanical lung model with wireless electronic control built into a realistic, 2500 g baby body, which is constructed from skillfully hand-painted silicone. The baby’s airways are accessible via the nostrils, which enables trainees and teachers to insert nasal endotracheal tubes and nasal prongs and carry out high-flow oxygen therapy.

The airway opening leads to a lung compartment complete with both lung compliance and resistance. The lungs are able to take tidal volumes up to 35 ml, and pressures of up to 50 mbar. Users can render the lungs fully recruited or collapsed with integrated motors, depending on the pathology needed for the simulation. Additionally, users are able to create variable and programmable respiratory activities.

Airflow resistance is adjustable, and the integrated pressure, oxygen and volume sensors are capable of measuring level of therapy given to the simulated pediatric patient, while the integrated microprocessor calculates real-time outcome parameters such as venous admixture and pre-ductal and arterial oxygenation.

What simulation experience does LuSi offer NICU staff and trainees?

LuSi offers a fully immersive simulation experience for NICU trainees and teachers, with real-time data being transferred wirelessly to a monitor, where it is shown as wave forms and trends, including ECG, SpO2 plethysmogram, capnogram, respiratory impedance curves and transcutaneous PCO2. Adding to the authentic simulation is the blood pressure, heart rate and temperature display, and access to blood gas values and spirometric data allows to obtain lab data with timing determined by the trainer.

LuSi comes programmed with LuSiLIFE: a scenario building, PC-based program that facilitates the fast execution of pre-assembled simulation scenarios, loading patient case libraries, ad-hoc changes when they are needed, note-taking capabilities so that trainees and teachers can remember certain incidents for debriefing, and complete data recording for post-simulation analysis. Patient cases can readily be imported and exported for sharing with other LuSi users, with all data made completely transparent in .JSON format.

LuSi connects to any laptop through a bluetooth connection and can be used in the NICU hospital setting or in training facilities outside of the NICU hospital setting without requiring any additional equipment or setup. LuSi is entirely tetherless and wireless.

LuSi can also be calibrated to take into account any sensor drift and inaccuracies, and calibration is an entirely automatic process, creating a pass or fail report for quality assurance records.

The tables below offer a complete list of LuSi’s features.

  • Sensor Data measured (Sensor Data)
  • Parameters to configure LuSi (Control Parameters)
  • Measured and calculated variables (Resulting Outcome)
  • Technical data available for quality assurance (Technical Data).

Figure 1 illustrates the technical components seen in LuSi.

Components comprising LuSi, the baby lung simulator for NICU staff and training. The physiological models are built into the microprocessor, including a respiratory control center that adjusts inspiratory pressure and respiratory rate to maintain the PaCO2 set by the user.

Figure 1. Components comprising LuSi, the baby lung simulator for NICU staff and training. The physiological models are built into the microprocessor, including a respiratory control center that adjusts inspiratory pressure and respiratory rate to maintain the PaCO2 set by the user. Image Credit: neosim AG

Sensor data

The built-in sensors constantly measure the data detailed below.

Table 1. Source: neosim AG

Sensor/Signal Range
Lung volume, VL (measured at 200 Hz) 0 to 200.00
Alveolar pressure, Palv (measured at 200 Hz) +/- 60.0
Airway pressure, Paw (measured at 200 Hz) +/- 60.0
Alveolar PO2 (measured at 200 Hz) 100 to 1100 mbar
Patient position  


Control parameters

The parameters set out below are set by the operator and define LuSi's pathologies. The parameters can be influenced by either the physiological model, or that pre-set by the user. This decision is at the discretion of the trainer, who should use the parameters in bold in the table below.

Autonomous is defined as model-based (simulates gas exchange), and central respiratory PaCO2 control refers to the built-in respiratory center (simulates central breath control).

Table 2. Source: neosim AG

Control Parameter Range Autonomous or user
Airways resistance, Rtot (mbar/(L/s)) 20..40, 30..45,45..65,60..115,250..350 user set
Expected FRC (ml) 10 to 100 user set
Degree of lung collapse (%) 0 to 100 both
Recruitability (ml/mbar) 0 to 10 user set
Recruitability threshold (mbar) 0 to 50 user set
Recruitment time constant (sec) 1 to 30 user set
Lung collapse threshold ( mbar) 0 to 50 user set
Lung collapse time constant (sec) 1 to 30 user set
P/V curve (24 combinations) 0 to 30 both
Total respiratory compliance Crs (ml/mbar) 0.8 to 1.9 both
Chest wall compliance (ml/mbar) 1 to 50 user set
Lower inflection point LIP (ml) 0 to 60 user set
Compliance below LIP (ml/mbar) fixed value at 0.2 user set
Upper inflection point UIP (ml) fixed value at 25 user set
Compliance above UIP ( ml/mbar) fixed value at 0.2 user set
Maximal volume change (ml) 1 to 100 both
Airways dead space (ml) 1 to 20 user set
Alveolar dead space ventilation (%) 0 to 100 user set
Diffusion limitation (Torr) 40 to 800 user set
Total blood volume (ml) 100 to 1000 user set
Cardiac Output (ml/min) 50 to 1000 user set
BP sys (Torr) 0 to 200 user set
BP dia (Torr) 0 to 200 user set
BP mean (Torr) 0 to 200 user set
Plethysmogram Variation (%/mbarPpl) 0 to 100 user set
Pulse rate (/min) 0 to 360 both
Pulse variability (%) 0 to 100 both
Central bradycardia (/min) 0 to -50 user set
O2 diss.curve shift DP50 (Torr) +/-20 user set
Fetal Hb (%) 0 to 100 user set
CO2 production (ml/min STPD) 0 to 60 user set
Patent ductus arteriosus (%) 0 to 100 user set
Inspiratory effort Pinsp (mbar) 0 to 35 both
Inspiratory curve form square, exponential, sinusoidal, linear user set
Variation of Pinsp (mbar) 0 to 10 both
Respiratory Rate (/min) 5 to 120 both
Variation of Resp.Rate (%) 0 to 100 user set
Expiratory wave form square, exponential, sinusoidal, grunting user set
Sigh rate (/hour at 2* Pinsp) 0 to 60 user set
Expiratory muscle tone (% Pinsp) 0 to 50 user set
Apnea rate (/h) 0 to 60 user set
Variation Apnea Rate (%) 0 to 100 user set
Apnea time (sec) 0 to 100 user set
Variation Apnea Time (%) 0 to 100 user set
Gas exchange control user set or autonomous user set
Base Excess (mEq/L) -40 to +40 user set
Temperature (Degree C) 20 to 44 user set
PtcCO2 Bias (mmHg) -20 to +20 user set
Central respiratory PaCO2 control user set or autonomous user set
Leak (on, off) 2 values user set
Capnometer T90 20 to 500 user set
O2 Saturation pre-ductal (%) 30 to 100 both
O2 Saturation post-ductal (%) 30 to 100 both
PaCO2 (mmHg) 5 to 100 both
Arterial pH 6.5 to 8.0 both
End-tidal CO2 (mmHg) 0 to 100 both
Movement artifacts 0-10 user set
Added dead space (ml) 0 to 20 user set


Resulting outcome

The real-time data detailed below has been calculated based on the actually measured sensor data and the entered parameters using physiological models.

Table 3. Source: neosim AG

Sensor/Signal Range
Pleural pressure, Pes (calculated based on Palv and Cw) +/- 60.0
PeCO2 (calculated) 0 to 150.0
Plethysmogramm (calculated) 0 to 100
ECG (calculated) 0 to 100
Chest Impedance (calculated) 0 to 100


The following data is measured breath-by-breath for use by the physiological models and is displayed on the vital signs monitor:

Table 4. Source: neosim AG

Breath-by-breath measurements Range
FO2 0 to 100
Lung volume (VL_ee) 0 to 200.00
PaO2 0 to 1100
Vt 0 to 100.00
RR 0 to 100
Pmax in mbar 0 to 100
Pmin in mbar 0 to 100
V’A 0 to 500 ml/min
Patient Pitch Degrees
Patient Roll Degrees


The data in the table below is being calculated breath-by-breath using the physiological models built into LuSi and using the constantly measured data:

Table 5. Source: neosim AG

Breath-by-breath calculations Range
TLV in ml 0 to 300
Vbellows_EE 0 to 200.00
SvO2 0 too 100
SpO2 pre-ductal 0 to 100.0
SpO2 arterial 0 to 100.0
etCO2 0 to 150
Pmin in mbar 0 to 100
V’A 0 to 500 ml/min
pH 6.00 to 8.00
CollapsedLung 0 to 100
Pulse rate 0 to 300
QsQt 0 to 100
PtcCO2 0 to 300.0


The NICU trainer pre-sets the following additional data in order to complete the clinical simulation. It remains unchanged by the physiological model.

Table 6. Source: neosim AG

Trainer set data for display Range
Temperature 20 to 50
BPsys 0 to 300
BPdia 0 to 300
BPmean 0 to 300


The LuSiLIFE virtual vital-signs monitor receives continuous wireless data from LuSi. Vital signs are displayed in real-time as curves, trends, and in numeric format, too. NICU trainers are able to decide what data is displayed or not displayed as they need, depending on the simulation they are using with NICU staff. Because of this, more real-world situations can be simulated, such as the the availability or sudden failure of sensors, enriching the simulation experience.

Table 7. Source: neosim AG

Vital signs displayed Format
ECG real-time curve
pre-ductal SpO2 plethysmogram real-time curve
SpO2 plethysmogram real-time curve
respiratory impedance real-time curve
end-tidal CO2 real-time curve
pulse numeric and trend curve
pre-ductal SpO2 numeric and trend curve
arterial SpO2 numeric and trend curve
respiratory rate numeric and trend curve
etCO2 numeric and trend curve
transcutaneous PCO2 numeric and trend curve
non-invasive SBP number and past values
non-invasive DBP number and past values
non-invasive MBP number and past values
temperature number


NICU trainers and trainees are able to configure the vital signs’ position, color and presence. As a result, the vital signs monitor can be replicated for optimal training effects in order to best represent real-world NICU conditions.

Technical data

The data set out in the table below is generated and measured for technical service and quality management purposes.

Table 8. Source: neosim AG

Technical information Range
Calibration status 0 or 1
Battery status 0 to 100
Motor Temperature -100 to +100
HW status 16 bit coded
LuSi Hardware Version 0 to 100
LuSi Firmware Version 0 to 100
LuSi use time in minutes 0 to 100000


About neosim AG

neosim is a Swiss company founded by experts with strong background in lung physiology and mechanical ventilation of intensive care patients. The mission of neosim is to bring high-fidelity physiology and pathophysiology to the patient simulator community.

For training and education of clinicians, especially respiratory therapists and intensive care professionals, neosim simulators create realistic breathing in health and disease. In contrast to other simulators, neosim’s simulators can be treated with intensive care therapy methods and responds like a real human patient. The result manifests itself clinically and can be measured quantitatively with state-of-the-art monitoring in real-time.

Sponsored Content Policy: publishes articles and related content that may be derived from sources where we have existing commercial relationships, provided such content adds value to the core editorial ethos of News-Medical.Net which is to educate and inform site visitors interested in medical research, science, medical devices and treatments.

Last updated: Jul 9, 2020 at 3:45 AM


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