public Task Start(CancellationToken cancellationToken)
{
return(Task.Run(async() =>
{
while (!cancellationToken.IsCancellationRequested)
{
var start = DateTime.Now;
try
{
var settings = webSocketThread.Settings;
CalculatedValues calculatedValues = new CalculatedValues();
// are we active?
if (!(settings.ContainsKey("ACTIVE") && (int)settings["ACTIVE"] == 3))
{
logger.LogDebug("Machine not active, wait for 2 seconds, current status: {0}", settings.ContainsKey("ACTIVE") ? settings["ACTIVE"] : -1);
await Task.Delay(2000);
continue;
}
else
{
if (!alarmThread.Active && settings.ContainsKey("RR"))
{
if ((DateTime.UtcNow - alarmThread.InactiveSince).TotalSeconds > 60.0f / (int)settings["RR"] * 5.0f)
{
// we have been inactive for 5 breathing cycles, check alarms again
alarmThread.Active = true;
}
}
}
uint alarmBits = 0;
var values = dbService.GetDocuments("measured_values", DateTime.UtcNow.AddSeconds(-70));
if (values.Count == 0)
{
// no data yet, wait for it to become available
await Task.Delay(2000);
continue;
}
// find the lowest datetime value that we have
var maxDateTime = values.First().Value.ArduinoTime;
values.Reverse();
// check breaths per minute
List <Tuple <long, long> > breathingCycles = GetBreathingCyclesFromTargetPressure(values, maxDateTime);
// do we have a full cycle
if (breathingCycles.Count > 0)
{
long startBreathingCycle = breathingCycles.Last().Item1;
long endBreathingCycle = breathingCycles.Last().Item2;
var minValTargetPressure = GetMinimum(values, (valueEntry) => valueEntry.Value.TargetPressure, startBreathingCycle, endBreathingCycle);
var maxValTargetPressure = GetMaximum(values, (valueEntry) => valueEntry.Value.TargetPressure, startBreathingCycle, endBreathingCycle);
var targetPressureExhale = values
.Where(v => v.Value.ArduinoTime > startBreathingCycle && v.Value.ArduinoTime <= endBreathingCycle && v.Value.TargetPressure == minValTargetPressure)
.FirstOrDefault();
if (targetPressureExhale == null)
{
continue;
}
long exhalemoment = targetPressureExhale.Value.ArduinoTime - 40;
if (targetPressureExhale == null)
{
continue;
}
var breathingCycleDuration = (endBreathingCycle - startBreathingCycle) / 1000.0;
var bpm = 60.0 / breathingCycleDuration;
calculatedValues.RespatoryRate = bpm;
if (settings.ContainsKey("HRR"))
{
if (bpm >= (int)settings["HRR"] + 1)
{
alarmBits |= BPM_TOO_HIGH;
}
}
if (settings.ContainsKey("LRR"))
{
if (bpm < (int)settings["LRR"])
{
alarmBits |= BPM_TOO_LOW;
}
}
else
{
if (settings.ContainsKey("RR") && bpm < (int)settings["RR"] - 1.0f)
{
alarmBits |= BPM_TOO_LOW;
}
}
var inhaleTime = (exhalemoment - startBreathingCycle) / 1000.0;
var exhaleTime = (endBreathingCycle - exhalemoment) / 1000.0;
calculatedValues.IE = inhaleTime / breathingCycleDuration;
var tidalVolume = GetMaximum(values, (valueEntry) => valueEntry.Value.Volume, startBreathingCycle, endBreathingCycle);
calculatedValues.TidalVolume = tidalVolume;
if (((int)settings["MODE"] & 4) > 0)
{
// we are in volume limited mode
if (settings.ContainsKey("VT") && settings.ContainsKey("ADVT"))
{
// todo: in future versions it might be easier to convert ADVT and ADPK to absolute values
var upperLimit = (int)settings["VT"] + (int)settings["ADVT"];
var lowerLimit = (int)settings["VT"] - (int)settings["ADVT"];
if (tidalVolume > upperLimit)
{
alarmBits |= VOLUME_NOT_OK;
}
else if (tidalVolume < lowerLimit)
{
alarmBits |= VOLUME_TOO_LOW;
}
}
}
else
{
// pressure control without volume limiting, only check if tidalVolume is above ADVT
if (settings.ContainsKey("ADVT"))
{
if (tidalVolume < (int)settings["ADVT"])
{
alarmBits |= TIDAL_VOLUME_TOO_LOW_PC_MODE;
}
}
}
var residualVolume = GetMinimum(values, (valueEntry) => valueEntry.Value.Volume, exhalemoment, endBreathingCycle - 10);
int residualVolumeSetting = 50;
if (settings.ContainsKey("RVOL"))
{
residualVolumeSetting = (int)settings["RVOL"];
}
if (residualVolume > residualVolumeSetting)
{
alarmBits |= RESIDUAL_VOLUME_NOT_OK;
}
calculatedValues.ResidualVolume = residualVolume;
var peakPressureMoment = values
.Where(v => v.Value.ArduinoTime >= startBreathingCycle && v.Value.ArduinoTime <= exhalemoment)
.Aggregate((i1, i2) => i1.Value.Pressure > i2.Value.Pressure ? i1 : i2);
var plateauMinimumPressure = GetMinimum(values, (valueEntry) => valueEntry.Value.Pressure, peakPressureMoment.Value.ArduinoTime, exhalemoment);
// temp code until arduino has the HPK and LPK
if (settings.ContainsKey("ADPK") && settings.ContainsKey("PK"))
{
int adpk = (int)settings["ADPK"];
int pk = (int)settings["PK"];
if (!settings.ContainsKey("HPK"))
{
settings.AddOrUpdate("HPK", pk + adpk, (key, value) => pk + adpk);
}
if (!settings.ContainsKey("LPK"))
{
settings.AddOrUpdate("LPK", pk - adpk, (key, value) => pk - adpk);
}
}
// end temp code
if (settings.ContainsKey("HPK"))
{
int upperLimit = (int)settings["HPK"];
if (peakPressureMoment.Value.Pressure > upperLimit ||
plateauMinimumPressure > upperLimit)
{
alarmBits |= PRESSURE_NOT_OK;
}
}
if (settings.ContainsKey("LPK"))
{
int lowerLimit = (int)settings["LPK"];
if (lowerLimit >= maxValTargetPressure)
{
// we are probably using PSUPPORT
lowerLimit = (int)maxValTargetPressure - 5;
}
if (peakPressureMoment.Value.Pressure < lowerLimit ||
plateauMinimumPressure < lowerLimit)
{
alarmBits |= PRESSURE_TOO_LOW;
}
}
calculatedValues.PeakPressure = peakPressureMoment.Value.Pressure;
calculatedValues.PressurePlateau = plateauMinimumPressure;
calculatedValues.LungCompliance = tidalVolume / plateauMinimumPressure;
// check fio2 values in last cycle
// get biggest FiO2 deviation
if (settings.ContainsKey("FIO2") && settings.ContainsKey("ADFIO2"))
{
var upperLimit = (double)settings["FIO2"] + (double)settings["ADFIO2"];
var lowerLimit = (double)settings["FIO2"] - (double)settings["ADFIO2"];
var peakFio2moment = values
.Where(v => v.Value.ArduinoTime >= startBreathingCycle && v.Value.ArduinoTime <= exhalemoment)
.Aggregate((i1, i2) => Math.Abs(i1.Value.FiO2 - (double)settings["FIO2"]) > Math.Abs(i2.Value.FiO2 - (double)settings["FIO2"]) ? i1 : i2);
if (peakFio2moment.Value.FiO2 > upperLimit)
{
alarmBits |= FIO2_TOO_HIGH;
}
else if (peakFio2moment.Value.FiO2 < lowerLimit)
{
alarmBits |= FIO2_TOO_LOW;
}
}
// did we have a trigger within this cycle?
var triggerMoment = values
.FirstOrDefault(p => p.Value.ArduinoTime >= exhalemoment && p.Value.ArduinoTime <= endBreathingCycle && p.Value.Trigger > 0.0f);
var endPeep = endBreathingCycle;
if (triggerMoment != null)
{
endPeep = triggerMoment.Value.ArduinoTime - 50;
}
if (settings.ContainsKey("PP") && settings.ContainsKey("ADPP"))
{
bool firstPeepPressureIteration = true;
ValueEntry previousPoint = null;
List <float> slopes = new List <float>();
int plateauCounter = 0;
bool foundPlateau = false;
var pressureExhaleValues = values
.Where(v => v.Value.ArduinoTime >= exhalemoment + 100 && v.Value.ArduinoTime <= endPeep)
.OrderByDescending(v => v.Value.ArduinoTime)
.ToList();
for (int i = 0; i < pressureExhaleValues.Count - 2; i += 2)
{
var valueEntry = pressureExhaleValues[i];
// if last value is above PEEP, assume everything is ok
if (firstPeepPressureIteration)
{
if (valueEntry.Value.Pressure > (int)settings["PP"] - (int)settings["ADPP"])
{
foundPlateau = true;
calculatedValues.Peep = valueEntry.Value.Pressure;
break;
}
firstPeepPressureIteration = false;
}
// we are still here, so last value was not in peep threshold
// go back until we are above PEEP again and start calculating slope
// when the average slope is steadily declining, we have a leak
if (previousPoint != null)
{
var gradient = (previousPoint.Value.Pressure - valueEntry.Value.Pressure) / ((double)(previousPoint.Value.ArduinoTime - valueEntry.Value.ArduinoTime) / 1000.0);
if (gradient > -1.0f)
{
plateauCounter++;
if (plateauCounter == 3)
{
if (valueEntry.Value.Pressure > (int)settings["PP"] - (int)settings["ADPP"])
{
foundPlateau = true;
calculatedValues.Peep = valueEntry.Value.Pressure;
break;
}
else
{
plateauCounter = 0;
}
}
}
else
{
plateauCounter = 0;
}
}
previousPoint = valueEntry;
}
if (!foundPlateau)
{
// all points are below peep, clearly we should raise an alarm
alarmBits |= PEEP_NOT_OK;
}
}
// only for debug purposes, send the moments to the frontend
//await serialThread.SendSettingToServer("breathingCycleStart", startBreathingCycle.Value.);
}
if (serialThread.ConnectionState != ConnectionState.Connected)
{
alarmBits |= ARDUINO_CONNECTION_NOT_OK;
}
if (alarmThread.Active)
{
alarmThread.SetPCAlarmBits(alarmBits, settings, calculatedValues);
}
if (breathingCycles.Count > 1)
{
foreach (var breathingCycle in breathingCycles)
{
var tidalVolume = values
.Where(v => v.Value.ArduinoTime >= breathingCycle.Item1 && v.Value.ArduinoTime <= breathingCycle.Item2)
.Max(v => v.Value.Volume);
calculatedValues.VolumePerMinute += tidalVolume / 1000.0;
}
calculatedValues.VolumePerMinute = calculatedValues.VolumePerMinute / ((breathingCycles.Last().Item2 - breathingCycles.First().Item1) / 1000.0) * 60.0;
}
await apiService.SendCalculatedValuesToServerAsync(calculatedValues);
// serialThread.WriteData(ASCIIEncoding.ASCII.GetBytes(string.Format("{0}={1}", "PEEP", calculatedValues.Peep.ToString("0.00"))));
}
catch (Exception e)
{
logger.LogError(e, e.Message);
}
var timeSpent = (DateTime.Now - start).TotalMilliseconds;
// Console.WriteLine("Time taken processing: {0}", timeSpent);
await Task.Delay(Math.Max(1, 500 - (int)timeSpent));
}
}));
}
public Task Start(CancellationToken cancellationToken)
{
CalculatedValues calculatedValues = new CalculatedValues();
return(Task.Run(async() =>
{
while (!cancellationToken.IsCancellationRequested)
{
var start = DateTime.Now;
try
{
var settings = webSocketThread.Settings;
calculatedValues.ResetValues();
// are we active?
if (!(settings.ContainsKey("ACTIVE") && settings["ACTIVE"] > 1.0f))
{
// make sure we stop playing the alarm
serialThread.ResetAlarm();
await Task.Delay(2000);
continue;
}
uint alarmBits = 0;
var values = GetDocuments("measured_values", DateTime.UtcNow.AddSeconds(-70));
if (values.Count == 0)
{
// no data yet, wait for it to become available
await Task.Delay(2000);
continue;
}
// find the lowest datetime value that we all have
var maxDateTime = values.First().LoggedAt;
values.Reverse();
// check breaths per minute
List <Tuple <DateTime, DateTime> > breathingCycles = GetBreathingCyclesFromTargetPressure(values, maxDateTime);
// do we have a full cycle
if (breathingCycles.Count > 0)
{
DateTime startBreathingCycle = breathingCycles.Last().Item1;
DateTime endBreathingCycle = breathingCycles.Last().Item2;
var minValTargetPressure = GetMinimum(values, (valueEntry) => valueEntry.Value.TargetPressure, startBreathingCycle, endBreathingCycle);
var maxValTargetPressure = GetMaximum(values, (valueEntry) => valueEntry.Value.TargetPressure, startBreathingCycle, endBreathingCycle);
var targetPressureExhale = values
.Where(v => v.LoggedAt > startBreathingCycle && v.LoggedAt <= endBreathingCycle && v.Value.TargetPressure == minValTargetPressure)
.FirstOrDefault();
DateTime exhalemoment = targetPressureExhale.LoggedAt.AddMilliseconds(-40);
var breathingCycleDuration = (endBreathingCycle - startBreathingCycle).TotalSeconds;
var bpm = 60.0 / breathingCycleDuration;
calculatedValues.RespatoryRate = bpm;
if (settings.ContainsKey("RR"))
{
if (bpm <= settings["RR"] - 1.0)
{
alarmBits |= BPM_TOO_LOW;
}
}
var inhaleTime = (exhalemoment - startBreathingCycle).TotalSeconds;
var exhaleTime = (endBreathingCycle - exhalemoment).TotalSeconds;
calculatedValues.IE = inhaleTime / breathingCycleDuration;
var tidalVolume = GetMaximum(values, (valueEntry) => valueEntry.Value.Volume, startBreathingCycle, endBreathingCycle);
if (settings.ContainsKey("VT") && settings.ContainsKey("ADVT"))
{
if (Math.Abs(tidalVolume - settings["VT"]) > settings["ADVT"])
{
alarmBits |= VOLUME_NOT_OK;
}
}
calculatedValues.TidalVolume = tidalVolume;
var residualVolume = GetMinimum(values, (valueEntry) => valueEntry.Value.Volume, exhalemoment, endBreathingCycle.AddMilliseconds(-80));
if (Math.Abs(residualVolume) > 50)
{
alarmBits |= RESIDUAL_VOLUME_NOT_OK;
}
var peakPressureMoment = values
.Where(v => v.LoggedAt >= startBreathingCycle && v.LoggedAt <= exhalemoment)
.Aggregate((i1, i2) => i1.Value.Pressure > i2.Value.Pressure ? i1 : i2);
var plateauMinimumPressure = GetMinimum(values, (valueEntry) => valueEntry.Value.Pressure, peakPressureMoment.LoggedAt, exhalemoment);
if (settings.ContainsKey("ADPK"))
{
if (!(Math.Abs(peakPressureMoment.Value.Pressure - maxValTargetPressure) < settings["ADPK"] &&
Math.Abs(plateauMinimumPressure - maxValTargetPressure) < settings["ADPK"]))
{
alarmBits |= PRESSURE_NOT_OK;
}
}
calculatedValues.PressurePlateau = plateauMinimumPressure;
//did we have a trigger within this cycle?
var triggerMoment = values
.FirstOrDefault(p => p.LoggedAt >= exhalemoment && p.LoggedAt <= endBreathingCycle && p.Value.Trigger > 0.0f);
var endPeep = endBreathingCycle;
if (triggerMoment != null)
{
endPeep = triggerMoment.LoggedAt.AddMilliseconds(-50);
}
if (settings.ContainsKey("PP") && settings.ContainsKey("ADPP"))
{
bool firstPeepPressureIteration = true;
ValueEntry previousPoint = null;
List <float> slopes = new List <float>();
int plateauCounter = 0;
bool foundPlateau = false;
var pressureExhaleValues = values
.Where(v => v.LoggedAt >= exhalemoment.AddMilliseconds(100) && v.LoggedAt <= endPeep)
.OrderByDescending(v => v.LoggedAt)
.ToList();
for (int i = 0; i < pressureExhaleValues.Count - 2; i += 2)
{
var valueEntry = pressureExhaleValues[i];
// if last value is above PEEP, assume everything is ok
if (firstPeepPressureIteration)
{
if (valueEntry.Value.Pressure > settings["PP"] - settings["ADPP"])
{
foundPlateau = true;
break;
}
firstPeepPressureIteration = false;
}
// we are still here, so last value was not in peep threshold
// go back until we are above PEEP again and start calculating slope
// when the average slope is steadily declining, we have a leak
if (previousPoint != null)
{
var gradient = (previousPoint.Value.Pressure - valueEntry.Value.Pressure) / ((float)(previousPoint.LoggedAt - valueEntry.LoggedAt).TotalSeconds);
if (gradient > -1.0f)
{
plateauCounter++;
if (plateauCounter == 3)
{
if (valueEntry.Value.Pressure > settings["PP"] - settings["ADPP"])
{
foundPlateau = true;
break;
}
else
{
plateauCounter = 0;
}
}
}
else
{
plateauCounter = 0;
}
}
previousPoint = valueEntry;
}
if (!foundPlateau)
{
// all points are below peep, clearly we should raise an alarm
alarmBits |= PEEP_NOT_OK;
}
}
// only for debug purposes, send the moments to the frontend
//await serialThread.SendSettingToServer("breathingCycleStart", startBreathingCycle.Value.);
}
serialThread.AlarmValue = alarmBits;
if (breathingCycles.Count > 1)
{
foreach (var breathingCycle in breathingCycles)
{
var tidalVolume = values
.Where(v => v.LoggedAt >= breathingCycle.Item1 && v.LoggedAt <= breathingCycle.Item2)
.Max(v => v.Value.Volume);
calculatedValues.VolumePerMinute += tidalVolume / 1000.0;
}
calculatedValues.VolumePerMinute = calculatedValues.VolumePerMinute / (breathingCycles.Last().Item2 - breathingCycles.First().Item1).TotalSeconds * 60.0;
}
await flurlClient.Request("/api/calculated_values")
.PutJsonAsync(calculatedValues);
}
catch (Exception e)
{
Console.WriteLine(e.Message);
Console.WriteLine(e.StackTrace);
}
var timeSpent = (DateTime.Now - start).TotalMilliseconds;
// Console.WriteLine("Time taken processing: {0}", timeSpent);
await Task.Delay(Math.Max(1, 500 - (int)timeSpent));
}
}));
}