VENTILA2: A Fuzzy Logic-Based Simulation and Decision-Support Framework for Pressure-Controlled Ventilation-A Proof of Concept.

Background and Objectives: Non-invasive mechanical ventilation is the first-line treatment for managing acute respiratory failure. However, patient variability and complex pulmonary mechanics complicate therapy adjustments, frequently leading to ventilator-induced lung injuries. This study aims to propose and define a simulation platform and decision support prototype, named VENTILA2, to optimize pressure-controlled ventilation strategies. Methods: The system integrates a bicompartmental series model of the respiratory system incorporating severity-stratified physiological profiles of chronic obstructive pulmonary disease and acute respiratory distress syndrome, and it is coupled with a Mamdani fuzzy inference system. This architecture maps inspiratory time adjustments based on pressure errors and their derivatives across predefined clinical profiles within a scenario-based feedforward parameter-mapping framework. Results: Evaluated through quantitative operational verification across all profiles and proof-of-concept case studies, the platform successfully recreates complex clinical scenarios, accurately simulating phenomena such as accelerated lung emptying in severe acute respiratory distress syndrome and air trapping in moderate chronic obstructive pulmonary disease. Conclusions: VENTILA2 provides a controlled simulation environment for evaluating pathology-specific ventilatory configurations across simulated profiles prior to clinical implementation, though it remains an early-stage prototype whose clinical effectiveness, safety, and robustness remain to be rigorously evaluated.