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The Lab

How the model works

Reference ranges, color emphasis & intervention warnings

Normal ranges and illustrative alerts are separate from clinical diagnosis.

Overview

The table moves numerals from dark toward crimson and increases weight as they depart from the chosen reference/alert landmarks. Color is display emphasis; it does not change the simulated state or establish a disease severity grade.

ESC/ERS 2022 Table 11 supplies available right-heart/flow reference ranges. Ventricular/systemic ranges are explicitly supplemental. ACC shock guidance informs context, but the software’s full set of color thresholds is not an ESC or ACC validated severity scale.

Current reference ranges

This table is generated from the same reference definitions as the hemodynamic summary.

MetricReferenceBasis
RA mean2–6 mmHgESC/ERS 2022 Table 11
PA systolic15–30 mmHgESC/ERS 2022 Table 11
PA diastolic4–12 mmHgESC/ERS 2022 Table 11
PA mean8–20 mmHgESC/ERS 2022 Table 11
PCWP / PAWP mean≤15 mmHgESC/ERS 2022 Table 11
Cardiac output4–8 L/minESC/ERS 2022 Table 11
Cardiac index2.5–4 L/min/m²ESC/ERS 2022 Table 11
PVR0.3–2 WU · 24–160 dyn·s/cm⁵ESC/ERS 2022 Table 11
RV systolic15–30 mmHgSupplemental reference
RVEDP0–8 mmHgSupplemental reference
LV systolic90–140 mmHgSupplemental reference
LVEDP5–12 mmHgSupplemental reference
Arterial systolic90–140 mmHgSupplemental reference
Arterial diastolic60–90 mmHgSupplemental reference
SVR10–15 WU · 800–1200 dyn·s/cm⁵Supplemental reference

Illustrative alert landmarks

Examples include mean PA ≥20, wedge ≥20, LVEDP ≥20 mmHg; PVR >2 WU; CI <2.2 L/min/m²; severe low/high arterial pressure; and marked right-sided filling elevation. The ≥20 mean-PA display landmark intentionally differs from the guideline PH definition of >20 mmHg. PVR >2 is a definition-related abnormality, not automatically “very severe PH.”

Ventricular minimum/mean do not have invented standalone normal ranges: their emphasis borrows systolic/EDP context. Atrial peaks/troughs use mean pressure with additional extreme-wave flags. MAP receives added emphasis at low/high pressure landmarks. Continuous color interpolation is a UI choice, not a calibrated risk probability.

Intervention deterioration

The generic warning compares matched treated and untreated states for worsening output, pressure, filling, rate or outflow gradient. Pre-existing abnormal values alone are not proof that the intervention caused deterioration. Explicit contraindicated-use examples remain separate, including AV-nodal drugs in pre-excited AF, preload-reducing therapies in tamponade and IABP in significant AR.

For cardiogenic shock already receiving selected pressor plus inotrope support, expected MCS loading can be exempted from a loading-only warning when perfusion has not deteriorated and no contraindication is active. This is a display exception, not a rule that patients must receive both drugs before MCS.

Sedation and warning limits

Sedation has a stricter matched-comparison check so expected modest procedural effects do not automatically trigger the critical banner. Genuine modeled collapse still can.

A missing warning is not safety clearance. Clinical contraindications, patient-specific risks and procedural complications exceed the simulator’s rule set. The model is literature-informed synthetic educational data, not validated for clinical decision making or patient care.

References & further reading

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