Deep Learning-Based Detection of the Acute Respiratory Distress Syndrome: What Are the Models Learning?

The acute respiratory distress syndrome (ARDS) is a severe form of hypoxemic respiratory failure with in-hospital mortality of 35-46%. High mortality is thought to be related in part to challenges in making a prompt diagnosis, which may in turn delay implementation of evidence-based therapies. A deep neural network (DNN) algorithm utilizing unbiased ventilator waveform data (VWD) may help to improve screening for ARDS. We first show that a convolutional neural network-based ARDS detection model can outperform prior work with random forest models in AUC (0.95+/-0.019 vs. 0.88+/-0.064), accuracy (0.84+/-0.026 vs 0.80+/-0.078), and specificity (0.81+/-0.06 vs 0.71+/-0.089). Frequency ablation studies imply that our model can learn features from low frequency domains typically used for expert feature engineering, and high-frequency information that may be difficult to manually featurize. Further experiments suggest that subtle, high-frequency components of physiologic signals may explain the superior performance of DL models over traditional ML when using physiologic waveform data. Our observations may enable improved interpretability of DL-based physiologic models and may improve the understanding of how high-frequency information in physiologic data impacts the performance our DL model.

Improving Mechanical Ventilator Clinical Decision Support Systems with A Machine Learning Classifier for Determining Ventilator Mode

Clinical decision support systems (CDSS) will play an in-creasing role in improving the quality of medical care for critically ill patients. However, due to limitations in current informatics infrastructure, CDSS do not always have com-plete information on state of supporting physiologic monitor-ing devices, which can limit the input data available to CDSS. This is especially true in the use case of mechanical ventilation (MV), where current CDSS have no knowledge of critical ventilation settings, such as ventilation mode. To enable MV CDSS to make accurate recommendations related to ventilator mode, we developed a highly performant ma-chine learning model that is able to perform per-breath clas-sification of 5 of the most widely used ventilation modes in the USA with an average F1-score of 97.52%. We also show how our approach makes methodologic improvements over previous work and that it is highly robust to missing data caused by software/sensor error.