Clinical Validation of Single-Chamber Model-Based Algorithms Used to Estimate Respiratory Compliance

Non-invasive estimation of respiratory physiology using computational algorithms promises to be a valuable technique for future clinicians to detect detrimental changes in patient pathophysiology. However, few clinical algorithms used to non-invasively analyze lung physiology have undergone rigorous validation in a clinical setting, and are often validated either using mechanical devices, or with small clinical validation datasets using 2-8 patients. This work aims to improve this situation by first, establishing an open, and clinically validated dataset comprising data from both mechanical lungs and nearly 40,000 breaths from 18 intubated patients. Next, we use this data to evaluate 15 different algorithms that use the "single chamber" model of estimating respiratory compliance. We evaluate these algorithms under varying clinical scenarios patients typically experience during hospitalization. In particular, we explore algorithm performance under four different types of patient ventilator asynchrony. We also analyze algorithms under varying ventilation modes to benchmark algorithm performance and to determine if ventilation mode has any impact on the algorithm. Our approach yields several advances by 1) showing which specific algorithms work best clinically under varying mode and asynchrony scenarios, 2) developing a simple mathematical method to reduce variance in algorithmic results, and 3) presenting additional insights about single-chamber model algorithms. We hope that our paper, approach, dataset, and software framework can thus be used by future researchers to improve their work and allow future integration of "single chamber" algorithms into clinical practice.

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.