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A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients

RATIONALE: Acute respiratory failure is a life-threatening clinical outcome in critically ill pediatric patients. In severe cases, patients can require mechanical ventilation (MV) for survival. Early recognition of these patients can potentially help clinicians alter the clinical course and lead to...

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Autores principales: Bose, Sanjukta N., Defante, Andrew, Greenstein, Joseph L., Haddad, Gabriel G., Ryu, Julie, Winslow, Raimond L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403092/
https://www.ncbi.nlm.nih.gov/pubmed/37540703
http://dx.doi.org/10.1371/journal.pone.0289763
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author Bose, Sanjukta N.
Defante, Andrew
Greenstein, Joseph L.
Haddad, Gabriel G.
Ryu, Julie
Winslow, Raimond L.
author_facet Bose, Sanjukta N.
Defante, Andrew
Greenstein, Joseph L.
Haddad, Gabriel G.
Ryu, Julie
Winslow, Raimond L.
author_sort Bose, Sanjukta N.
collection PubMed
description RATIONALE: Acute respiratory failure is a life-threatening clinical outcome in critically ill pediatric patients. In severe cases, patients can require mechanical ventilation (MV) for survival. Early recognition of these patients can potentially help clinicians alter the clinical course and lead to improved outcomes. OBJECTIVES: To build a data-driven model for early prediction of the need for mechanical ventilation in pediatric intensive care unit (PICU) patients. METHODS: The study consists of a single-center retrospective observational study on a cohort of 13,651 PICU patients admitted between 1/01/2010 and 5/15/2018 with a prevalence of 8.06% for MV due to respiratory failure. XGBoost (extreme gradient boosting) and a convolutional neural network (CNN) using medication history were used to develop a prediction model that could yield a time-varying "risk-score"—a continuous probability of whether a patient will receive MV—and an ideal global threshold was calculated from the receiver operating characteristics (ROC) curve. The early prediction point (EPP) was the first time the risk-score surpassed the optimal threshold, and the interval between the EPP and the start of the MV was the early warning period (EWT). Spectral clustering identified patient groups based on risk-score trajectories after EPP. RESULTS: A clinical and medication history-based model achieved a 0.89 area under the ROC curve (AUROC), 0.6 sensitivity, 0.95 specificity, 0.55 positive predictive value (PPV), and 0.95 negative predictive value (NPV). Early warning time (EWT) median [inter-quartile range] of this model was 9.9[4.2–69.2] hours. Clustering risk-score trajectories within a six-hour window after the early prediction point (EPP) established three patient groups, with the highest risk group’s PPV being 0.92. CONCLUSIONS: This study uses a unique method to extract and apply medication history information, such as time-varying variables, to identify patients who may need mechanical ventilation for respiratory failure and provide an early warning period to avert it.
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spelling pubmed-104030922023-08-05 A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients Bose, Sanjukta N. Defante, Andrew Greenstein, Joseph L. Haddad, Gabriel G. Ryu, Julie Winslow, Raimond L. PLoS One Research Article RATIONALE: Acute respiratory failure is a life-threatening clinical outcome in critically ill pediatric patients. In severe cases, patients can require mechanical ventilation (MV) for survival. Early recognition of these patients can potentially help clinicians alter the clinical course and lead to improved outcomes. OBJECTIVES: To build a data-driven model for early prediction of the need for mechanical ventilation in pediatric intensive care unit (PICU) patients. METHODS: The study consists of a single-center retrospective observational study on a cohort of 13,651 PICU patients admitted between 1/01/2010 and 5/15/2018 with a prevalence of 8.06% for MV due to respiratory failure. XGBoost (extreme gradient boosting) and a convolutional neural network (CNN) using medication history were used to develop a prediction model that could yield a time-varying "risk-score"—a continuous probability of whether a patient will receive MV—and an ideal global threshold was calculated from the receiver operating characteristics (ROC) curve. The early prediction point (EPP) was the first time the risk-score surpassed the optimal threshold, and the interval between the EPP and the start of the MV was the early warning period (EWT). Spectral clustering identified patient groups based on risk-score trajectories after EPP. RESULTS: A clinical and medication history-based model achieved a 0.89 area under the ROC curve (AUROC), 0.6 sensitivity, 0.95 specificity, 0.55 positive predictive value (PPV), and 0.95 negative predictive value (NPV). Early warning time (EWT) median [inter-quartile range] of this model was 9.9[4.2–69.2] hours. Clustering risk-score trajectories within a six-hour window after the early prediction point (EPP) established three patient groups, with the highest risk group’s PPV being 0.92. CONCLUSIONS: This study uses a unique method to extract and apply medication history information, such as time-varying variables, to identify patients who may need mechanical ventilation for respiratory failure and provide an early warning period to avert it. Public Library of Science 2023-08-04 /pmc/articles/PMC10403092/ /pubmed/37540703 http://dx.doi.org/10.1371/journal.pone.0289763 Text en © 2023 Bose et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Bose, Sanjukta N.
Defante, Andrew
Greenstein, Joseph L.
Haddad, Gabriel G.
Ryu, Julie
Winslow, Raimond L.
A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
title A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
title_full A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
title_fullStr A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
title_full_unstemmed A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
title_short A data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
title_sort data-driven model for early prediction of need for invasive mechanical ventilation in pediatric intensive care unit patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403092/
https://www.ncbi.nlm.nih.gov/pubmed/37540703
http://dx.doi.org/10.1371/journal.pone.0289763
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