Pulmonary gas exchange evaluated by machine learning: a computer simulation

Using computer simulation we investigated whether machine learning (ML) analysis of selected ICU monitoring data can quantify pulmonary gas exchange in multi-compartment format. A 21 compartment ventilation/perfusion (V/Q) model of pulmonary blood flow processed 34,551 combinations of cardiac output, hemoglobin concentration, standard P50, base excess, VO(2) and VCO(2) plus three model-defining parameters: shunt, log SD and mean V/Q. From these inputs the model produced paired arterial blood gases, first with the inspired O(2) fraction (FiO(2)) adjusted to arterial saturation (SaO(2)) = 0.90, and second with FiO(2) increased by 0.1. ‘Stacked regressor’ ML ensembles were trained/validated on 90% of this dataset. The remainder with shunt, log SD, and mean ‘held back’ formed the test-set. ‘Two-Point’ ML estimates of shunt, log SD and mean utilized data from both FiO(2) settings. ‘Single-Point’ estimates used only data from SaO(2) = 0.90. From 3454 test gas exchange scenarios, two-point shunt, log SD and mean estimates produced linear regression models versus true values with slopes ~ 1.00, intercepts ~ 0.00 and R(2) ~ 1.00. Kernel density and Bland–Altman plots confirmed close agreement. Single-point estimates were less accurate: R(2) = 0.77–0.89, slope = 0.991–0.993, intercept = 0.009–0.334. ML applications using blood gas, indirect calorimetry, and cardiac output data can quantify pulmonary gas exchange in terms describing a 20 compartment V/Q model of pulmonary blood flow. High fidelity reports require data from two FiO(2) settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10877-022-00879-1.