Auton Lab, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Sensors (Basel). 2022 Jan 28;22(3):1024. doi: 10.3390/s22031024.
For fluid resuscitation of critically ill individuals to be effective, it must be well calibrated in terms of timing and dosages of treatments. In current practice, the cardiovascular sufficiency of patients during fluid resuscitation is determined using primarily invasively measured vital signs, including Arterial Pressure and Mixed Venous Oxygen Saturation (SvO2), which may not be available in outside-of-hospital settings, particularly in the field when treating subjects injured in traffic accidents or wounded in combat where only non-invasive monitoring is available to drive care. In this paper, we propose (1) a Machine Learning (ML) approach to estimate the sufficiency utilizing features extracted from non-invasive vital signs and (2) a novel framework to address the detrimental impact of inter-patient diversity on the ability of ML models to generalize well to unseen subjects. Through comprehensive evaluation on the physiological data collected in laboratory animal experiments, we demonstrate that the proposed approaches can achieve competitive performance on new patients using only non-invasive measurements. These characteristics enable effective monitoring of fluid resuscitation in real-world acute settings with limited monitoring resources and can help facilitate broader adoption of ML in this important subfield of healthcare.
为了使危重症患者的液体复苏治疗有效,必须在治疗的时间和剂量上进行精确调整。在当前的实践中,液体复苏期间患者的心血管充盈情况主要通过侵入性测量的生命体征来确定,包括动脉压和混合静脉血氧饱和度(SvO2),但这些在院外环境中可能无法获得,尤其是在交通事故中受伤或在战斗中受伤的患者的现场,此时只能使用非侵入性监测来进行治疗。在本文中,我们提出了一种利用非侵入性生命体征提取的特征来估计充盈度的(1)机器学习(ML)方法,以及(2)一种新的框架来解决患者间差异对 ML 模型推广到未见患者的能力的不利影响。通过对实验室动物实验中收集的生理数据进行全面评估,我们证明了所提出的方法仅使用非侵入性测量即可在新患者中实现有竞争力的性能。这些特性使在资源有限的现实急性环境中进行有效的液体复苏监测成为可能,并有助于促进在这一重要医疗领域中更广泛地采用 ML。