Igarashi Yutaka, Ogawa Kei, Nishimura Kan, Osawa Shuichiro, Ohwada Hayato, Yokobori Shoji
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
Department of Industrial Administration, Tokyo University of Science, Chiba, Japan.
Front Med (Lausanne). 2022 Aug 11;9:961252. doi: 10.3389/fmed.2022.961252. eCollection 2022.
Ventilator liberation is one of the most critical decisions in the intensive care unit; however, prediction of extubation failure is difficult, and the proportion thereof remains high. Machine learning can potentially provide a breakthrough in the prediction of extubation success. A total of seven studies on the prediction of extubation success using machine learning have been published. These machine learning models were developed using data from electronic health records, 8-78 features, and algorithms such as artificial neural network, LightGBM, and XGBoost. Sensitivity ranged from 0.64 to 0.96, specificity ranged from 0.73 to 0.85, and area under the receiver operating characteristic curve ranged from 0.70 to 0.98. The features deemed most important included duration of mechanical ventilation, PaO, blood urea nitrogen, heart rate, and Glasgow Coma Scale score. Although the studies had limitations, prediction of extubation success by machine learning has the potential to be a powerful tool. Further studies are needed to assess whether machine learning prediction reduces the incidence of extubation failure or prolongs the duration of ventilator use, thereby increasing tracheostomy and ventilator-related complications and mortality.
撤机是重症监护病房中最关键的决策之一;然而,预测拔管失败很困难,且其比例仍然很高。机器学习有可能在预测拔管成功方面带来突破。目前已发表了七项关于使用机器学习预测拔管成功的研究。这些机器学习模型是利用电子健康记录中的数据、8至78个特征以及诸如人工神经网络、LightGBM和XGBoost等算法开发的。敏感性范围为0.64至0.96,特异性范围为0.73至0.85,受试者工作特征曲线下面积范围为0.70至0.98。被认为最重要的特征包括机械通气持续时间、动脉血氧分压、血尿素氮、心率和格拉斯哥昏迷量表评分。尽管这些研究存在局限性,但通过机器学习预测拔管成功有可能成为一种强大的工具。需要进一步研究来评估机器学习预测是否能降低拔管失败的发生率或延长呼吸机使用时间,从而增加气管切开术及与呼吸机相关的并发症和死亡率。