An Innovative Deep Learning Approach for Ventilator-Associated Pneumonia (VAP) Prediction in Intensive Care Units-Pneumonia Risk Evaluation and Diagnostic Intelligence via Computational Technology (PREDICT).

Ventilator-associated pneumonia (VAP) is a common and serious ICU complication, affecting up to 40% of mechanically ventilated patients. The diagnosis of VAP currently relies on retrospective clinical, radiological, and microbiological criteria, which often delays targeted treatment and promotes the overuse of broad-spectrum antibiotics. The early prediction of VAP is crucial to improve outcomes and guide antimicrobial use related to this disease. This study aimed to develop and validate PREDICT (Pneumonia Risk Evaluation and Diagnostic Intelligence via Computational Technology), a deep learning algorithm for early VAP prediction that is based solely on vital signs. : We conducted a retrospective cohort study using the MIMIC-IV database, which includes ICU patients who were ventilated for at least 48 h. Five vital signs (respiratory rate, SpO, heart rate, temperature, and mean arterial pressure) were structured into 24 h temporal windows. The PREDICT model, based on a long short-term memory neural network, was trained to predict the onset of VAP 6, 12, and 24 h in the future. Its performance was compared to that of conventional machine learning models (random forest, XGBoost, logistic regression) using their AUPRC, sensitivity, specificity, and predictive values. : PREDICT achieved high predictive accuracy with AUPRC values of 96.0%, 94.1%, and 94.7% at 6, 12, and 24 h before the onset of VAP, respectively. Its sensitivity and positive predictive values exceeded 85% across all horizons. Traditional ML models showed a drop in performance over longer timeframes. Analysis of the model's explainability highlighted the respiratory rate, SpO, and temperature as key predictive features. : PREDICT is the first deep learning model specifically designed for early VAP prediction in ICUs. It represents a promising tool for timely clinical decision-making and improved antibiotic stewardship.