Analysis of the Cardiorespiratory Pattern of Patients Undergoing Weaning Using Artificial Intelligence

Abstract

The optimal extubating moment is still a challenge in clinical practice. Respiratory pattern variability analysis in patients assisted through mechanical ventilation to identify this optimal moment could contribute to this process. This work proposes the analysis of this variability using several time series obtained from the respiratory flow and electrocardiogram signals, applying techniques based on artificial intelligence. 154 patients undergoing the extubating process were classified in three groups: successful group, patients who failed during weaning process, and patients who after extubating failed before 48 hours and need to reintubated. Power Spectral Density and time-frequency domain analysis were applied, computing Discrete Wavelet Transform. A new Q index was proposed to determine the most relevant parameters and the best decomposition level to discriminate between groups. Forward selection and bidirectional techniques were implemented to reduce dimensionality. Linear Discriminant Analysis and Neural Networks methods were implemented to classify these patients. The best results in terms of accuracy were, 84.61 ± 3.1% for successful versus failure groups, 86.90 ± 1.0% for successful versus reintubated groups, and 91.62 ± 4.9% comparing the failure and reintubated groups. Parameters related to Q index and Neural Networks classification presented the best performance in the classification of these patients.

Using Artificial Intelligence to Predict Mechanical Ventilation Weaning Success in Patients with Respiratory Failure, Including Those with Acute Respiratory Distress Syndrome

“…The essential clinical parameters include the resolution of, or a significant improvement in, the underlying cause for ventilation and ensuring adequate gas exchange, typically reflected by an arterial oxygen saturation > 90% with FiO 2 < 0.4 or PaO 2 /FiO 2 > 200 with PEEP ≤ 5 cmH 2 O. Additional criteria include: the absence of fever, satisfactory neurological and muscular status, stable cardiovascular function, appropriate hemoglobin concentrations, and the correction of metabolic and/or electrolyte disturbances [ 1 , 7 , 9 ]. Factors predicting extubation failure include but are not limited to excessive secretions, a mechanical ventilation duration exceeding 72 h, and upper airway disorders.…”

“…Patients exhibiting positive indications of probable successful weaning according to one or more of the predictive parameters mentioned above often proceed to a spontaneous breathing trial (SBT). This method is currently regarded as the most reliable diagnostic test [ 1 ]. It involves allowing the patient to breath spontaneously for 30–120 min, either through a T-piece, which provides supplemental oxygen, connected to the endotracheal tube [ 7 ], or while providing minimal respiratory support through the mechanical ventilator using Pressure Support Ventilation (PSV) or Continuous Positive Airway Pressure (CPAP).…”

“…Invasive mechanical ventilation (MV) is required in about 40% of the patients admitted to intensive care units (ICUs) [ 1 , 2 ]. This life-sustaining intervention is indispensable for the support of patients with a diverse range of critical conditions affecting the pulmonary, neurological, neuromuscular, and cardiac systems [ 3 , 4 ].…”

“…While MV may be crucial for immediate life preservation, its prolonged use may result in complications such as ventilator-associated pneumonia, vocal cord injury, and tracheomalacia. These complications are relatively common, posing a significant clinical risk and contributing to increased morbidity and mortality in ICU patients [ 1 , 5 ].…”

“…While the majority of the intubated mechanically ventilated patients in ICUs undergo easy and uncomplicated weaning from the mechanical ventilator, about 25–30% of them fail to wean, resulting in prolonged ventilation and increased mortality [ 1 , 6 , 7 ]. The weaning process, a crucial step in MV management, involves the process of liberating the patient from mechanical support and removing the endotracheal tube, commonly known as extubation [ 2 ].…”