Development and Validation of a Deep Learning Classifier Using Chest Radiographs to Predict Extubation Success in Patients Undergoing Invasive Mechanical Ventilation

Autor: Pranai Tandon, Kim-Anh-Nhi Nguyen, Masoud Edalati, Prathamesh Parchure, Ganesh Raut, David L. Reich, Robert Freeman, Matthew A. Levin, Prem Timsina, Charles A. Powell, Zahi A. Fayad, Arash Kia
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Bioengineering, Vol 11, Iss 6, p 626 (2024)
Druh dokumentu: article
ISSN: 2306-5354
10302018
DOI: 10.3390/bioengineering11060626
Popis: The decision to extubate patients on invasive mechanical ventilation is critical; however, clinician performance in identifying patients to liberate from the ventilator is poor. Machine Learning-based predictors using tabular data have been developed; however, these fail to capture the wide spectrum of data available. Here, we develop and validate a deep learning-based model using routinely collected chest X-rays to predict the outcome of attempted extubation. We included 2288 serial patients admitted to the Medical ICU at an urban academic medical center, who underwent invasive mechanical ventilation, with at least one intubated CXR, and a documented extubation attempt. The last CXR before extubation for each patient was taken and split 79/21 for training/testing sets, then transfer learning with k-fold cross-validation was used on a pre-trained ResNet50 deep learning architecture. The top three models were ensembled to form a final classifier. The Grad-CAM technique was used to visualize image regions driving predictions. The model achieved an AUC of 0.66, AUPRC of 0.94, sensitivity of 0.62, and specificity of 0.60. The model performance was improved compared to the Rapid Shallow Breathing Index (AUC 0.61) and the only identified previous study in this domain (AUC 0.55), but significant room for improvement and experimentation remains.
Databáze: Directory of Open Access Journals
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