A Machine Learning Algorithm for Detecting Abnormal Patterns in Continuous Capnography and Pulse Oximetry Monitoring
Author:
Spijkerboer Feline L.1, Overdyk Frank J.2, Dahan Albert1
Affiliation:
1. Leiden University Medical Center 2. Trident Health System, South Carolina
Abstract
Abstract
Purpose: Continuous capnography monitors patient ventilation but can be susceptible to artifact, resulting in alarm fatigue. Development of smart algorithms may facilitate accurate detection of abnormal ventilation, allowing intervention before patient deterioration. The objective of this analysis was to use machine learning (ML) to classify combined waveforms of continuous capnography and pulse oximetry as normal or abnormal.
Methods: This analysis used data collected during the observational, prospective PRODIGY trial, in which patients receiving parenteral opioids underwent continuous capnography and pulse oximetry monitoring while on the general care floor [1]. Abnormal ventilation segments in the data stream were reviewed by nine experts and inter-rater agreement was assessed. Abnormal segments were defined as the time series 60sec before and 30sec after an abnormal pattern was detected. Normal segments (90sec continuous monitoring) were randomly sampled and filtered to discard sequences with missing values. Five ML models were trained on extracted features and optimized towards an Fβ score with β=2.
Results: The inter-rater agreement was high (>87%), allowing 7,858 sequences (2,944 abnormal) to be used for model development. Data were divided into 80% training and 20% test sequences. The XGBoost model had the highest Fβ score of 0.94 (with β=2), showcasing an impressive recall of 0.98 against a precision of 0.83.
Conclusions: This study presents a promising advancement in respiratory monitoring, focusing on reducing false alarms and enhancing accuracy of alarm systems. Our algorithm reliably distinguishes normal from abnormal waveforms. More research is needed to define patterns to distinguish abnormal ventilation from artifacts.
Trial Registration: clinicaltrials.gov: NCT02811302, registered June 23, 2016
Publisher
Research Square Platform LLC
Reference24 articles.
1. Khanna AK, Bergese SD, Jungquist CR, Morimatsu H, Uezono S, Lee S, Ti LK, Urman RD, McIntyre R, Tornero C, Dahan A, Saager L, Weingarten TN, Wittmann M, Auckley D, Brazzi L, Le Guen M, Soto R, Schramm F, Ayad S, Kaw R, Di Stefano P, Sessler DI, Uribe A, Moll V, Dempsey SJ, Buhre W, Overdyk FJ, Tanios M, Rivas E, Mejia M, Elliott K, Ali A, Fiorda-Diaz J, Carrasco-Moyano R, Mavarez-Martinez A, Gonzalez-Zacarias A, Roeth C, Kim J, Esparza-Gutierrez A, Weiss C, Chen C, Taniguchi A, Mihara Y, Ariyoshi M, Kondo I, Yamakawa K, Suga Y, Ikeda K, Takano K, Kuwabara Y, Carignan N, Rankin J, Egan K, Waters L, Sim MA, Lean LL, Liew QEL, Siu-Chun Law L, Gosnell J, Shrestha S, Okponyia C, Al-Musawi MH, Gonzalez MJP, Neumann C, Guttenthaler V, Männer O, Delis A, Winkler A, Marchand B, Schmal F, Aleskerov F, Nagori M, Shafi M, McPhee G, Newman C, Lopez E, Har SM, Asbahi M, Nordstrom McCaw K, Theunissen M, Smit-Fun V. (2020) Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial. Anesth Analg XXX:1012–1024. https://doi.org/10.1213/ANE.0000000000004788. 2. Incidence, reversal, and prevention of opioid-induced respiratory depression;Dahan A;Anesthesiology,2010 3. FDA Opioid Medications. https://www.fda.gov/drugs/information-drug-class/opioid-medications. 4. Risk factors for opioid-induced respiratory depression in surgical patients: A systematic review and meta-analyses;Gupta K;BMJ Open,2018 5. Continuous pulse oximetry and capnography monitoring for postoperative respiratory depression and adverse events: A systematic review and meta-analysis;Lam T;Anesth Analg,2017
|
|