Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning
Background: High flow nasal cannula (HFNC) is commonly used as non-invasive respiratory support in critically ill children. There are limited data to inform consensus on optimal device parameters, determinants of successful patient response, and indications for escalation of support. Clinical scores...
Guardado en:
| Autores principales: | , , , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Frontiers Media S.A.
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/936a3e40619c4397af3d8200c68880d5 |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:936a3e40619c4397af3d8200c68880d5 |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:936a3e40619c4397af3d8200c68880d52021-11-08T06:50:15ZPredicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning2296-236010.3389/fped.2021.734753https://doaj.org/article/936a3e40619c4397af3d8200c68880d52021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.734753/fullhttps://doaj.org/toc/2296-2360Background: High flow nasal cannula (HFNC) is commonly used as non-invasive respiratory support in critically ill children. There are limited data to inform consensus on optimal device parameters, determinants of successful patient response, and indications for escalation of support. Clinical scores, such as the respiratory rate-oxygenation (ROX) index, have been described as a means to predict HFNC non-response, but are limited to evaluating for escalations to invasive mechanical ventilation (MV). In the presence of apparent HFNC non-response, a clinician may choose to increase the HFNC flow rate to hypothetically prevent further respiratory deterioration, transition to an alternative non-invasive interface, or intubation for MV. To date, no models have been assessed to predict subsequent escalations of HFNC flow rates after HFNC initiation.Objective: To evaluate the abilities of tree-based machine learning algorithms to predict HFNC flow rate escalations.Methods: We performed a retrospective, cohort study assessing children admitted for acute respiratory failure under 24 months of age placed on HFNC in the Johns Hopkins Children's Center pediatric intensive care unit from January 2019 through January 2020. We excluded encounters with gaps in recorded clinical data, encounters in which MV treatment occurred prior to HFNC, and cases electively intubated in the operating room. The primary study outcome was discriminatory capacity of generated machine learning algorithms to predict HFNC flow rate escalations as compared to each other and ROX indices using area under the receiver operating characteristic (AUROC) analyses. In an exploratory fashion, model feature importance rankings were assessed by comparing Shapley values.Results: Our gradient boosting model with a time window of 8 h and lead time of 1 h before HFNC flow rate escalation achieved an AUROC with a 95% confidence interval of 0.810 ± 0.003. In comparison, the ROX index achieved an AUROC of 0.525 ± 0.000.Conclusion: In this single-center, retrospective cohort study assessing children under 24 months of age receiving HFNC for acute respiratory failure, tree-based machine learning models outperformed the ROX index in predicting subsequent flow rate escalations. Further validation studies are needed to ensure generalizability for bedside application.Joshua A. KrachmanJessica A. PatricoskiJessica A. PatricoskiChristopher T. LeJina ParkRuijing ZhangKirby D. GongIndranuj GanganRaimond L. WinslowJoseph L. GreensteinJames FacklerAnthony A. SochetAnthony A. SochetJules P. BergmannFrontiers Media S.A.articlehigh flow nasal cannulaflow rate escalationpediatric critical carenon-responsemachine learningacute respiratory failurePediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
high flow nasal cannula flow rate escalation pediatric critical care non-response machine learning acute respiratory failure Pediatrics RJ1-570 |
| spellingShingle |
high flow nasal cannula flow rate escalation pediatric critical care non-response machine learning acute respiratory failure Pediatrics RJ1-570 Joshua A. Krachman Jessica A. Patricoski Jessica A. Patricoski Christopher T. Le Jina Park Ruijing Zhang Kirby D. Gong Indranuj Gangan Raimond L. Winslow Joseph L. Greenstein James Fackler Anthony A. Sochet Anthony A. Sochet Jules P. Bergmann Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning |
| description |
Background: High flow nasal cannula (HFNC) is commonly used as non-invasive respiratory support in critically ill children. There are limited data to inform consensus on optimal device parameters, determinants of successful patient response, and indications for escalation of support. Clinical scores, such as the respiratory rate-oxygenation (ROX) index, have been described as a means to predict HFNC non-response, but are limited to evaluating for escalations to invasive mechanical ventilation (MV). In the presence of apparent HFNC non-response, a clinician may choose to increase the HFNC flow rate to hypothetically prevent further respiratory deterioration, transition to an alternative non-invasive interface, or intubation for MV. To date, no models have been assessed to predict subsequent escalations of HFNC flow rates after HFNC initiation.Objective: To evaluate the abilities of tree-based machine learning algorithms to predict HFNC flow rate escalations.Methods: We performed a retrospective, cohort study assessing children admitted for acute respiratory failure under 24 months of age placed on HFNC in the Johns Hopkins Children's Center pediatric intensive care unit from January 2019 through January 2020. We excluded encounters with gaps in recorded clinical data, encounters in which MV treatment occurred prior to HFNC, and cases electively intubated in the operating room. The primary study outcome was discriminatory capacity of generated machine learning algorithms to predict HFNC flow rate escalations as compared to each other and ROX indices using area under the receiver operating characteristic (AUROC) analyses. In an exploratory fashion, model feature importance rankings were assessed by comparing Shapley values.Results: Our gradient boosting model with a time window of 8 h and lead time of 1 h before HFNC flow rate escalation achieved an AUROC with a 95% confidence interval of 0.810 ± 0.003. In comparison, the ROX index achieved an AUROC of 0.525 ± 0.000.Conclusion: In this single-center, retrospective cohort study assessing children under 24 months of age receiving HFNC for acute respiratory failure, tree-based machine learning models outperformed the ROX index in predicting subsequent flow rate escalations. Further validation studies are needed to ensure generalizability for bedside application. |
| format |
article |
| author |
Joshua A. Krachman Jessica A. Patricoski Jessica A. Patricoski Christopher T. Le Jina Park Ruijing Zhang Kirby D. Gong Indranuj Gangan Raimond L. Winslow Joseph L. Greenstein James Fackler Anthony A. Sochet Anthony A. Sochet Jules P. Bergmann |
| author_facet |
Joshua A. Krachman Jessica A. Patricoski Jessica A. Patricoski Christopher T. Le Jina Park Ruijing Zhang Kirby D. Gong Indranuj Gangan Raimond L. Winslow Joseph L. Greenstein James Fackler Anthony A. Sochet Anthony A. Sochet Jules P. Bergmann |
| author_sort |
Joshua A. Krachman |
| title |
Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning |
| title_short |
Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning |
| title_full |
Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning |
| title_fullStr |
Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning |
| title_full_unstemmed |
Predicting Flow Rate Escalation for Pediatric Patients on High Flow Nasal Cannula Using Machine Learning |
| title_sort |
predicting flow rate escalation for pediatric patients on high flow nasal cannula using machine learning |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/936a3e40619c4397af3d8200c68880d5 |
| work_keys_str_mv |
AT joshuaakrachman predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT jessicaapatricoski predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT jessicaapatricoski predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT christophertle predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT jinapark predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT ruijingzhang predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT kirbydgong predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT indranujgangan predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT raimondlwinslow predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT josephlgreenstein predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT jamesfackler predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT anthonyasochet predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT anthonyasochet predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning AT julespbergmann predictingflowrateescalationforpediatricpatientsonhighflownasalcannulausingmachinelearning |
| _version_ |
1718442928510074880 |