Stochastic Modeling of Central Apnea Events in Preterm Infants

A near-ubiquitous pathology in very low birth weight infants is neonatal apnea, breathing pauses with slowing of the heart and falling blood oxygen. Events of substantial duration occasionally occur after an infant is discharged from the neonatal intensive care unit (NICU). It is not known whether apneas result from a predictable process or from a stochastic process, but the observation that they occur in seemingly random clusters justifies the use of stochastic models. We use a hidden-Markov model to analyze the distribution of durations of apneas and the distribution of times between apneas. The model suggests the presence of four breathing states, ranging from very stable (with an average lifetime of 12 h) to very unstable (with an average lifetime of 10 s). Although the states themselves are not visible, the mathematical analysis gives estimates of the transition rates among these states. We have obtained these transition rates, and shown how they change with post-menstrual age; as expected, the residence time in the more stable breathing states increases with age. We also extrapolated the model to predict the frequency of very prolonged apnea during the first year of life. This paradigm-stochastic modeling of cardiorespiratory control in neonatal infants to estimate risk for severe clinical events-may be a first step toward personalized risk assessment for life threatening apnea events after NICU discharge

Automating the Calibration of a Neonatal Condition Monitoring System

Abstract. Condition monitoring of premature babies in intensive care can be carried out using a Factorial Switching Linear Dynamical System (FSLDS) [15]. A crucial part of training the FSLDS is the manual calibration stage, where an interval of normality must be identified for each baby that is monitored. In this paper we replace this manual step by using a classifier to predict whether an interval is normal or not. We show that the monitoring results obtained using automated calibration are almost as good as those using manual calibration

Effect of a machine learning-based severe sepsis prediction algorithm on patient survival and hospital length of stay: a randomised clinical trial.

IntroductionSeveral methods have been developed to electronically monitor patients for severe sepsis, but few provide predictive capabilities to enable early intervention; furthermore, no severe sepsis prediction systems have been previously validated in a randomised study. We tested the use of a machine learning-based severe sepsis prediction system for reductions in average length of stay and in-hospital mortality rate.MethodsWe conducted a randomised controlled clinical trial at two medical-surgical intensive care units at the University of California, San Francisco Medical Center, evaluating the primary outcome of average length of stay, and secondary outcome of in-hospital mortality rate from December 2016 to February 2017. Adult patients (18+) admitted to participating units were eligible for this factorial, open-label study. Enrolled patients were assigned to a trial arm by a random allocation sequence. In the control group, only the current severe sepsis detector was used; in the experimental group, the machine learning algorithm (MLA) was also used. On receiving an alert, the care team evaluated the patient and initiated the severe sepsis bundle, if appropriate. Although participants were randomly assigned to a trial arm, group assignments were automatically revealed for any patients who received MLA alerts.ResultsOutcomes from 75 patients in the control and 67 patients in the experimental group were analysed. Average length of stay decreased from 13.0 days in the control to 10.3 days in the experimental group (p=0.042). In-hospital mortality decreased by 12.4 percentage points when using the MLA (p=0.018), a relative reduction of 58.0%. No adverse events were reported during this trial.ConclusionThe MLA was associated with improved patient outcomes. This is the first randomised controlled trial of a sepsis surveillance system to demonstrate statistically significant differences in length of stay and in-hospital mortality.Trial registrationNCT03015454

Modern approaches to sepsis - evolving definitions, clinician roles, and AI-based diagnostic aids

Sepsis is an ongoing concern in critical care. It is hard to quickly detect, and rapid deterioration of a patient into septic shock causes death in around 30% - 50% of patients, while survivors may live with organ damage and shorter lifespans. Traditional methods of detection require long laboratory tests and clinician vigilance, which put a strain on hospital resources. New advances in machine learning offer an alternative – using algorithmic analysis in real-time to watch for a deteriorating patient state. The use of readily available data – heart rate, respiratory rate – combined with electronic medical records and fast laboratory tests presents an opportunity for early detection of sepsis, which can potentially make great strides in minimizing damage to patients. A variety of algorithmic methods have been proposed by researchers, and research so far has been promising. Algorithms inretrospective studies have performed equal or better to standard protocols such as SIRS or SOFA. Some promising research even presents the opportunity to approach sepsis diagnosis and treatment in an entirely new manner. At the present stage, however, the field is at too early a stage for use in a clinical environment. This review intends to review some prominent types of machine learning algorithms, as well as discuss current concerns regarding machine learning-based detection support systems (ML-DSS)