Respiratory physiology after resupination following prone ventilation to predict 28-day mortality in mechanically ventilated patients: a machine learning analysis
Abstract
Abstract The clinical significance of resupination parameters following prone positioning remains largely unknown. This study employed machine learning to predict the survival of patients receiving mechanical ventilation (MV) by analyzing oxygenation and respiratory mechanics after resupination. Data were extracted from the COVID-Predict Dutch Data Warehouse. Patients receiving MV who underwent the supine–prone–supine sequence were selected, and the variables related to respiratory physiology within 4 h before proning and after resupination were recorded. Machine learning models were trained on the features selected using LASSO regression to predict the 28-day mortality. Patients who did not survive (157/522, 30.1%) had lower PaO 2 /FiO 2 values, higher ventilatory ratios, increased physiological dead space, higher driving pressure, and lower static and dynamic lung compliance values at resupination. The predictive performance of the individual clinical parameters for 28-day mortality was generally modest, and FiO 2 , PaO 2 /FiO 2 , physiological dead space, and dynamic lung compliance were the best predictors of mortality. Overall, XGBoost showed the best recall (0.732) and maintained the highest AUC (0.719), while its F1-score (0.500) was the best for predicting mortality despite a low precision (0.380). Survival after prone positioning in patients receiving MV can be stratified by physiological responses after resupination.
Article Details
Authors (45)
Lada Lijović
Tariq A. Dam
Moon Seong Baek
Tae Wan Kim
Gyungah Kim
Paul W. G. Elbers
Won-Young Kim
Diederik Gommers
Olaf L. Cremer
Rob J. Bosman
Sander Rigter
Evert-Jan Wils
Tim Frenzel
Dave A. Dongelmans
Remko de Jong
Marco A.A. Peters
Marlijn J.A Kamps
Dharmanand Ramnarain
Ralph Nowitzky
Arjan Cloïn
Wouter de Ruijter
Louise C. Urlings-Strop
Ellen G.M. Smit
D.Jannet Mehagnoul-Schipper
Tom Dormans
Cornelis P.C. de Jager
Stefaan H.A. Hendriks
Sefanja Achterberg
Evelien Oostdijk
Auke C. Reidinga
Barbara Festen-Spanjer
Gert B. Brunnekreef
Alexander D. Cornet
Walter van denTempel
Age D. Boelens
Peter Koetsier
Judith Lens
Harald J. Faber
A. Karakus
Robert Entjes
Paul de Jong
Thijs C.D. Rettig
Sesmu Arbous
Lucas M. Fleuren
Patrick J. Thoral