Validation of an automated system for detecting ineffective triggering asynchronies during mechanical ventilation: a ret
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Validation of an automated system for detecting ineffective triggering asynchronies during mechanical ventilation: a retrospective study Timothy S. Phan1 · Roberta Costa2 · Wassim M. Haddad3 · Jerry C. Mullis4 · Levi T. Price4 · Andrew D. Cason4 · James M. Bailey4 · Behnood Gholami1 Received: 28 October 2019 / Accepted: 1 December 2019 © Springer Nature B.V. 2019
Abstract We compare the sensitivity and specificity of clinician visual waveform analysis against an automated system’s waveform analysis in detecting ineffective triggering in mechanically ventilated intensive care unit patients when compared against a reference label set based upon analysis of respiratory muscle activity. Electrical activity of the diaphragm or esophageal/ transdiaphragmatic pressure waveforms were available to a single clinician for the generation of a reference label set indicating the ground truth, that is, presence or absence of ineffective triggering, on a breath-by-breath basis. Pressure and flow versus time tracings were made available to (i) a group of three clinicians; and (ii) the automated Syncron-E™ system capable of detecting patient-ventilator asynchrony in real-time, in order to obtain breath-by-breath labels indicating the presence or absence of ineffective triggering. The clinicians and the automated system did not have access to other waveforms such as electrical activity of the diaphragm or esophageal/transdiaphragmatic pressure. In total, 926 breaths were analyzed across the seven patients. Specificity for clinicians and the automated system were high (99.3% for clinician and 98.5% for the automated system). The automated system had a significantly higher sensitivity (83.2%) compared to clinicians (41.1%). Ineffective triggering detected by the automated system, which has access only to airway pressure and flow versus time tracings, is in substantial agreement with a reference detection derived from analysis of invasively measured patient effort waveforms. Keywords Patient-ventilator asynchrony · Mechanical ventilation · Automated waveform analysis · Ineffective triggering
1 Introduction Patient-ventilator asynchrony (PVA) is a well-recognized problem in mechanically ventilated patients in the intensive care unit. Recent studies have shown that severe asynchrony (i.e., asynchrony index > 10%) is associated with higher mortality [1, 2]. Ineffective triggering (i.e., inspiratory
* Behnood Gholami [email protected] 1
Autonomous Healthcare, Inc., Hoboken, NJ, USA
2
Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli, Rome, Italy
3
School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA, USA
4
Northeast Georgia Medical Center, Gainesville, GA, USA
efforts during expiration that fail to trigger ventilatorassisted breaths) is a common type of PVA. Many studies to quantify PVA depend on manual and time-consuming annotations of ventilation waveforms at the bedside. Furthermore
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