-Original-

Machine Learning for Prediction of Successful Extubation of Mechanical Ventilated Patients in an Intensive Care Unit: A Retrospective Observational Study

Takanobu Otaguro¹, Hidenori Tanaka², Yutaka Igarashi¹, Takashi Tagami¹, Tomohiko Masuno¹, Shoji Yokobori¹, Hisashi Matsumoto¹, Hayato Ohwada² and Hiroyuki Yokota¹

¹Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
²Department of Industrial Administration, Tokyo University of Science, Chiba, Japan

Background: Ventilator weaning protocols are commonly implemented for patients receiving mechanical ventilation. However, despite such protocols, the rate of extubation failure remains high. This study analyzed the usefulness and accuracy of machine learning in predicting extubation success.
Methods: We retrospectively evaluated data from patients who underwent intubation for respiratory failure and received mechanical ventilation in an intensive care unit (ICU). Information on 57 features, including patient demographics, vital signs, laboratory data, and ventilator data, were extracted. Extubation failure was defined as re-intubation within 72 hours of extubation. For supervised learning, data were labeled as intubation-required or not. We used three learning algorithms (Random Forest, XGBoost, and LightGBM) to predict successful extubation. We also analyzed important features and evaluated the area under curve (AUC) and prediction metrics.
Results: Overall, 13 of the 117 included patients required re-intubation. LightGBM had the highest AUC (0.950), followed by XGBoost (0.946) and Random Forest (0.930). The accuracy, precision, and recall performance were 0.897, 0.910, and 0.909 for Random Forest; 0.910, 0.912, and 0.931 for XGBoost; and 0.927, 0.915, and 0.960 for LightGBM, respectively. The most important feature was duration of mechanical ventilation, followed by fraction of inspired oxygen, positive end-expiratory pressure, maximum and mean airway pressures, and Glasgow Coma Scale.
Conclusions: Machine learning predicted successful extubation of ICU patients on mechanical ventilation. LightGBM had the best overall performance. Duration of mechanical ventilation was the most important feature in all models.

J Nippon Med Sch 2021; 88: 408-417

Keywords
machine learning, mechanical ventilation, extubation failure, intensive care unit

Correspondence to
Yutaka Igarashi, MD, PhD, Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
igarashiy@nms.ac.jp

Received, August 10, 2020
Accepted, October 28, 2020