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Power index of the inspiratory flow signal as a predictor of weaning in intensive care units

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Chaparro Preciado, Javier Alberto
Giraldo, Beatriz
Abstract (Spanish)
La desconexión de la ventilación mecánica, denominada proceso de destete, es una dificultad añadida en el manejo de los pacientes en las unidades de cuidados intensivos (UCI). Los retrasos innecesarios en el proceso de desconexión y un ensayo de destete demasiado precoz son indeseables. En este estudio, proponemos un índice de extubación basado en la potencia de la señal de flujo respiratorio (Pi). Se estudiaron 132 pacientes en ensayos de destete: 94 pacientes con ensayos satisfactorios (grupo S) y 38 pacientes que no consiguieron mantener la respiración espontánea y fueron reconectados (grupo F). Las señales de flujo respiratorio se procesaron considerando las tres etapas siguientes: a) detección del cruce por cero de la fase inspiratoria, b) detección del punto de inflexión de la curva de flujo durante la fase inspiratoria, y c) cálculo de la potencia de la señal en el instante de tiempo indicado por el punto de inflexión. La detección del paso por cero se realizó mediante un algoritmo basado en umbrales. Los puntos de inflexión se marcaron considerando el cruce por cero de la segunda derivada. Por último, la potencia inspiratoria se calculó a partir de la energía contenida en el intervalo de tiempo finito (entre el instante del cruce por cero y el punto de inflexión). El rendimiento de este parámetro se evaluó utilizando los siguientes clasificadores: regresión logística, análisis discriminante lineal, el árbol de clasificación y regresión, Naive Bayes y la máquina de vectores de apoyo. Los mejores resultados se obtuvieron utilizando el clasificador bayesiano, que tuvo una precisión, sensibilidad y especificidad del 87%, 90% y 81% respectivamente.
Abstract (English)
Disconnection from mechanical ventilation, called the weaning process, is an additional difficulty in the management of patients in intensive care units (ICU). Unnecessary delays in the discontinuation process and a weaning trial that is undertaken too early are undesirable. In this study, we propose an extubation index based on the power of the respiratory flow signal (Pi). A total of 132 patients on weaning trials were studied: 94 patients with successful trials (group S) and 38 patients who failed to maintain spontaneous breathing and were reconnected (group F). The respiratory flow signals were processed considering the following three stages: a) zero crossing detection of the inspiratory phase, b) inflection point detection of the flow curve during the inspiratory phase, and c) calculation of the signal power on the time instant indicated by the inflection point. The zero crossing detection was performed using an algorithm based on thresholds. The inflection points were marked considering the zero crossing of the second derivative. Finally, the inspiratory power was calculated from the energy contained over the finite time interval (between the instant of zero crossing and the inflection point). The performance of this parameter was evaluated using the following classifiers: logistic regression, linear discriminant analysis, the classification and regression tree, Naive Bayes, and the support vector machine. The best results were obtained using the Bayesian classifier, which had an accuracy, sensitivity and specificity of 87%, 90% and 81% respectively.
Extent
4 páginas
URI: https://repositorio.escuelaing.edu.co/handle/001/2308
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