Predicting Prolonged Apnea During Nurse-Administered Procedural Sedation: Machine Learning Study.

Aaron Conway,Kristina Chang,Sebastian Mafeld,Navpreet Kamboj,Matteo Parotto,Joanna Sutherland,Carla R Jungquist

doi:10.2196/29200

Aaron Conway, Kristina Chang + Show 5 more

Open Access

https://doi.org/10.2196/29200

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Abstract

BackgroundCapnography is commonly used for nurse-administered procedural sedation. Distinguishing between capnography waveform abnormalities that signal the need for clinical intervention for an event and those that do not indicate the need for intervention is essential for the successful implementation of this technology into practice. It is possible that capnography alarm management may be improved by using machine learning to create a “smart alarm” that can alert clinicians to apneic events that are predicted to be prolonged.ObjectiveTo determine the accuracy of machine learning models for predicting at the 15-second time point if apnea will be prolonged (ie, apnea that persists for >30 seconds).MethodsA secondary analysis of an observational study was conducted. We selected several candidate models to evaluate, including a random forest model, generalized linear model (logistic regression), least absolute shrinkage and selection operator regression, ridge regression, and the XGBoost model. Out-of-sample accuracy of the models was calculated using 10-fold cross-validation. The net benefit decision analytic measure was used to assist with deciding whether using the models in practice would lead to better outcomes on average than using the current default capnography alarm management strategies. The default strategies are the aggressive approach, in which an alarm is triggered after brief periods of apnea (typically 15 seconds) and the conservative approach, in which an alarm is triggered for only prolonged periods of apnea (typically >30 seconds).ResultsA total of 384 apneic events longer than 15 seconds were observed in 61 of the 102 patients (59.8%) who participated in the observational study. Nearly half of the apneic events (180/384, 46.9%) were prolonged. The random forest model performed the best in terms of discrimination (area under the receiver operating characteristic curve 0.66) and calibration. The net benefit associated with the random forest model exceeded that associated with the aggressive strategy but was lower than that associated with the conservative strategy.ConclusionsDecision curve analysis indicated that using a random forest model would lead to a better outcome for capnography alarm management than using an aggressive strategy in which alarms are triggered after 15 seconds of apnea. The model would not be superior to the conservative strategy in which alarms are only triggered after 30 seconds.

Highlights

With the recent increase in the use of electronic monitoring devices in the hospital setting, alarm fatigue has become a serious problem that impacts patient safety and nursing care [1]
The net benefit associated with the random forest model exceeded that associated with the aggressive strategy but was lower than that associated with the conservative strategy
Decision curve analysis indicated that using a random forest model would lead to a better outcome for capnography alarm management than using an aggressive strategy in which alarms are triggered after 15 seconds of apnea

Summary

Introduction

With the recent increase in the use of electronic monitoring devices in the hospital setting, alarm fatigue has become a serious problem that impacts patient safety and nursing care [1]. Capnography waveform abnormalities assist in detecting and diagnosing specific conditions such as partial airway obstruction and apnea. For this reason, the implementation of capnography into practice for respiratory monitoring is considered a high priority to improve patient safety by leading authorities, including national and international professional organizations for anesthesiology in Canada, the United States, and Europe [3,4,5]. Capnography is commonly used for nurse-administered procedural sedation [6,7,8], including in the interventional radiology setting [9,10,11,12,13]. It is possible that capnography alarm management may be improved by using machine learning to create a “smart alarm” that can alert clinicians to apneic events that are predicted to be prolonged

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