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Performance of a machine-learning algorithm to predict hypotension in mechanically ventilated patients with COVID-19 admitted to the intensive care unit: a cohort study.
van der Ven, Ward H; Terwindt, Lotte E; Risvanoglu, Nurseda; Ie, Evy L K; Wijnberge, Marije; Veelo, Denise P; Geerts, Bart F; Vlaar, Alexander P J; van der Ster, Björn J P.
  • van der Ven WH; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
  • Terwindt LE; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
  • Risvanoglu N; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
  • Ie ELK; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
  • Wijnberge M; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
  • Veelo DP; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
  • Geerts BF; Department of Intensive Care, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, The Netherlands.
  • Vlaar APJ; Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. a.p.vlaar@amsterdamumc.nl.
  • van der Ster BJP; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. a.p.vlaar@amsterdamumc.nl.
J Clin Monit Comput ; 36(5): 1397-1405, 2022 10.
Article in English | MEDLINE | ID: covidwho-1514056
ABSTRACT
The Hypotension Prediction Index (HPI) is a commercially available machine-learning algorithm that provides warnings for impending hypotension, based on real-time arterial waveform analysis. The HPI was developed with arterial waveform data of surgical and intensive care unit (ICU) patients, but has never been externally validated in the latter group. In this study, we evaluated diagnostic ability of the HPI with invasively collected arterial blood pressure data in 41 patients with COVID-19 admitted to the ICU for mechanical ventilation. Predictive ability was evaluated at HPI thresholds from 0 to 100, at incremental intervals of 5. After exceeding the studied threshold, the next 20 min were screened for positive (mean arterial pressure (MAP) < 65 mmHg for at least 1 min) or negative (absence of MAP < 65 mmHg for at least 1 min) events. Subsequently, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and time to event were determined for every threshold. Almost all patients (93%) experienced at least one hypotensive event. Median number of events was 21 [7-54] and time spent in hypotension was 114 min [20-303]. The optimal threshold was 90, with a sensitivity of 0.91 (95% confidence interval 0.81-0.98), specificity of 0.87 (0.81-0.92), PPV of 0.69 (0.61-0.77), NPV of 0.99 (0.97-1.00), and median time to event of 3.93 min (3.72-4.15). Discrimination ability of the HPI was excellent, with an area under the curve of 0.95 (0.93-0.97). This validation study shows that the HPI correctly predicts hypotension in mechanically ventilated COVID-19 patients in the ICU, and provides a basis for future studies to assess whether hypotension can be reduced in ICU patients using this algorithm.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypotension Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Clin Monit Comput Journal subject: Medical Informatics / Medicine Year: 2022 Document Type: Article Affiliation country: S10877-021-00778-x

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypotension Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Clin Monit Comput Journal subject: Medical Informatics / Medicine Year: 2022 Document Type: Article Affiliation country: S10877-021-00778-x