title: The design and implementation of a ventilator-management advisor.
abstract: VentPlan is an implementation of the architecture developed by the qualitative-quantitative (QQ) research group for combining qualitative and quantitative computation in a ventilator-management advisor (VMA). VentPlan calculates recommended settings for four controls of a ventilator by evaluating the predicted effects of alternative ventilator settings. A belief network converts clinical diagnoses to distributions on physiologic parameters. A mathematical-modeling module applies a patient-specific mathematical model of cardiopulmonary physiology to predict the effects of alternative ventilator settings. A decision-theoretic plan evaluator ranks the predicted effects of alternative ventilator settings according to a multiattribute-value model that specifies physician preferences for ventilator treatments. Our architecture allows VentPlan to interpret quantitative observations in light of the clinical context (such as the clinical diagnosis). We report a retrospective study of the ventilator-setting changes encountered in postoperative patients in a surgical intensive-care unit (ICU). We conclude that the QQ architecture allows VentPlan to apply a patient-specific physiologic model to calculate ventilator settings that are optimal with respect to a decision-theoretic value model describing physician preferences for setting the ventilator.
authors.affiliation: Section on Medical Informatics, Stanford University, CA 94305-5479.
authors.forename: G W
authors.initials: GW
authors.lastname: Rutledge
authors.forename: G E
authors.initials: GE
authors.lastname: Thomsen
authors.forename: B R
authors.initials: BR
authors.lastname: Farr
authors.forename: M A
authors.initials: MA
authors.lastname: Tovar
authors.forename: J X
authors.initials: JX
authors.lastname: Polaschek
authors.forename: I A
authors.initials: IA
authors.lastname: Beinlich
authors.forename: L B
authors.initials: LB
authors.lastname: Sheiner
authors.forename: L M
authors.initials: LM
authors.lastname: Fagan
mesh_terms: D000465:Algorithms; D001185:Artificial Intelligence; D003196:Computer Graphics; D003662:Decision Theory; D006801:Humans; D007362:Intensive Care Units; D008954:Models, Biological; D008991:Monitoring, Physiologic / Q000295:instrumentation; D012121:Respiration, Artificial / Q000295:instrumentation*; D012189:Retrospective Studies; D014584:User-Computer Interface; D012122:Ventilators, Mechanical