title: Classification of patients undergoing weaning from mechanical ventilation using the coherence between heart rate variability and respiratory flow signal.
abstract: Weaning from mechanical ventilation is still one of the most challenging problems in intensive care. Unnecessary delays in discontinuation and weaning trials that are undertaken too early are both undesirable. This study investigated the contribution of spectral signals of heart rate variability (HRV) and respiratory flow, and their coherence to classifying patients on weaning process from mechanical ventilation. A total of 121 candidates for weaning, undergoing spontaneous breathing tests, were analyzed: 73 were successfully weaned (GSucc), 33 failed to maintain spontaneous breathing so were reconnected (GFail), and 15 were extubated after the test but reintubated within 48 h (GRein). The power spectral density and magnitude squared coherence (MSC) of HRV and respiratory flow signals were estimated. Dimensionality reduction was performed using principal component analysis (PCA) and sequential floating feature selection. The patients were classified using a fuzzy K-nearest neighbour method. PCA of the MSC gave the best classification with the highest accuracy of 92% classifying GSucc versus GFail patients, and 86% classifying GSucc versus GRein patients. PCA of the respiratory flow signal gave the best classification between GFail and GRein patients (79% accuracy). These classifiers showed a good balance between sensitivity and specificity. Besides, the spectral coherence between HRV and the respiratory flow signal, in patients on weaning trial process, can contribute to the extubation decision.
authors.affiliation: Institut de Bioenginyeria de Catalunya (IBEC), c/ Baldiri Reixac, 4-8, 08028 Barcelona, Spain. CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), c/ Monforte de Lemos 3-5, PabellÓn 11, 28029 Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Arcentales
authors.forename: P
authors.initials: P
authors.lastname: Caminal
authors.forename: I
authors.initials: I
authors.lastname: Diaz
authors.forename: S
authors.initials: S
authors.lastname: Benito
authors.forename: B F
authors.initials: BF
authors.lastname: Giraldo
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D012129:Respiratory Function Tests / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology*; D019233:Retreatment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*