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316 Machine Learning to Predict Fluid Responsiveness in Hypotensive Children

Published online by Cambridge University Press:  03 April 2024

Sarah B. Walker
Affiliation:
Ann & Robert H. Lurie Children’s Hospital of Chicago
Kyle S. Honegger
Affiliation:
Divisions of Critical Care Medicine and Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago; Stanley Manne Children’s Research Institute; Northwestern University Feinberg School of Medicine Department of Pediatrics, Chicago IL
Michael S. Carroll
Affiliation:
Divisions of Critical Care Medicine and Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago; Stanley Manne Children’s Research Institute; Northwestern University Feinberg School of Medicine Department of Pediatrics, Chicago IL
Debra E. Weese-Mayer
Affiliation:
Divisions of Critical Care Medicine and Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago; Stanley Manne Children’s Research Institute; Northwestern University Feinberg School of Medicine Department of Pediatrics, Chicago IL
L. Nelson Sanchez-Pinto
Affiliation:
Divisions of Critical Care Medicine and Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago; Stanley Manne Children’s Research Institute; Northwestern University Feinberg School of Medicine Department of Pediatrics, Chicago IL
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Abstract

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OBJECTIVES/GOALS: Fluid boluses are administered to hypotensive, critically ill children but may not reverse hypotension, leading to delay of vasoactive infusion, end-organ damage, and mortality. We hypothesize that a machine learning-based model will predict which children will have sustained response to fluid bolus. METHODS/STUDY POPULATION: We will conduct a single-center retrospective observational cohort study of hypotensive critically ill children who received intravenous isotonic fluid of at least 10 ml/kg within 72 hours of pediatric intensive care unit admission between 2013 and 2023. We will extract physiologic variables from stored bedside monitors data and clinical variables from the EHR. Fluid responsive (FR) will be defined as a MAP increase by 310%. We will construct elastic net, random forest, and a long short-term memory models to predict FR. We will compare complicated course (multiple organ dysfunction on day 7 or death by day 28) between: 1) FRs and non-FRs, 2) predicted FRs and non-FRs, 3), FRs and non-FRs stratified by race/ethnicity, and 4) FRs and non-FRs stratified by sex as a biologic variable. RESULTS/ANTICIPATED RESULTS: We anticipate approximately 800 critically ill children will receive 2,000 intravenous isotonic fluid boluses, with a 60% rate of FR. We anticipate being able to complete all three models. We hypothesize that the model with the best performance will be the long short-term memory model and the easiest to interpret will be the tree-based random forest model. We hypothesize non-FRs will have a higher complicated course than FRs and that predicted non-FRs will have a higher rate of complicated course than FRs. Based on previous adult studies, we hypothesize that there will be a higher rate of complicated course in patients of black race and/or Hispanic ethnicity when compared to non-Hispanic white patients. We also hypothesize that there will be no difference in complicated course when comparing sex as a biologic variable. DISCUSSION/SIGNIFICANCE: We have a critical need for easily-deployed, real-time prediction of fluid response to personalize and improve resuscitation for children in shock. We anticipate the clinical application of such a model will decrease time with hypotension for critically ill children, leading to decreased morbidity and mortality.

Type
Informatics and Data Science
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2024. The Association for Clinical and Translational Science