Development of a prediction model for hypotension after induction of anesthesia using machine learning

PLoS One. 2020 Apr 16;15(4):e0231172. doi: 10.1371/journal.pone.0231172. eCollection 2020.

Abstract

Arterial hypotension during the early phase of anesthesia can lead to adverse outcomes such as a prolonged postoperative stay or even death. Predicting hypotension during anesthesia induction is complicated by its diverse causes. We investigated the feasibility of developing a machine-learning model to predict postinduction hypotension. Naïve Bayes, logistic regression, random forest, and artificial neural network models were trained to predict postinduction hypotension, occurring between tracheal intubation and incision, using data for the period from between the start of anesthesia induction and immediately before tracheal intubation obtained from an anesthesia monitor, a drug administration infusion pump, an anesthesia machine, and from patients' demographics, together with preexisting disease information from electronic health records. Among 222 patients, 126 developed postinduction hypotension. The random-forest model showed the best performance, with an area under the receiver operating characteristic curve of 0.842 (95% confidence interval [CI]: 0.736-0.948). This was higher than that for the Naïve Bayes (0.778; 95% CI: 0.65-0.898), logistic regression (0.756; 95% CI: 0.630-0.881), and artificial-neural-network (0.760; 95% CI: 0.640-0.880) models. The most important features affecting the accuracy of machine-learning prediction were a patient's lowest systolic blood pressure, lowest mean blood pressure, and mean systolic blood pressure before tracheal intubation. We found that machine-learning models using data obtained from various anesthesia machines between the start of anesthesia induction and immediately before tracheal intubation can predict hypotension occurring during the period between tracheal intubation and incision.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anesthesia, General / adverse effects*
  • Anesthesia, General / instrumentation
  • Anesthetics / administration & dosage
  • Anesthetics / adverse effects*
  • Arterial Pressure / drug effects
  • Bayes Theorem
  • Cholecystectomy, Laparoscopic / adverse effects
  • Drug Delivery Systems / statistics & numerical data
  • Electronic Health Records / statistics & numerical data
  • Feasibility Studies
  • Female
  • Humans
  • Hypotension / epidemiology*
  • Hypotension / etiology
  • Intubation, Intratracheal / adverse effects
  • Machine Learning*
  • Male
  • Middle Aged
  • Models, Cardiovascular*
  • Monitoring, Intraoperative / statistics & numerical data
  • Neural Networks, Computer
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment / methods

Substances

  • Anesthetics

Grants and funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2018R1A6A3A01011337), the Soonchunhyang University Research Fund and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2017R1C1B5076787).