Convolutional long short-term memory neural network integrated with classifier in classifying type of asynchrony breathing in mechanically ventilated patients

BACKGROUND AND OBJECTIVE: Asynchronous breathing (AB) occurs when a mechanically ventilated patient's breathing does not align with the mechanical ventilator (MV). Asynchrony can negatively impact recovery and outcome, and/or hinder MV management. A model-based method to accurately classify different AB types could automate detection and have a measurable clinical impact.

METHODS: This study presents an approach using a 1-dimensional (1D) of airway pressure data as an input to the convolutional long short-term memory neural network (CNN-LSTM) with a classifier method to classify AB types into three categories: 1) reverse Triggering (RT); 2) premature cycling (PC); and 3) normal breathing (NB), which cover normal breathing and 2 primary forms of AB. Three types of classifier are integrated with the CNN-LSTM model which are random forest (RF), support vector machine (SVM) and logistic regression (LR). Clinical data inputs include measured airway pressure from 7 MV patients in IIUM Hospital ICU under informed consent with a total of 4500 breaths. Model performance is first assessed in a k-fold cross-validation assessing accuracy in comparison to the proposed CNN-LSTM integrated with each type of classifier. Then, confusion matrices are used to summarize classification performance for the CNN without classifier, CNN-LSTM without classifier, and CNN-LSTM with each of the 3 classifiers (RF, SVM, LR).

RESULTS AND DISCUSSION: The 1D CNN-LSTM with classifier method achieves 100 % accuracy using 5-fold cross validation. The confusion matrix results showed that the combined CNN-LSTM model with classifier performed better, demostrating higher accuracy, sensitivity, specificity, and F1 score, all exceeding 83.5 % across all three breathing categories. The CNN model without classifier and CNN-LSTM model without classifier displayed comparatively lower performance, with average values of F1 score below 71.8 % for all three breathing categories.

CONCLUSION: The results validate the effectiveness of the CNN-LSTM neural network model with classifier in accurately detecting and classifying the different categories of AB and NB. Overall, this model-based approach has the potential to precisely classify the type of AB and differentiate normal breathing. With this developed model, a better MV management can be provided at the bedside, and these results justify prospective clinical testing.