Early prediction of hemodynamic interventions in the intensive care unit using machine learning

Table 1 Criteria used to define hemodynamic instability

A segment was labeled “intervention” under any of the following conditions
Administration of any quantity of any of the following inotropic and vasopressor medications: Dobutamine Dopamine Epinephrine Norepinephrine Phenylephrine Vasopressin Administration of Fluid Therapy (colloid or crystalloid) in the following dosages: 2400 cc in 8 h 3000 cc in 12 h 700 cc in 1 h 1500 cc total in 4 h 500 cc twice in 4 h Administration of Packed Red Blood Cells (PRBCs) in either of the following dosages: 800 cc PRBC over course of 24 h 500 cc in two hours followed by fluid therapy within 12 h. (What qualifies as “fluid therapy” is described in this table, titled “Administration of Fluid Therapy.”) 500 cc PRBC not followed by fluid therapy within the following 24 h. (What qualifies as “fluid therapy” is described in this table entry titled “Administration of Fluid Therapy.”)

The fluid trigger criteria were derived from clinical consensus of a panel of clinical experts in fluid and hemodynamic management. Some are multiples of standard dosing regimens (10 cc/kg, 20 cc/kg) or multiples of the size of bags of solution that are used for fluid resuscitation (500 cc or 1 L). The starting bolus for an adult is 500 cc OR 10 cc/kg. For significant hypovolemia, this might be 1400 cc (20 cc/kg) or 1 L (the size of a 1-L bag of solution). The fluid triggers represent what was considered a significant intervention in response to hypovolemia. Additional details describing the rationale for each fluid trigger can be found in the Additional file 1

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