Mechanical ventilation is a critical life-support intervention that uses a machine to deliver controlled air and oxygen to a patient's lungs, assisting or replacing spontaneous breathing. While several data-driven approaches have been proposed to optimize ventilator control strategies, they often lack interpretability and agreement with general domain knowledge. This paper proposes a methodology for interpretable reinforcement learning (RL) using decision trees for mechanical ventilation control. Using a causal, nonparametric model-based off-policy evaluation, we evaluate the policies in their ability to gain increases in SpO2 while avoiding aggressive ventilator settings which are known to cause ventilator induced lung injuries and other complications. Numerical experiments using MIMIC-III data on the stays of real patients' intensive care unit stays demonstrate that the decision tree policy outperforms the behavior cloning policy and is comparable to state-of-the-art RL policy. Future work concerns better aligning the cost function with medical objectives to generate deeper clinical insights.

The development of respiratory failure is common among patients in intensive care units (ICU). Large data quantities from ICU patient monitoring systems make timely and comprehensive analysis by clinicians difficult but are ideal for automatic processing by machine learning algorithms. Early prediction of respiratory system failure could alert clinicians to patients at risk of respiratory failure and allow for early patient reassessment and treatment adjustment. We propose an early warning system that predicts moderate/severe respiratory failure up to 8 hours in advance. Our system was trained on HiRID-II, a data-set containing more than 60,000 admissions to a tertiary care ICU. An alarm is typically triggered several hours before the beginning of respiratory failure. Our system outperforms a clinical baseline mimicking traditional clinical decision-making based on pulse-oximetric oxygen saturation and the fraction of inspired oxygen. To provide model introspection and diagnostics, we developed an easy-to-use web browser-based system to explore model input data and predictions visually.