-- Nasotracheal intubation (NTI) is critical for establishing artificial airways in clinical anesthesia and critical care. Current manual methods face significant challenges, including cross-infection, especially during respiratory infection care, and insufficient control of endoluminal contact forces, increasing the risk of mucosal injuries. While existing studies have focused on automated endoscopic insertion, the automation of NTI remains unexplored despite its unique challenges: Nasotracheal tubes exhibit greater diameter and rigidity than standard endoscopes, substantially increasing insertion complexity and patient risks. We propose a novel autonomous NTI system with two key components to address these challenges. First, an autonomous NTI system is developed, incorporating a prosthesis embedded with force sensors, allowing for safety assessment and data filtering. Then, the Recurrent Action-Confidence Chunking with Transformer (RACCT) model is developed to handle complex tube-tissue interactions and partial visual observations. Experimental results demonstrate that the RACCT model outperforms the ACT model in all aspects and achieves a 66% reduction in average peak insertion force compared to manual operations while maintaining equivalent success rates.

Rationing of healthcare resources is a challenging decision that policy makers and providers may be forced to make during a pandemic, natural disaster, or mass casualty event. Well-defined guidelines to triage scarce life-saving resources must be designed to promote transparency, trust, and consistency. To facilitate buy-in and use during high-stress situations, these guidelines need to be interpretable and operational. We propose a novel data-driven model to compute interpretable triage guidelines based on policies for Markov Decision Process that can be represented as simple sequences of decision trees ("tree policies"). In particular, we characterize the properties of optimal tree policies and present an algorithm based on dynamic programming recursions to compute good tree policies. We utilize this methodology to obtain simple, novel triage guidelines for ventilator allocations for COVID-19 patients, based on real patient data from Montefiore hospitals. We also compare the performance of our guidelines to the official New York State guidelines that were developed in 2015 (well before the COVID-19 pandemic). Our empirical study shows that the number of excess deaths associated with ventilator shortages could be reduced significantly using our policy. Our work highlights the limitations of the existing official triage guidelines, which need to be adapted specifically to COVID-19 before being successfully deployed.

Although the availability of a large amount of data is usually given for granted, there are relevant scenarios where this is not the case; for instance, in the biomedical/healthcare domain, some applications require to build huge datasets of proper images, but the acquisition of such images is often hard for different reasons (e.g., accessibility, costs, pathology-related variability), thus causing limited and usually imbalanced datasets. Hence, the need for synthesizing photo-realistic images via advanced Data Augmentation techniques is crucial. In this paper we propose a hybrid inductive-deductive approach to the problem; in particular, starting from a limited set of real labeled images, the proposed framework makes use of logic programs for declaratively specifying the structure of new images, that is guaranteed to comply with both a set of constraints coming from the domain knowledge and some specific desiderata. The resulting labeled images undergo a dedicated process based on Deep Learning in charge of creating photo-realistic images that comply with the generated label.

Electronic Health Record (EHR) provides abundant information through various modalities. However, learning multi-modal EHR is currently facing two major challenges, namely, 1) data embedding and 2) cases with missing modality. A lack of shared embedding function across modalities can discard the temporal relationship between different EHR modalities. On the other hand, most EHR studies are limited to relying only on EHR Times-series, and therefore, missing modality in EHR has not been well-explored. Therefore, in this study, we introduce a Unified Multi-modal Set Embedding (UMSE) and Modality-Aware Attention (MAA) with Skip Bottleneck (SB). UMSE treats all EHR modalities without a separate imputation module or error-prone carry-forward, whereas MAA with SB learns missing modal EHR with effective modality-aware attention. Our model outperforms other baseline models in mortality, vasopressor need, and intubation need prediction with the MIMIC-IV dataset.

We propose a two-stage unsupervised approach for parsing videos into phases. We use motion cues to divide the video into coarse segments. Noisy segment labels are then used to weakly supervise an appearance-based classifier. We show the effectiveness of the method for phase detection in colonoscopy videos.

Delaying intubation for patients failing Bi-Level Positive Airway Pressure (BIPAP) may be associated with harm. The objective of this study was to develop a deep learning model capable of aiding clinical decision making by predicting Bi-Level Positive Airway Pressure (BIPAP) failure. This was a retrospective cohort study in a tertiary pediatric intensive care unit (PICU) between 2010 and 2020. Three machine learning models were developed to predict BIPAP failure: two logistic regression models and one deep learning model, a recurrent neural network with a Long Short-Term Memory (LSTM-RNN) architecture. Model performance was evaluated in a holdout test set. 175 (27.7%) of 630 total BIPAP sessions were BIPAP failures. Patients in the BIPAP failure group were on BIPAP for a median of 32.8 (9.2–91.3) hours prior to intubation. Late BIPAP failure (intubation after using BIPAP > 24 h) patients had fewer 28-day Ventilator Free Days (13.40 [0.68–20.96]), longer ICU length of stay and more post-extubation BIPAP days compared to those who were intubated ≤ 24 h from BIPAP initiation. An AUROC above 0.5 indicates that a model has extracted new information, potentially valuable to the clinical team, about BIPAP failure. Within 6 h of BIPAP initiation, the LSTM-RNN model predicted which patients were likely to fail BIPAP with an AUROC of 0.81 (0.80, 0.82), superior to all other models. Within 6 h of BIPAP initiation, the LSTM-RNN model would identify nearly 80% of BIPAP failures with a 50% false alarm rate, equal to an NNA of 2. In conclusion, a deep learning method using readily available data from the electronic health record can identify which patients on BIPAP are likely to fail with good discrimination, oftentimes days before they are intubated in usual practice.

High Flow Nasal Cannula (HFNC) provides non-invasive respiratory support for critically ill children who may tolerate it more readily than other Non-Invasive (NIV) techniques. Timely prediction of HFNC failure can provide an indication for increasing respiratory support. This work developed and compared machine learning models to predict HFNC failure. A retrospective study was conducted using EMR of patients admitted to a tertiary pediatric ICU from January 2010 to February 2020. A Long Short-Term Memory (LSTM) model was trained to generate a continuous prediction of HFNC failure. Performance was assessed using the area under the receiver operating curve (AUROC) at various times following HFNC initiation. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) of predictions at two hours after HFNC initiation were also evaluated. These metrics were also computed in a cohort with primarily respiratory diagnoses. 834 HFNC trials [455 training, 173 validation, 206 test] met the inclusion criteria, of which 175 [103, 30, 42] (21.0%) escalated to NIV or intubation. The LSTM models trained with transfer learning generally performed better than the LR models, with the best LSTM model achieving an AUROC of 0.78, vs 0.66 for the LR, two hours after initiation. Machine learning models trained using EMR data were able to identify children at risk for failing HFNC within 24 hours of initiation. LSTM models that incorporated transfer learning, input data perseveration and ensembling showed improved performance than the LR and standard LSTM models.

Critical Care Suite 2.0 helps bedside staff and radiologists assess Endotracheal Tube (ETT) placement for intubated patients, including critical COVID-19 patients GE Healthcare announced a new artificial intelligence (AI) algorithm to help clinicians assess Endotracheal Tube (ETT) placements, a necessary and important step when ventilating critically ill COVID-19 patients. The AI solution is one of five included in GE Healthcare's Critical Care Suite 2.0, an industry-first collection of AI algorithms embedded on a mobile x-ray device for automated measurements, case prioritization and quality control. Research shows that up to 25 percent of patients intubated outside of the operating room have misplaced ETTs on chest x-rays, which can lead to severe complications for patients, including hyperinflation, pneumothorax, cardiac arrest and death. Moreover, as COVID-19 cases climb, with more than 50 million confirmed worldwide, anywhere from 5-15 percent require intensive care surveillance and intubation for ventilatory support. "Today, clinicians are overwhelmed, experiencing mounting pressure as a result of an ever-increasing number of patients," said Jan Makela, President and CEO, Imaging at GE Healthcare.