Explainable machine learning approach to predict extubation in critically ill ventilated patients: a retrospective study in central Taiwan.

backgroundWeaning from mechanical ventilation (MV) is an essential issue in critically ill patients, and we used an explainable machine learning (ML) approach to establish an extubation prediction model.

methodsWe enrolled patients who were admitted to intensive care units during 2015-2019 at Taichung Veterans General Hospital, a referral hospital in central Taiwan. We used five ML models, including extreme gradient boosting (XGBoost), categorical boosting (CatBoost), light gradient boosting machine (LightGBM), random forest (RF) and logistic regression (LR), to establish the extubation prediction model, and the feature window as well as prediction window was 48 h and 24 h, respectively. We further employed feature importance, Shapley additive explanations (SHAP) plot, partial dependence plot (PDP) and local interpretable model-agnostic explanations (LIME) for interpretation of the model at the domain, feature, and individual levels.

resultsWe enrolled 5,940 patients and found the accuracy was comparable among XGBoost, LightGBM, CatBoost and RF, with the area under the receiver operating characteristic curve using XGBoost to predict extubation was 0.921. The calibration and decision curve analysis showed well applicability of models. We also used the SHAP summary plot and PDP plot to demonstrate discriminative points of six key features in predicting extubation. Moreover, we employed LIME and SHAP force plots to show predicted probabilities of extubation and the rationale of the prediction at the individual level.

conclusionsWe developed an extubation prediction model with high accuracy and visualised explanations aligned with clinical workflow, and the model may serve as an autonomous screen tool for timely weaning.