Optimizing Inotropic Infusion With Cluster Specific AI Decision Models and Digital TwinsNair, V

Abstract

Inotropes are critical care medications essential for maintaining normal blood pressure (BP) in hospitalized patients. Titrating infusion rates of inotropes such as noradrenaline, vasopressin, and adrenaline based on fluctuating BP presents significant challenges in critical care settings. Typically, clinicians set a constant infusion rate for one hour, which may not accommodate the dynamic variability of BP inherent in critically ill patients, potentially leading to inadvertent hypotension or hypertension. Conventional feedback controllers, including fuzzy logic controllers (FLC), struggle to adapt to complex BP variations due to fixed algorithms and intracohort variability in drug responses. We propose an AI-enhanced closed-loop noradrenaline infusion control mechanism utilizing long short-term memory (LSTM) networks. This approach captures variability in drug responses through clustering of patients using LSTM autoencoders and K-means algorithms, subsequently developing LSTM-based decision models for infusion rates tailored to clusters. Additionally, a digital twin cardiac model serves as a simulation tool for validating the impact of inotropic infusion as indicated by the decision model. Comparative performance analyses demonstrate that our AI-enhanced closed-loop feedback method outperforms conventional systems like FLC regulators and pharmacokinetic-pharmacodynamic (PK-PD) models while ensuring patient safety as well as reducing the workload of clinicians.