• Mohammed Sayed, David Riaño, and Jesús Villar.
• Banzai Research Group On Artificial Intelligence, Department of Computer Engineering, Universitat Rovira I Virgili, Av Paisos Catalans 26, 43007, Tarragona, Spain. mgamal.sayed@urv.cat.
• Crit Care. 2021 Apr 20; 25 (1): 150.

BackgroundUsually, arterial oxygenation in patients with the acute respiratory distress syndrome (ARDS) improves substantially by increasing the level of positive end-expiratory pressure (PEEP). Herein, we are proposing a novel variable [PaO2/(FiO2xPEEP) or P/FPE] for PEEP ≥ 5 to address Berlin's definition gap for ARDS severity by using machine learning (ML) approaches.MethodsWe examined P/FPE values delimiting the boundaries of mild, moderate, and severe ARDS. We applied ML to predict ARDS severity after onset over time by comparing current Berlin PaO2/FiO2 criteria with P/FPE under three different scenarios. We extracted clinical data from the first 3 ICU days after ARDS onset (N = 2738, 1519, and 1341 patients, respectively) from MIMIC-III database according to Berlin criteria for severity. Then, we used the multicenter database eICU (2014-2015) and extracted data from the first 3 ICU days after ARDS onset (N = 5153, 2981, and 2326 patients, respectively). Disease progression in each database was tracked along those 3 ICU days to assess ARDS severity. Three robust ML classification techniques were implemented using Python 3.7 (LightGBM, RF, and XGBoost) for predicting ARDS severity over time.ResultsP/FPE ratio outperformed PaO2/FiO2 ratio in all ML models for predicting ARDS severity after onset over time (MIMIC-III: AUC 0.711-0.788 and CORR 0.376-0.566; eICU: AUC 0.734-0.873 and CORR 0.511-0.745).ConclusionsThe novel P/FPE ratio to assess ARDS severity after onset over time is markedly better than current PaO2/FiO2 criteria. The use of P/FPE could help to manage ARDS patients with a more precise therapeutic regimen for each ARDS category of severity.

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