Expectations of Intensive Care Physicians Regarding an AI-Based Decision Support System for Weaning From Continuous...

Critically ill patients in intensive care units (ICUs) require continuous monitoring, generating vast amounts of data. Clinical decision support systems (CDSS) leveraging artificial intelligence (AI) technologies have shown promise in improving diagnostic, prognostic, and therapeutic decision-making. However, these models are rarely implemented in clinical practice.

The aim of this study was to survey ICU physicians to understand their expectations, opinions, and level of knowledge regarding a proposed AI-based CDSS for continuous renal replacement therapy (CRRT) weaning, a clinical decision-making process that is still complex and lacking in guidelines. This will be used to guide the development of an AI-based CDSS on which our team is working to ensure user-centered design and successful integration into clinical practice.

A prospective cross-sectional survey of French-speaking physicians with clinical activity in intensive care was conducted between December 2023 and April 2024. The questionnaire consisted of 20 questions structured around 4 axes: overview of the problem and current practices concerning weaning from CRRT, opinion on AI-based CDSS, implementation in daily clinical practice, real-life operation and willingness to adopt the CDSS in everyday practice. Statistical analyses included Wilcoxon rank sum tests for quantitative variables and χ2 or Fisher exact tests for qualitative variables, with multivariate analyses performed using ordinal logistic regression.

A total of 171 complete responses were received. Physicians expressed an interest in a CDSS for CRRT weaning, with 70.2% (120/171) viewing AI-based CDSS favorably. Opinions were split regarding the difficulty of the weaning decision itself, with 46.2% (79/171) disagreeing that it is challenging, while 31.6% (54/171) agreed. However, 66.1% (113/171) of respondents supported the value of an AI-based CDSS to assist them in this decision, with younger physicians showing stronger support (81.8%, 27/33 vs 62.3%; 86/138; P=.01). Most respondents (163/171, 95.3%) emphasized the importance of understanding the criteria used by the model to make its predictions.

Our findings highlight an optimistic attitude among ICU physicians toward AI-based CDSS for CRRT weaning, emphasizing the need for transparency, integration into existing workflows, and alignment with clinicians' decision-making processes. Actionable recommendations include incorporating key variables such as urine output and biological parameters, defining probability thresholds for recommendations and ensuring model transparency to facilitate the successful adoption and integration into clinical practice. The methodology of this survey may help the development of further predevelopment studies accompanying AI-based CDSS projects.