通过LLM驱动的准则来加强呼吸器支持的预测建模
Xiaolei Lu1, Michael Miller1, Alex K Pearce1
1University of California, San Diego.
Research square
|August 20, 2025
概括
将大型语言模型 (LLM) 与深度反事实模型相结合,改善了重症监护室 (ICU) 患者的呼吸支持建议,降低了侵入性机械通风 (IMV) 率和死亡率.
科学领域:
- 危急护理医学
- 医疗保健中的人工智能
- 呼吸疗法
背景情况:
- 对于患有侵入性机械通风风险的重症监护室 (ICU) 患者,高流量鼻腔管 (HFNC) 和非侵入性通风 (NIV) 之间的最佳选择尚不清楚.
- 之前的深度反事实模型 (RepFlow-CFR) 缺乏可解释性和临床指导方针.
- 这项研究通过整合临床指南驱动的LLM来应对这些挑战.
研究的目的:
- 开发和整合临床指南驱动的LLM,以加强NIV与HFNC的深度反事实模型建议.
- 在高风险的ICU患者中改善呼吸辅助决策的解释性和临床准则的遵守性.
- 评估LLM增强建议对患者结果和临床实践的影响.
主要方法:
- 通过结合大型语言模型 (LLM,Claude 3.5 Sonnet) 改进了RepFlow-CFR模型,以实现准则的遵守和可解释的建议.
- 在符合HIPAA的AWS环境中配置LLM,使用结构化患者数据,临床笔记和提示指南标准.
- 将LLM增强的建议与实际治疗决策进行比较,评估侵入性机械呼吸 (IMV) 和死亡率/临终关怀率. 对临床有效性和安全性进行了表格审查.
主要成果:
- 与LLM增强建议相一致的治疗与显著降低的IMV率 (24. 47%对52. 94%) 和降低死亡率或临终关怀退院率 (OR=0. 670, p=0. 046) 相关.
- 在对20例病例的病历审查中,95%的LLM建议符合临床指南,医生同意65%的最终建议.
- 在11/20例中发现错误,其中大多数被认为是低或中等风险;只有2例被评为可能造成严重伤害.
结论:
- 整合LLM可提高呼吸辅助决策的反事实模型的解释性和临床一致性.
- 这种混合框架提高了与现实实践的一致性,并显示出更好的患者结果的潜力.
- 未来的工作重点是通过未来的临床试验来完善禁忌检测和扩大验证.
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