Abstract
INTRODUCTION: Patient-ventilator asynchrony (PVA) is a common and harmful complication during mechanical ventilation, often requiring labor-intensive manual assessment. Machine learning (ML) offers a promising approach for automated and accurate PVA detection and prediction. We conducted a systematic review to evaluate the methodologies and performance of ML models applied to PVA. METHODS: Following a pre-established PROSPERO-registered protocol (CRD42024626163), we systematically searched PubMed, Embase, Web of Science, and Cochrane databases from inception to November 2024. Original studies applying ML techniques to assess PVA in adult patients receiving mechanical ventilation were included. A refined quality assessment method was developed to evaluate methodological and technical features of included studies. RESULTS: Among the 74 articles, fourteen were included, employing 11 distinct ML methods to address 19 targeted types of PVA. Thirteen studies focused on PVA identification, while only one predicted its occurrence. ML models demonstrated promising performance for PVA identification, with high F1 scores (ranging from 0.731 to 0.988) and strong results across other robust metrics (e.g., accuracy, sensitivity, specificity, MCC, AUROC) where reported. However, only two studies conducted external validation. Furthermore, reporting of crucial technical details, such as class imbalance handling (addressed in 5 studies) and hyperparameter tuning (described in 4 studies), was often limited. CONCLUSIONS: ML models show significant potential for identifying and predicting PVA, as evidenced by their high reported performance metrics. However, their widespread clinical application is currently limited by substantial methodological heterogeneity, variability in PVA definitions and outcome measures, insufficient external validation, and inconsistent reporting of crucial technical details. Future research should prioritize developing generalizable models validated externally in diverse clinical settings, standardizing PVA definitions and outcome measures, and providing detailed methodological reporting to enhance reproducibility and clinical applicability.