Representation of Dynamic Clinical Knowledge: Measurement Interpretation in the Intensive Care Unit

Abstract

This paper reports work in progress on a program to provide diagnostic and therapeutic suggestions about patients in the Intensive Care Unit (ICU). The Ventilator Manager program (VM) dynamically interprets the clinical significance of quantitative data from the ICU. This data is used to manage post-surgical patients receiving mechanical ventilatory assistance. An extension of a physiological monitoring system, VM (1) provides a summary of the patient's physiological status appropriate for the clinician, (2) recognizes untoward events in the patient/machine system and provides suggestions for corrective action, (3) suggests adjustments to ventilatory therapy based on a long-term assessment of the patient status and therapeutic goals, (4) detects possible measurement errors, and (5) maintains a set of patient-specific expectations and goals for future evaluation. The program produces interpretations of the physiological measurements over time, using a model of the therapeutic procedures in the ICU and clinical knowledge about the diagnostic implications of the data. These therapeutic guidelines are represented by a knowledge base of rules created by clinicians with extensive ICU experience.