Dynamic Prediction of Intraoperative Hypotension Based on Hemodynamic Monitoring Data With a Transformer-Based Deep Learning Model

Timely prediction and intervention for Intraoperative Hypotension (IOH), a prevalent complication associated with general anesthesia, is crucial to prevent severe postoperative outcomes. While existing machine learning methods for IOH prediction have shown promise, they face limitations such as reliance on single data sources and disregard for crucial features like the trend in Arterial Blood Pressure (ABP) waveforms. To address these challenges, this paper proposes a novel multichannel deep learning framework that combines Convolutional Neural Networks (CNN) and Transformers for automatic IOH prediction. The model leverages four types of physiological waveforms, including ABP, ElectroCardioGram (ECG), photoplethysmography (PLE), and Carbon Dioxide (CO2), to capture both local and global information, enhancing information representation. Experimental results on retrospective data of 14,140 adult patients undergoing non-cardiac surgery from VitalDB, a public data repository of vital signs taken during surgeries in 10 operating rooms at Seoul National University Hospital (from January 6, 2005 to March 1, 2014), demonstrate that the proposed model consistently outperforms other methods, achieving superior AUROC values of 0.943, 0.928, and 0.923 at 5, 10, and 15 minutes before the event, respectively. These results demonstrate the powerfulness of multi-modal data source as well as the importance of ABP waveform trends. Additionally, the incorporation of multi-task learning and the attention mechanism validates the effectiveness and superiority of our model, highlighting its potential for proactive clinical interventions and improved postoperative patient outcomes.