Computational Approaches to Alleviate Alarm Fatigue in Intensive Care Medicine: A Systematic Literature Review. Chromik, Jonas; Klopfenstein, Sophie Anne Ines; Pfitzner, Bjarne; Sinno, Zeena-Carola; Arnrich, Bert; Balzer, Felix; Poncette, Akira-Sebastian in Frontiers in Digital Health (2022). 4
Patient monitoring technology has been used to guide therapy and alert staff when a vital sign leaves a predefined range in the intensive care unit (ICU) for decades. However, large amounts of technically false or clinically irrelevant alarms provoke alarm fatigue in staff leading to desensitisation towards critical alarms. With this systematic review, we are following the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist in order to summarise scientific efforts that aimed to develop IT systems to reduce alarm fatigue in ICUs. 69 peer-reviewed publications were included. The majority of publications targeted the avoidance of technically false alarms, while the remainder focused on prediction of patient deterioration or alarm presentation. The investigated alarm types were mostly associated with heart rate or arrhythmia, followed by arterial blood pressure, oxygen saturation, and respiratory rate. Most publications focused on the development of software solutions, some on wearables, smartphones, or headmounted displays for delivering alarms to staff. The most commonly used statistical models were tree-based. In conclusion, we found strong evidence that alarm fatigue can be alleviated by IT-based solutions. However, future efforts should focus more on the avoidance of clinically non-actionable alarms which could be accelerated by improving the data availability.
Extracting Alarm Events from the MIMIC-III Clinical Database. Chromik., Jonas; Pfitzner., Bjarne; Ihde., Nina; Michaelis., Marius; Schmidt., Denise; Klopfenstein., Sophie; Poncette., Akira-Sebastian; Balzer., Felix; Arnrich., Bert (2022). 328–335.
Lack of readily available data on ICU alarm events constitutes a major obstacle to alarm fatigue research. There are ICU databases available that aim to give a holistic picture of everything happening at the respective ICU. However, these databases do not contain data on alarm events. We utilise the vital parameters and alarm thresholds recorded in the MIMIC-III database in order to artificially extract alarm events from this database. Prior to that, we uncover, investigate, and mitigate inconsistencies we found in the data. The results of this work are an approach and an algorithm for cleaning the alarm data available in MIMIC-III and extract concrete alarm events from them. The data set generated by this algorithm is investigated in this work and can be used for further research into the problem of alarm fatigue.
Forecasting Thresholds Alarms in Medical Patient Monitors using Time Series Models. Chromik., Jonas; Pfitzner., Bjarne; Ihde., Nina; Michaelis., Marius; Schmidt., Denise; Klopfenstein., Sophie; Poncette., Akira-Sebastian; Balzer., Felix; Arnrich., Bert (2022). 26–34.
Too many alarms are a persistent problem in today’s intensive care medicine leading to alarm desensitisation and alarm fatigue. This puts patients and staff at risk. We propose a forecasting strategy for threshold alarms in patient monitors in order to replace alarms that are actionable right now with scheduled tasks in an attempt to remove the urgency from the situation. Therefore, we employ both statistical and machine learning mod- els for time series forecasting and apply these models to vital parameter data such as blood pressure, heart rate, and oxygen saturation. The results are promising, although impaired by low and non-constant sampling frequencies of the time series data in use. The combination of a GRU model with medium-resampled data shows the best performance for most types of alarms. However, higher time resolution and constant sampling frequencies are needed in order to meaningfully evaluate our approach.
Defending against Reconstruction Attacks through Differentially Private Federated Learning for Classification of Heterogeneous Chest X-ray Data. Ziegler, Joceline; Pfitzner, Bjarne; Schulz, Heinrich; Saalbach, Axel; Arnrich, Bert in Sensors, (F. Marulli; L. Verde, reds.) (2022). 22(14)
Privacy regulations and the physical distribution of heterogeneous data are often primary concerns for the development of deep learning models in a medical context. This paper evaluates the feasibility of differentially private federated learning for chest X-ray classification as a defense against data privacy attacks. To the best of our knowledge, we are the first to directly compare the impact of differentially private training on two different neural network architectures, DenseNet121 and ResNet50. Extending the federated learning environments previously analyzed in terms of privacy, we simulated a heterogeneous and imbalanced federated setting by distributing images from the public CheXpert and Mendeley chest X-ray datasets unevenly among 36 clients. Both non-private baseline models achieved an area under the receiver operating characteristic curve (AUC) of 0.94 on the binary classification task of detecting the presence of a medical finding. We demonstrate that both model architectures are vulnerable to privacy violation by applying image reconstruction attacks to local model updates from individual clients. The attack was particularly successful during later training stages. To mitigate the risk of a privacy breach, we integrated Rényi differential privacy with a Gaussian noise mechanism into local model training. We evaluate model performance and attack vulnerability for privacy budgets ε∈1,3,6,10. The DenseNet121 achieved the best utility-privacy trade-off with an AUC of 0.94 for ε=6. Model performance deteriorated slightly for individual clients compared to the non-private baseline. The ResNet50 only reached an AUC of 0.76 in the same privacy setting. Its performance was inferior to that of the DenseNet121 for all considered privacy constraints, suggesting that the DenseNet121 architecture is more robust to differentially private training.
DPD-fVAE: Synthetic Data Generation Using Federated Variational Autoencoders With Differentially-Private Decoder Pfitzner, Bjarne; Arnrich, Bert (2022).
Federated learning (FL) is getting increased attention for processing sensitive, distributed datasets common to domains such as healthcare. Instead of directly training classification models on these datasets, recent works have considered training data generators capable of synthesising a new dataset which is not protected by any privacy restrictions. Thus, the synthetic data can be made available to anyone, which enables further evaluation of machine learning architectures and research questions off-site. As an additional layer of privacy-preservation, differential privacy can be introduced into the training process. We propose DPD-fVAE, a federated Variational Autoencoder with Differentially-Private Decoder, to synthesise a new, labelled dataset for subsequent machine learning tasks. By synchronising only the decoder component with FL, we can reduce the privacy cost per epoch and thus enable better data generators. In our evaluation on MNIST, Fashion-MNIST and CelebA, we show the benefits of DPD-fVAE and report competitive performance to related work in terms of Fréchet Inception Distance and accuracy of classifiers trained on the synthesised dataset.
