AI for the hemodynamic assessment of critically ill and surgical patients: focus on clinical applications

Several artificial intelligence (AI)-driven tools have emerged for the hemodynamic evaluation of critically ill and surgical patients. This article provides an overview of current developments and potential clinical applications of machine learning (ML) for blood pressure measurements, hypotension prediction, hemodynamic profiling, and echocardiography. ML algorithms have shown promise in enabling continuous, non-invasive blood pressure monitoring by analyzing pulse oximetry waveforms, though these methods require periodic calibration with traditional oscillometric brachial cuffs. Additionally, a variety of ML models have been trained to forecast impending hypotension. However, clinical research indicates that these algorithms often primarily rely on mean arterial pressure, leading to questions about their added predictive value. The issue of false-positive alerts is also significant and can result in unwarranted clinical interventions. In terms of hemodynamic profiling, ML algorithms have been proposed to automatically classify patients into specific hemodynamic endotypes. However, current evidence suggests these models tend to replicate conventional hemodynamic profiles found in medical textbooks or depicted on advanced hemodynamic monitors. This raises questions about their practical clinical utility, especially given occasional discrepancies that could impact treatment decisions. Point-of-care ultrasound (POCUS) has gained traction for evaluating cardiac function in patients experiencing circulatory shock. ML algorithms now embedded in some POCUS systems can assist by recognizing ultrasound images, guiding users for optimal imaging, automating and reducing the variability of key echocardiographic measurements. These capabilities are especially beneficial for novice operators, potentially enhancing accuracy and confidence in clinical decision-making. In conclusion, while several AI-based technologies show promise for refining hemodynamic assessment in both critically ill and surgical patients, their clinical value varies. Comprehensive validation studies and real-world testing are essential to identify which innovations will genuinely contribute to improving the quality of care.