As critically ill patients frequently develop anemia or coagulopathy, transfusion of blood products is a frequent intervention in the Intensive Care Units (ICU). However, inappropriate transfusion decisions made by physicians are often associated with increased risk of complications and higher hospital costs. In this work, we aim to develop a decision support tool that uses available patient information for transfusion decision-making on three common blood products (red blood cells, platelets, and fresh frozen plasma). To this end, we adopt an off-policy batch reinforcement learning (RL) algorithm, namely, discretized Batch Constrained Q-learning, to determine the best action (transfusion or not) given observed patient trajectories. Simultaneously, we consider different state representation approaches and reward design mechanisms to evaluate their impacts on policy learning. Experiments are conducted on two real-world critical care datasets: the MIMIC-III and the UCSF. Results demonstrate that policy recommendations on transfusion achieved comparable matching against true hospital policies via accuracy and weighted importance sampling evaluations on the MIMIC-III dataset. Furthermore, a combination of transfer learning (TL) and RL on the data-scarce UCSF dataset can provide up to $17.02% improvement in terms of accuracy, and up to 18.94% and 21.63% improvement in jump-start and asymptotic performance in terms of weighted importance sampling averaged over three transfusion tasks. Finally, simulations on transfusion decisions suggest that the transferred RL policy could reduce patients' estimated 28-day mortality rate by 2.74% and decreased acuity rate by 1.18% on the UCSF dataset.

该论文通过使用强化学习算法，基于患者重症监护室中的临床数据，开发出一种用于输注决策辅助的工具，结合状态表示方法和奖励设计机制进行了实验以提高策略的性能，并对真实医院数据的策略准确性进行了评估，结果表明，该方法能够有效地改善患者预后和减少医疗成本。

应用强化学习预测重症监护室输血需求