Intelligent decision support with machine learning for efficient management of mechanical ventilation in the intensive care unit – A critical overview

•ICU patients’ treatment is enhanced with effective mechanical ventilation management.•Decision support with machine learning is hampered by poor modelling techniques.•Heterogenous research methods hamper a unified decision support approach.•Closed-loop control of waveforms will help improve patients’ morbidity and mortality.•Ensemble modelling provides better accuracy than a single algorithm model. Effective management of Mechanical Ventilation (MV) is vital for reducing morbidity, mortality, and cost of healthcare. This study aims to synthesize evidence for effective MV management through Intelligent decision support (IDS) with Machine Learning (ML). Databases that include EBSCO, IEEEXplore, Google Scholar, SCOPUS, and the Web of Science were systematically searched to identify studies on IDS for effective MV management regarding Tidal Volume (TV), asynchrony, weaning, and other outcomes such as the risk of Prolonged Mechanical ventilation (PMV). The quality of the articles identified was assessed with a modified Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sessional research. A total of 26 articles were identified for the study that has IDS for TV (n = 2, 7.8 %), asynchrony (n = 9, 34.6 %), weaning (n = 12, 46.2 %), and others (n = 3, 11.5 %). It was affirmed that implementing IDS in MV management will enhance seamless ICU patient management following the utilization of various Machine Learning (ML) algorithms in decision support. The studies relied on (n = 14) ML algorithms to predict the TV, asynchrony, weaning, risk of PMV and Positive End-Expiratory Pressure (PEEP) changes of 11–20262 ICU patients records with model inputs ranging from (n = 1) for timeseries analysis of TV to (n = 47) for weaning prediction. The small data size, poor study design, and result reporting, with the heterogeneity of techniques used in the various studies, hampered the development of a unified approach for managing MV efficiency in TV monitoring, asynchrony, and weaning predictions. Notwithstanding, the ensemble model was able to predict TV, asynchrony, and weaning to a higher accuracy than the other algorithms.