Development and evaluation of an ontology for non-invasive respiratory support in acute care

Clinical Snapshot

Key Findings

• P Value: Not applicable - no statistical testing

• Effect Size: 100% success rate in SPARQL query validation across 6 test scenarios

• Primary Outcome: Successful development of NIRS ontology with 145 classes, 11 object properties, 18 data properties

• Nnt Or Sensitivity: 392 standardised annotations added for clinical concept clarity

• Confidence Interval: Not reported

Clinical Application

Requires significant IT infrastructure and clinical workflow integration; proof-of-concept stage only Could support standardised NIRS documentation in Australian hospitals and align with TGA device classifications, though implementation would require local validation and integration with existing EMR systems Acute care patients requiring non-invasive respiratory support across all healthcare settings

Abstract

Managing patients with respiratory failure increasingly involves non-invasive respiratory support (NIRS) strategies to support respiration, often preventing the need for invasive mechanical ventilation. However, despite the rapidly expanding use of NIRS, there remains a significant challenge to its optimal use across all medical circumstances. It lacks a unified ontological structure, complicating guidance on NIRS modalities across healthcare systems. In this study, we introduced NIRS ontology to support knowledge representation in acute care settings by providing a unified framework that enhances data clarity and interoperability, laying the groundwork for future clinical decision-making research. We developed NIRS ontology using the Web Ontology Language (OWL) and Protégé to organize clinical concepts and relationships. To enable rule-based clinical reasoning beyond hierarchical structures, we added Semantic Web Rule Language (SWRL) rules. We evaluated logical reasoning using a sample of 6 patient scenarios and used SPARQL queries to retrieve and test targeted inferences. The ontology has 145 classes, 11 object properties, and 18 data properties across 949 axioms that establish concept relationships. To standardize clinical concepts, we added 392 annotations, including descriptive definitions based on controlled vocabularies. SPARQL queries successfully validated all test cases (rules) by retrieving appropriate patients' outcomes: for instance, a patient treated with HFNC (high-flow nasal cannula) for 2 hours due to acute respiratory failure may avoid endotracheal intubation. This NIRS ontology formally represents domain-specific concepts, including ventilation modalities, patient characteristics, therapy parameters, and outcomes. SPARQL query evaluations across clinical scenarios confirmed the ontology's ability to support rule‑based reasoning and therapy recommendations, providing a foundation for consistent documentation practices, integration into clinical data models, and advanced analysis of NIRS outcomes. In conclusion, this proof-of-concept NIRS ontology demonstrates how clinical concepts can be formally represented and queried, offering a foundation for future validation, EHR integration, and evidence-based refinement of NIRS practices.

References

1. 1.Islam, M. F., Mosier, J., & Subbian, V. (2026). Development and evaluation of an ontology for non-invasive respiratory support in acute care. PLoS One. https://doi.org/10.1371/journal.pone.0348199