Motivated by the Acute Respiratory Distress Syndrome Network (ARDSNetwork) ARDS respiratory management (ARMA) trial, we developed a flexible Bayesian machine learning approach to estimate the average causal effect and heterogeneous causal effects among the always-survivors stratum when clinical outcomes are subject to truncation. We adopted Bayesian additive regression trees (BART) to flexibly specify separate models for the potential outcomes and latent strata membership. In the analysis of the ARMA trial, we found that the low tidal volume treatment had an overall benefit for participants sustaining acute lung injuries on the outcome of time to returning home, but substantial heterogeneity in treatment effects among the always-survivors, driven most strongly by sex and the alveolar-arterial oxygen gradient at baseline (a physiologic measure of lung function and source of hypoxemia). These findings illustrate how the proposed methodology could guide the prognostic enrichment of future trials in the field. We also demonstrated through a simulation study that our proposed Bayesian machine learning approach outperforms other parametric methods in reducing the estimation bias in both the average causal effect and heterogeneous causal effects for always-survivors.

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