# Realistic CDSS Drug Dosing with End-to-end Recurrent Q-learning for Dual Vasopressor Control

arXiv: https://arxiv.org/abs/2510.01508 · HTML: https://mlsanity.com/paper/2510.01508/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in RL for clinical treatment and surgery, one of 15 directions in Deep reinforcement learning methods.
- Builds on 13 of its 27 references that are in the map.
- First posted on arXiv 1 Oct 2025.

## Placed in

- Deep reinforcement learning methods / [RL for clinical treatment and surgery](https://mlsanity.com/deeprl/rl-for-clinical-treatment-and-surgery/)

## Builds on (most cited first, 13 of 13)

- [Conservative Q-Learning for Offline Reinforcement Learning](https://mlsanity.com/paper/2006.04779/) (2020)
- [Deep Reinforcement Learning with Double Q-learning](https://mlsanity.com/paper/1509.06461/) (2015)
- [Mastering Atari, Go, Chess and Shogi by Planning with a Learned Model](https://mlsanity.com/paper/1911.08265/) (2019)
- [Offline Reinforcement Learning with Implicit Q-Learning](https://mlsanity.com/paper/2110.06169/) (2021)
- [Prioritized Experience Replay](https://mlsanity.com/paper/1511.05952/) (2015)
- [AWAC: Accelerating Online Reinforcement Learning with Offline Datasets](https://mlsanity.com/paper/2006.09359/) (2020)
- [MOReL : Model-Based Offline Reinforcement Learning](https://mlsanity.com/paper/2005.05951/) (2020)
- [Hierarchical Deep Reinforcement Learning: Integrating Temporal Abstraction and Intrinsic Motivation](https://mlsanity.com/paper/1604.06057/) (2016)
- [Action Robust Reinforcement Learning and Applications in Continuous Control](https://mlsanity.com/paper/1901.09184/) (2019)
- [A Review of Off-Policy Evaluation in Reinforcement Learning](https://mlsanity.com/paper/2212.06355/) (2022)
- [Action Branching Architectures for Deep Reinforcement Learning](https://mlsanity.com/paper/1711.08946/) (2017)
- [Discrete and Continuous Action Representation for Practical RL in Video Games](https://mlsanity.com/paper/1912.11077/) (2019)
- [Off-Policy Fitted Q-Evaluation with Differentiable Function Approximators: Z-Estimation and Inference Theory](https://mlsanity.com/paper/2202.04970/) (2022)

## Abstract (arXiv)

Reinforcement learning (RL) applications in Clinical Decision Support Systems (CDSS) frequently encounter skepticism because models may recommend inoperable dosing decisions. We propose an end-to-end offline RL framework for dual vasopressor administration in Intensive Care Units (ICUs) that directly addresses this challenge through principled action space design. Our method integrates discrete, continuous, and directional dosing strategies with conservative Q-learning and incorporates a novel recurrent modeling using a replay buffer to capture temporal dependencies in ICU time-series data. Our comparative analysis of norepinephrine dosing strategies across different action space formulations reveals that the designed action spaces improve interpretability and facilitate clinical adoption while preserving efficacy. Empirical results on eICU and MIMIC demonstrate that action space design profoundly influences learned behavioral policies. Compared with baselines, the proposed methods achieve more than 3x expected reward improvements, while aligning with established clinical protocols.