APACHE II score cannot predict successful weaning from prolonged mechanical ventilation

Anna Rojek-Jarmuła, Rainer Hombach, Łukasz J Krzych, Anna Rojek-Jarmuła, Rainer Hombach, Łukasz J Krzych

Abstract

At least 5% of all intensive care unit patients require prolonged respiratory support. Multiple factors have been suggested as possible predictors of successful respiratory weaning so far. We sought to verify whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) can predict freedom from prolonged mechanical ventilation (PMV) in patients treated in a regional weaning centre. The study group comprised 130 consecutive patients (age; median (interquartile range): 71 (62-77) years), hospitalized between 1 January 2012, and 31 December 2013. APACHE II score was assessed based on the worst values taken during the first 24 hours after admission. Glasgow coma scale was excluded from calculations due to the likely influence of sedative agents. The outcome was defined as freedom from mechanical ventilation, with or without tracheostomy on discharge. Among survivors ( n = 115), 88.2% were successfully liberated from mechanical ventilation and 60.9% from tracheostomy. APACHE II failed to predict freedom from mechanical ventilation (area under the receiver-operating characteristic curve [AUROC] = 0.534; 95% confidence interval [CI]: 0.439-0.628; p = 0.65) and tracheostomy tube removal (AUROC = 0.527; 95% CI: 0.431-0.621; p = 0.63). Weaning outcome was unrelated to the aetiology of respiratory failure on admission ( p = 0.41). APACHE II cannot predict weaning outcome in patients requiring PMV.

Keywords: APACHE score; Prolonged mechanical ventilation; outcome; prediction; weaning.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patients’ flow chart by weaning outcome.
Figure 2.
Figure 2.
Prediction of ventilatory independence (a) with or without tracheostomy and (b) without tracheostomy by APACHE II score. APACHE II: Acute Physiology and Chronic Health Evaluation II.
Figure 3.
Figure 3.
Ventilatory independence (with or without tracheostomy) by aetiology of respiratory failure.

References

    1. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.
    1. Zimmerman JE, Kramer AA. A history of outcome prediction in the ICU. Curr Opin Crit Care 2014; 20: 550–556.
    1. Hong S, Wang S, Xu G, et al. Evaluation of the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems in predicting postoperative mortality and morbidity in gastric cancer patients. Asian J Surg. Epub ahead of print 23 September 2015. DOI: 10.1016/j.asjsur.2015.07.004.
    1. Cho JH, Kim TN, Chung HH, et al. Comparison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol 2015; 21: 2387–2394.
    1. Fadaizadeh L, Tamadon R, Saeedfar K, et al. Performance assessment of acute physiology and chronic health evaluation II and simplified acute physiology score II in a referral respiratory intensive care unit in Iran. Acta Anaesthesiol Taiwan 2012; 50: 59–62.
    1. Aydoğdu M, Ozyilmaz E, Aksoy H, et al. Mortality prediction in community-acquired pneumonia requiring mechanical ventilation; values of pneumonia and intensive care unit severity scores. TuberkToraks 2010; 58: 25–34.
    1. Kübler A, Maciejewski D, Adamik B, et al. Mechanical ventilation in ICUs in Poland: a multi-center point-prevalence study. Med Sci Monit 2013; 19: 424–429.
    1. Peñuelas O, Frutos-Vivar F, Fernández C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med 2011; 184: 430–437.
    1. Dasgupta A, Rice R, Mascha E, et al. Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest 1999; 116: 447–455.
    1. Rose L, Fraser IM. Patient characteristics and outcomes of a provincial prolonged-ventilation weaning centre: a retrospective cohort study. Can Respir J 2012; 19: 216–220.
    1. Mamary AJ, Kondapaneni S, Vance GB, et al. Survival in patients receiving prolonged ventilation: factors that influence outcome. Clin Med Insights Circ Respir Pulm Med 2011; 5: 17–26.
    1. Seneff MG, Zimmerman JE, Knaus WA, et al. Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics. Chest 1996; 110: 469–479.
    1. Clark PA, Lettieri CJ. Clinical model for predicting prolonged mechanical ventilation. J Crit Care 2013; 28: 880e1–7.
    1. Schönhofer B, Geiseler J, Dellweg D, et al. Prolonged weaning: S2k-guideline published by the German Respiratory Society. Pneumologie 2014; 68: 19–75.
    1. Rojek-Jarmuła A, Hombach R, Gierek D, et al. A single-centre seven-year experience with mechanical ventilation weaning. Anaesthesiol Intensive Ther 2015; 47: 204–209.
    1. Schönhofer B, Geiseler J, Pfeifer M, et al. WeanNet: a network of weaning units headed by pneumologists. Pneumologie 2014; 68: 737–742.
    1. Shaikh H, Morales D, Laghi F. Weaning from mechanical ventilation. Semin Respir Crit Care Med 2014; 35: 451–468.
    1. McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med 2012; 367: 2233–2239.
    1. Pilcher DV, Bailey MJ, Treacher DF, et al. Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax 2005; 60: 187–192.
    1. Lone NI, Walsh TS. Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit. Crit Care 2011; 15: R102.
    1. Barchfeld T, Dellweg D, Böckling S, et al. Weaning from long-term mechanical ventilation: data of a single weaning center from 2007 to 2011. Dtsch Med Wochenschr 2014; 139: 527–533.
    1. Oehmichen F, Ketter G, Mertl-Rötzer M, et al. Weaning from prolonged mechanical ventilation in neurological weaning units: an evaluation of the German Working Group for early neurorehabilitation. Nervenarzt 2012; 83: 1300–1307.
    1. Damuth E, Mitchell JA, Bartock JL, et al. Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med 2015; 3: 544–553.
    1. Sporn PH, Morganroth ML. Discontinuation of mechanical ventilation. Clin Chest Med 1988; 9: 113–126.
    1. Schönhofer B, Guo JJ, Suchi S, et al. The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation. Eur J Anaesthesiol 2004; 21: 558–565.
    1. Matic I, Titlic M, Dikanovic M, et al. Effects of APACHE II score on mechanical ventilation; prediction and outcome. Acta Anaesthesiol Belg 2007; 58: 177–183.
    1. Quinnell TG, Pilsworth S, Shneerson JM, et al. Prolonged invasive ventilation following acute ventilatory failure in COPD: weaning results, survival, and the role of noninvasive ventilation. Chest 2006; 129: 133–139.
    1. Gluck EH. Predicting eventual success or failure to wean in patients receiving long-term mechanical ventilation. Chest 1996; 110: 1018–1024. Erratum in: Chest 1997; 111: 836.
    1. Safavi M, Honarmand A. Comparison of infection probability score, APACHE II, and APACHE III scoring systems in predicting need for ventilator and ventilation duration in critically ill patients. Arch Iran Med 2007; 10: 354–360.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel