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The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation

Published online by Cambridge University Press:  23 December 2004

B. Schönhofer ,
J. J. Guo ,
S. Suchi ,
D. Köhler  and
R. Lefering
B. Schönhofer
Affiliation:
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg, Germany
J. J. Guo
Affiliation:
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg, Germany
S. Suchi
Affiliation:
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg, Germany
D. Köhler
Affiliation:
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg, Germany
R. Lefering
Affiliation:
University of Cologne, 2nd Department of Surgery, Biochemical and Experimental Division, Cologne, Germany
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Extract

Summary

Background and objective: To examine the calibration of the prognostic system Acute Physiology and Chronic Health Evaluation Score (APACHE II) regarding hospital mortality and predicting weaning outcome after long-term mechanical ventilation of the lungs.

Methods: Prospective observational cohort study performed in a respiratory intensive care unit including 246 patients whose lungs were ventilated for 42.1 ± 37.8 (median 30) days in the referring hospital. APACHE II (24 h after admission to our respiratory intensive care unit) and the cause of respiratory failure, underlying disease, prior duration of mechanical ventilation and gender were recorded. The predictive power was evaluated with sensitivity and specificity for different cut-off points and summarized in a receiver operating characteristic curve.

Results: No difference was found between survivors (APACHE II 16.0 ± 4.3) and non-survivors (APACHE II 16.9 ± 5.1). In a mean time of 8.0 ± 10.3 days, 146 patients (59.3%) were successfully weaned (APACHE II 15.2 ± 3.5). One-hundred patients (40.7%) were considered unweanable (APACHE II 17.7 ± 5.3). Recalibration of APACHE II to predict weaning failure was possible, resulting in an area under the receiver operating characteristic curve (AUC) of 0.638. Furthermore the AUC improved to 0.723 by changing the weights of selected APACHE items and introducing external factors. Diagnostic accuracy fell from group with mechanical ventilation ≤25 days (AUC 0.770) to group with mechanical ventilation >50 days (AUC 0.517).

Conclusions: APACHE II did not predict hospital mortality after long-term mechanical ventilation of the lungs. Not the original APACHE II but a recalibrated and adapted APACHE II can be useful to predict weaning outcome in patients with less than 25 days of prior lung ventilation.

Keywords

HEALTH STATUS INDICATORS, APACHE IIHOSPITAL MORTALITYPULMONARY DISEASE, chronic obstructiveRESPIRATORY THERAPY, respiration, artificial, ventilator weaning
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 7 , July 2004 , pp. 558 - 565
Copyright
2004 European Society of Anaesthesiology

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