Predictors of mortality in mechanically ventilated patients

Abstract

Objectives: There are scarce data from India validating scoring systems used to predict outcome in patients requiring mechanical ventilation. This study prospectively compared the organ system failure (OSF), the acute physiology and chronic health evaluation (APACHE) II, and the APACHE III, scores on patients requiring mechanical ventilation in the medical intensive care unit, to predict outcome. Methods: 200 consecutive patients requiring mechanical ventilation in a medical intensive care unit were recruited. OSF, APACHE II, and APCHE III scores were calculated at admission and daily for one week or until discharge in all patients. Other variables recorded include age, sex, diagnosis, oxygen therapy before ventilation, complications on ventilation, duration in hospital before ventilation, duration of ventilation, type of respiratory failure, alveolar arterial oxygen gradient, P/F ratio, use of tracheostomy, time on ventilator before tracheostomy, muscle relaxant used, fluid balance, inotrope support. Logistic regression analysis and area under the curve were computed to determine which variables independently predict outcome. Results: Of the 200 patients, at discharge 143 patients (71.5%) had died. The factors that independently predicted outcome among these patients on mechanical ventilation were the type of respiratory failure (type I) OR = 2.7 (p = 0.02), the use of inotropes OR 2.4 (p = 0.04), and the APACHE II score OR = 1.8 (p = 0.008) for every five point increase in APACHE II score. Conclusions: Type 1 respiratory failure, the use of inotropes, and the APACHE II score measured at admission are significant independent predictors of mortality in the patients on mechanical ventilation.

A retrospective study of positive pressure ventilation in 58 dogs: indications, prognostic factors and outcome

“…Age was reported to be significantly and inversely associated with survival in dogs and cats undergoing PPV, such that each 1‐year increase in age, led to a 10% decrease in the survival odds (Hopper et al ). Similarly, in a study using the acute physiological and chronic health (APACH II) scoring system in ventilated humans, significantly higher survival rates were noted in younger (<34 years) PPV‐treated patients compared with older (>43 years) ones (Sudarsanam et al ).…”

“…The reported association between the duration of PPV and survival in humans is inconsistent. One study recorded a positive association between the two (Sudarsanam et al ), while others noted a negative one, partly due to prolonged PPV‐associated complications, especially VAP and airway trauma (Boles et al , Zanella et al ). In this study, there was no difference in the overall median duration of PPV between the outcome groups, in agreement with a previous veterinary report (Hopper et al ).…”

Mechanical Ventilation in the Intensive Care Unit: A Prospective Study of Indications and Factors that Affect Outcome in a Tertiary Hospital in Nigeria

“…Sudarsanam and co-workers [11] reported that one of the predictors of mortality in mechanically ventilated patients was the use of ionotropes. The reason for this finding may be due to the interplay which exists between the cardiovascular and respiratory systems.…”

Outcome of Patients Admitted to the Ccu (Critical Care Unit) of a Tertiary Care Hospital With Acute Exacerbation of Copd and Respiratory Failure

“…Similar results have been reported earlier by Hsu, Wann et al 20 in patients with respiratory failure due to various causes in a medical ICU and by Senef.et al 21 who found (A-a) DO2 to be more strongly associated with 180 day mortality rates (22% of explanatory power) than in-hospital mortality rates (4% of explanatory power) in patients admitted to ICU with acute exacerbation of COPD. In contrast, Sudarshanam et al 22 found (A-a) DO2 to be significantly associated with mortality on univariate analysis but was not an independent predictor on logistic regression analysis in a study comprising patients with respiratory failure due to all causes including COPD.…”