PURPOSE:The performance of tracheostomy in ICU in most instances is at the discretion of the physician involved. Development of a clinical prediction tool to identify patients who may benefit from early tracheostomy can be extremely helpful. APACHE IV scores have demonstrated utility in predicting outcomes based on severity of illness and pre-existing patient characteristics. We conducted a study to evaluate APACHE IV as a predictor for tracheostomy in patients admitted to the medical intensive care unit.
METHODS:We conducted a retrospective cohort study enrolling patients admitted to MICU with respiratory failure requiring mechanical ventilation at the time of admission or within 24 hours from the time of admission. APACHE scores were calculated using an online APACHE score calculator at the time of admission to the MICU. Outcomes of each of these patients were categorized in to those who were successfully extubated or patients who underwent tracheostomy.
RESULTS:Sixty-three consecutive patients were identified who were admitted to MICU with respiratory failure requiring mechanical ventilation and their APACHE IV score calculated. Eight (89%) of nine patients with APACHE IV score greater than 80 could not be extubated when compared to twenty-two (41%) of fifty-four patients with APACHE IV score less than 80 (P = 0.01).
CONCLUSION:Patients with APACHE IV scores greater than eighty are less likely to be extubated successfully.
CLINICAL IMPLICATIONS:APACHE IV scores can be used as a clinical predictor for early tracheostomy in patients with respiratory failure in ICU.
DISCLOSURE:Yatin Mehta, No Financial Disclosure Information; No Product/Research Disclosure Information