The timing for tracheostomy for patients with respiratory failure in ICU is at the discretion of the treating physician. The development of a clinical prediction tool to identify patients that may benefit from early tracheostomy can be extremely helpful. We conducted a study to evaluate the usefulness of Murray's score in predicting successful extubation in patients admitted to medical intensive care unit.
We conducted a prospective observational study enrolling patients admitted to MICU with respiratory failure requiring mechanical ventilation at the time of admission or within 24hrs from the time of admission. Murray's scores were calculated for all patients at the time of admission to the MICU. The Murray's score uses radiographic findings on admission, oxygenation, lung compliance and PEEP to assess the acuity of lung injury. Patients were categorized in to two groups: those that were successfully extubated (Group 1) and those who underwent tracheostomy or died while intubated (Group 2).
135 consecutive patients admitted to MICU with respiratory failure requiring mechanical ventilation were enrolled. All patients had Murray's Acute Lung Injury Score calculated on admission and categorized into two groups, Group A with score less than 2 and Group B with score greater than 2. Fisher's exact test was used for statistical analysis. 21 (61.8%) of 34 patients with Murray's score > 2 could not be extubated when compared to 41(40.6%) of 101 patients with Murray's score < 2. The p-value was statistically significant at 0.046(two tailed).
Patients with Murray's Acute Lung Injury Score greater than 2 are less likely to be extubated successfully.
Murray's Acute Lung Injury Score on admission can be used as a clinical predictor for early tracheostomy in patients with respiratory failure in ICU.
Prashant Gundre, No Financial Disclosure Information; No Product/Research Disclosure Information