Afessa B, Hogans L, Murphy R
Department of Medicine, University of Florida Health Science Center, Jacksonville, USA.
Chest. 1999 Aug;116(2):456-61. doi: 10.1378/chest.116.2.456.
To determine the correlation of acute physiology and chronic health evaluation (APACHE) II score and various weaning indexes (WIs) with 3- and 7-day weaning outcomes.
Prospective, observational.
The medical ICU of a teaching, urban hospital.
The study included 118 adults referred for weaning from mechanical ventilation (MV). Critical care physicians, critical care nurses, and respiratory care practitioners were asked to predict whether it would take < or =3 days, 4 to 7 days, or > or =8 days to wean each patient from MV. The WIs and APACHE II scores were measured or calculated. The causes of respiratory failure, the duration of MV before initiating weaning assessment, and the 3- and 7-day weaning outcomes were obtained. Significance was set at p<0.05.
The most common causes of respiratory failure were pneumonia (38 cases) and acute exacerbation of COPD (29 cases). Fifty-seven patients (48%) were successfully weaned from MV within 3 days of weaning assessment, and 67 (57%) were weaned within 7 days. The percentages of correct prediction of 3-day weaning outcome by critical care physicians, critical care nurses, and respiratory care practitioners were 64%, 62%, and 59%, respectively; for 7-day weaning outcome, 60%, 64%, and 58%, respectively. The successfully weaned groups had significantly lower APACHE II scores and higher maximal inspiratory pressures than the unsuccessfully weaned (failure) groups. There were no significant differences between the two groups for the remaining indexes, including rapid shallow breathing, dynamic compliance, static compliance, spontaneous respiratory rate, and the ratio of PaO2 to the fraction of inspired oxygen.
The overall severity of illness as assessed by APACHE II score correlates better with 3- and 7-day weaning outcome than the published WIs.
确定急性生理与慢性健康状况评估（APACHE）II评分及各种撤机指标（WI）与3天和7天撤机结果之间的相关性。
前瞻性观察研究。
一所城市教学医院的医学重症监护病房。
本研究纳入了118名接受机械通气（MV）撤机的成年人。要求重症监护医师、重症监护护士和呼吸治疗师预测每位患者从MV撤机需要≤3天、4至7天还是≥8天。测量或计算WI和APACHE II评分。获取呼吸衰竭的病因、开始撤机评估前的MV持续时间以及3天和7天的撤机结果。显著性设定为p<0.05。
呼吸衰竭最常见的病因是肺炎（38例）和慢性阻塞性肺疾病急性加重（29例）。57名患者（48%）在撤机评估后3天内成功从MV撤机，67名（57%）在7天内撤机。重症监护医师、重症监护护士和呼吸治疗师对3天撤机结果的正确预测百分比分别为64%、62%和59%；对7天撤机结果的正确预测百分比分别为60%、64%和58%。成功撤机组的APACHE II评分显著低于未成功撤机（失败）组，最大吸气压则显著高于未成功撤机组。两组在其余指标上无显著差异，包括快速浅呼吸、动态顺应性、静态顺应性、自主呼吸频率以及动脉血氧分压与吸入氧分数之比。
与已发表的WI相比，APACHE II评分评估的总体疾病严重程度与3天和7天撤机结果的相关性更好。
