Vázquez Saad Héctor Y, Rosado Toledo Héctor, Bredy Rafael
Internal Medicine Residency, Damas Hospital - Ponce School of Medicine Teaching Consortium, Ponce, Puerto Rico.
Bol Asoc Med P R. 2006 Oct-Dec;98(4):265-9.
There are some areas of uncertainty when it comes to determine how long a patient is going to require assisted ventilation. Our study uses Acute Physiologic and Chronic Health Evaluation (APACHE II) score to determine how many days a patient might require assisted ventilation.
All patients admitted to the Cardiac Critical Care unit and Intensive Care Units at Damas Hospital who were placed on mechanical ventilation were evaluated. Patients were evaluated from December 2003 to March 2004. During evaluation, the patient record was reviewed to obtain APACHE II score prior to mechanical ventilation placement. Exclusion criteria were patients who were not evaluated in the first 24 hrs. of admission.
11 patients were examined. Patients that had less than 3 day intubation (mean 2.4 days +/- .54) had lower APACHE II (mean 21.20). Patient with intubation longer than 3 days (mean 14.7 +/- 10.25) had higher APACHE II score (mean 27.5).
Based in our aims, general as well as specific, we conclude that lower APS do correlate with lower intubation days. Working on this data, with APACHE we could predict length of intubation and preventive actions. We think that APACHE II scoring system can be used as a prognostic factor to be discussed with family members and can also be added to current weaning indexes to predict weaning success. We recommend that APACHE II be calculated to every admitted patient to the Critical Care Units and that it should be added to weaning indexes to predict probability of extubation. We recommend a follow-up of this study with a wider population.
在确定患者需要辅助通气的时长方面，存在一些不确定的领域。我们的研究使用急性生理与慢性健康状况评估（APACHE II）评分来确定患者可能需要辅助通气的天数。
对大马士革医院心脏重症监护病房和重症监护病房中所有接受机械通气的患者进行评估。评估时间为2003年12月至2004年3月。在评估过程中，查阅患者病历以获取机械通气前的APACHE II评分。排除标准为入院后首24小时内未接受评估的患者。
共检查了11名患者。插管时间少于3天（平均2.4天±0.54）的患者APACHE II评分较低（平均21.20）。插管时间超过3天（平均14.7±10.25）的患者APACHE II评分较高（平均27.5）。
基于我们的总体及特定目标，我们得出结论，较低的APACHE评分确实与较短的插管天数相关。依据这些数据，借助APACHE评分我们能够预测插管时长并采取预防措施。我们认为APACHE II评分系统可作为一个预后因素与患者家属进行讨论，也可添加到当前的撤机指标中以预测撤机成功率。我们建议对重症监护病房的每一位入院患者都计算APACHE II评分，并将其添加到撤机指标中以预测拔管概率。我们建议对更多人群开展此项研究的后续跟进。
