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Research Article
 

Analyzing the Efficacy of Apache III versus Apache II on Duration of Mechanical Ventilation and ICU Stay



S. Abrishamkar, M. Masoudifar, M. Sabouri, F. Rouhani and M. Arrabian
 
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ABSTRACT

This study have been designed to compare Apache II and Apache III scores as a predictor factors for mechanical ventilation, mortality rate, duration of mechanical ventilation and ICU stay. This is a prospective study conducted in Alzahra General Hospital, Isfahan-Iran University of medical sciences, from September 2005 to September 2006. All patients with respiratory failure due to COPD, Bronchectasis, Asthma, pulmonary edema and pulmonary emboli admitted to ICU, were evaluated. The Apache II and Apache III scores obtained were calculated at admission. Other variables recorded were clinical outcome (dead/survival), mandatory intubation and mechanical ventilation, duration of mechanical ventilation and ICU stay. Correlation between Apache II and Apache III with duration of mechanical ventilation and ICU stay analyzed by Pearson correlation coefficient and p<0.05 considered meaningful. One hundred eighty patients were enrolled, that 38 % were women and 62% men. Of the 180 patients 52 (28.9%) died and 128 (71.1%) survived. Correlation between duration of ventilation and Apache II and III were, respectively p = 0.09 and p = 0.019 and correlation between of ICU stay and Apache II and III were p = 0.09 and p = 0.019. Apache III and Apache II both were used to predict outcome and necessity of intubation and mechanical ventilation but Apache III was more significant predictive factor for ICU stay and duration of mechanical ventilation.

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  How to cite this article:

S. Abrishamkar, M. Masoudifar, M. Sabouri, F. Rouhani and M. Arrabian, 2010. Analyzing the Efficacy of Apache III versus Apache II on Duration of Mechanical Ventilation and ICU Stay. Journal of Medical Sciences, 10: 45-48.

DOI: 10.3923/jms.2010.45.48

URL: https://scialert.net/abstract/?doi=jms.2010.45.48
 

INTRODUCTION

Mechanical ventilation is an essential life support mode of treatment given to many patients in Intensive Care Unit (ICU) (Debidas et al., 1997; Eapen et al., 1997). Different scoring systems have been developed to help the physician to determine the severity of medical conditions and prediction of mortality and mobility (Eapen et al., 1997; Listello and Sessler, 1994). Although ICU stay is an important predictive factor and indirectly related to weaning time (Woods et al., 2000; Sudarsanam et al., 2005; Menzies et al., 1989) but duration of mechanical ventilation is not almost always as necessary as the patient’s condition (Listello and Sessler, 1994). It other studies the relationship of Aphacy II Score with ICU stay and duration of mechanical ventilation had been shown (Debidas et al., 1997; Eapen et al., 1997). Because Apache III score is easier to use and it is clinically more practical but still it have not been tried to show that if Apache III is as useful as Apache II (Ludwigs et al., 1991; Jeffrey et al., 1992; Portier et al., 1992; Miller et al., 1992). Therefore, we prospectively compared the two scoring systems to predict during of mechanical ventilation and ICU stay.

MATERIALS AND METHODS

This prospective study which had been conducted in Alzahra General Hospital at Isfahan University of medical sciences from September 2007 to September 2008. All patients with respiratory failure due to COPD, bronchectasia, asthma, pulmonary edema and pulmonary emboli that needed ICU were evaluated. The patients with age under 18 years, burns, mortality at the first 24 h, pelvic fracture, cardiopulmonary arrest, cardiac disease and postoperative condition, were excluded. Respiratory failure was defined as PaO2<55 mmHg and PaCO2 >50 mm Hg. Indications of endotracheal intubation (ET) were respiratory arrest, unconsciousness, increasing PaCO2 and base acid disorder. The scores obtained in Apache II (Woods et al., 2000) and Apache III (Listello and Sessler, 1994) was calculated at admission. Other variables recorded included clinical outcome (dead/survival), necessity of intubation and mechanical ventilation, duration of mechanical ventilation and ICU stay. Other parameters such as temperature, pulse and respiratory rate, blood pressure, hematocrite, liver and renal function test, serum electrolytes, base acid balance and oxygenation were aggregated during study.

Apache II and Apache III scores based on the need to intubation and mechanical ventilation and mortality rate were analyzed. Correlation between Apache II and Apache III with duration of mechanical ventilation and ICU stay analyzed by Pearson correlation coefficient and p<0.05 considered meaningful.

RESULTS

One hundred eighty patients were enrolled that 38 % were women and 62% were men. Of the 180 patients 52 (28.9%) died and 128 (71.1%) survived. The mean of Apache II was 21.41+2.81 and Apache III was 63.97+11.2. 146 (81.1%) of patients were intubated. Of one hundred eighty patients, 137 (76.11%) of patients needed mechanical ventilation.The mean duration of intubation and mechanical ventilation and ICU stay were subsequently; 19.97+2.31, 11.17+1.19 and 31.62+8.14 days.

The average score of the Apache II and the Apache III based on necessity of intubation and mechanical ventilation and mortality rate are shown in Table 1.

Among 137 patients that needed mechanical ventilation, analysis of correlation was preformed between duration of ventilation and Apache II and III (Table 2).

The mean of duration of ICU stay was 31.62 days: (min: 6 max: 122 days) correlation between of ICU stay and two scores of Apache are shown in Table 3 (Woods et al., 2000).

Table 1: The average score of the Apache II and Apache III based on the need to intubation and mechanical ventilation and mortality rate
Image for - Analyzing the Efficacy of Apache III versus Apache II on Duration of Mechanical Ventilation and ICU Stay

Table 2: Correlation between duration of ventilation and Apache II and III score
Image for - Analyzing the Efficacy of Apache III versus Apache II on Duration of Mechanical Ventilation and ICU Stay
p = 0.019, p = 0.091

Table 3: Correlation between of ICU stay and two scores of apache
Image for - Analyzing the Efficacy of Apache III versus Apache II on Duration of Mechanical Ventilation and ICU Stay
p = 0.019, p = 0.091

DISCUSSION

Scoring systems primarily developed for estimating prognosis in critically ill patients have not been well validated in mechanically ventilated patients. Modified Organ System Failure (OSF) score had been shown that be superior to the Apache score in predicting mortality (Eapen et al., 1997).

So, suggested that Apache II score measured at admission is significant independent predictor of mortality in the patients on mechanical ventilation (Sudarsanam et al., 2005). This study was done on patients to compare Apache II and Apache III scores as predictor factors for mechanical ventilation and mortality rate and duration of mechanical ventilation and remaining in ICU.

The data show that 76.11% of patients admitted to ICU needed mechanical ventilation that is more than sudarsanam study (Sudarsanam et al., 2005) (76.11% vs. 41%) Our patients had more critical conditions. Patients with respiratory failure and lower mean arterial pressure, comorbid condition (Spicher and White, 1987; Menzies et al., 1989), high blood urea (Ludwigs et al., 1991) and requiring ventilation within first 24 h (Portier et al., 1992). Lower serum albumin and lower FEV1, had been found to have poorer prognosis but were not shown to independently predict outcome (Sudarsanam et al., 2005). Among patients with type I respiratory failure, sepsis, multi-organ system failure, cardiac failure, higher bronchoalveolar fluid interleukin 8 concentrations (Miller et al., 1992), worsening renal function (Sloane et al., 1992), a longer duration of mechanical ventilation, medically ill patients with sepsis and multiple transfusions as compared with trauma patients with the above comorbidities (Hudson, 1989) were all found to have an adverse affect on outcome. (Sudarsanam et al., 2005). Present study showed that Apache III as compared with Apache II causes significant longer duration of mechanical ventilation (Spicher and White, 1987). Then patients with higher Apache III will had more poor prognosis compared with others and could be consider as a predictive factor for prognosis (Suchyta et al., 1992). Gupta et al. (2001) had shown an Apache III score of >57 predicted a poor outcome but Sudarsanam et al. (2005) believed that Apache II score is a factor that had prognostic significance on out come Nevins and Epstein (2001) have also shown that the Apache II associated comorbidities predicted a poorer outcome for COPD patients requiring mechanical ventilation (Menzies et al., 1989). Present study showed that Apache III is more important predictive factor in ICU stay and duration of mechanical ventilation than Apache II (Ludwigs et al., 1991). Some other studies shown that Apache III score couldn’t be used as well as the Apache II for predict outcome because arterial PH, as a significant predictive value (Diener and Burrows, 2001), is not included in the Apache III scoring system and additional variables in the Apache III such as billirubin and glucose may not have any bearing on the population (Sudarsanam et al., 2005). However our study had shown that Apache III is more significant to predict ICU stay as an important predictive factor to weaning time (Woods et al., 2000).

In conclusion, we have noted that Apache III and Apache II both could be used to predict outcome and need to intubation and mechanical ventilation but Apache III is more significant index as a predictive factor for ICU stay and duration of mechanical ventilation.

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