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Chin Med J (Engl). 2014;127(1):11-7.

Prognosis and weaning of elderly multiple organ dysfunction syndrome patients with invasive mechanical ventilation.

Author information

1
Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
2
Department of Respiratory Medicine, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, China.
3
Department of Cardiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
4
Department of Respiratory Medicine, Shandong Jining No. 1 People's Hospital, Jining, Shandong 272001, China.
5
Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital, Beijing 100853, China. Email: xielx@263.net.

Abstract

BACKGROUND:

Elderly multiple organ dysfunction syndrome (MODS) patients receiving invasive mechanical ventilation have poor prognosis in intensive care units (ICUs). We studied the usefulness of four commonly used severity scores and extrapulmonary factors that affected weaning to predict outcome of such patients.

METHODS:

Clinical data of 197 patients on admission to ICUs (from January 2009 to June 2012) were used retrospectively. The Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Sample Acute Physiological Score (SAPS) II and MODS scores were calculated. All the patients were grouped into survivors and nonsurvivors according to the prognosis. Patients, who weaned from ventilator (n = 154), were subdivided into a successful weaning group and a failed weaning group. The receiver operating characteristic (ROC) curves and Logistic regression was used for prognostic and weaning assessment.

RESULTS:

Based on the outcomes, the areas under the ROC of APACHE II, APACHE III, SAPS II, and MODS were 0.837, 0.833, 0.824, and 0.837, respectively. The Logistic regression analysis revealed that the odds ratio (OR) of underlying lung diseases, serum albumin and creatinine, and the number of organ failures was 2.374, 0.920, 1.003, and 1.547. APACHE II scores on admission performed excellent (ROC: 0.921) on the weaning assessments.

CONCLUSIONS:

APACHE II and MODS systems were marginally better for evaluating the prognosis of elderly MODS patients who received invasive mechanical ventilation. Underlying lung diseases, serum albumin, serum creatinine and the number of organ failures were independent prognostic factors. Using the APACHE II scores on admission before weaning may increase the likelihood of successful weaning. (ClinicalTrial.gov identifier NCT01802983).

PMID:
24384417
[Indexed for MEDLINE]

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