APACHE Score Used in Predicting Weaning Outcomes in an Intermediate Respiratory Care Center

Background: This study explores the outcomes of patients with prolonged mechanical ventilation (PMV) treated in an intermediate respiratory care center (RCC), and assesses the effectiveness of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting outcomes in this group of difficult-to-wean patients. Methods: A prospective observational study was used to recruit consecutive PMV patients in an RCC. Demographics, patient source, time to weaning, and outcomes of weaning attempts were recorded. The APACHE II score was obtained within 24 hours after arriving at the RCC. Outcomes measured were successful weaning, mortality, transfer back to the intensive care unit, and transfer to the respiratory care ward. Results: In all, 508 consecutive patients from among the 6820 ventilator patients screened were recruited. The mean duration of mechanical ventilation before entering the RCC was 31.1±18. 6 days. The mean APACHE II score was 19.3±6.2 on arrival at the RCC. The mean duration of RCC stay was 21.3±13.4 days. Of the recruited patients, 55.5% were successfully weaned, 20.3% failed to wean, 19.7% died, and 4.5% were transferred back to intensive care units; 40% of the successfully weaned patients were weaned by day 10. The APACHE II score was negatively correlated with successful weaning, and positively correlated with mortality, but bore no relationship with the duration of RCC stay. Conclusion: The APACHE II score is moderately reliable in predicting outcomes of patients in an RCC. Our results offered some information that could be used in reforming services for PMV patients.