Development of a prognostic scoring system in patients with pneumonia requiring ventilator care for more than 4 days: a single-center observational study

Abstract

Background: The aim of the present study was to develop a prognostic model using demographic characteristics, comorbidities, and clinical variables measured on day 4 of mechanical ventilation (MV) for patients with prolonged acute mechanical ventilation (PAMV; MV for >96 hours). Methods: Data from 437 patients (70.9% male; median age, 68 years) were obtained over a period of 9 years. All patients were diagnosed with pneumonia. Binary logistic regression identified factors predicting mortality at 90 days after the start of MV. A PAMV prognosis score was calculating ß-coefficient values and assigning points to variables. Results: The overall 90-day mortality rate was 47.1%. Five factors (age ≥65 years, body mass index <18.5 kg/m 2 , hemato-oncologic diseases as comorbidities, requirement for vasopressors on day 4 of MV and requirement for neuromuscular blocking agents on day 4 of MV) were identified as prognostic indicators. Each factor was valued as +1 point, and used to develop a PAMV prognosis score. This score showed acceptable discrimination (area under the receiver operating characteristic curve of 0.695 for mortality, 95% confidence interval 0.650-0.738, p<0.001), and calibration (Hosmer-Lemeshow chi-square=6.331, with df 7 and p=0.502). The cutoff value for predicting mortality based on the maximum Youden index was ≤2 (sensitivity, 87.5%; specificity, 41.3%). For patients with PAMV scores ≤1, 2, 3 and ≥4, the 90-day mortality rates were 29.2%, 45.7%, 67.9%, and 90.9%, respectively (P<0.001). Conclusions: Our study developed a PAMV prognosis score for predicting 90-day mortality. Further research is needed to validate the utility of this score.

Ability of the modified NUTRIC score to predict mortality in patients requiring short-term versus prolonged acute mechanical ventilation: a retrospective cohort study

“… 24 Various prognostic indicators have been identified, including older age (⩾65 years); underweight (BMI ⩽ 18.5 kg/m 2 ); hemato-oncologic malignancies as comorbidities; the requirement for medical resources such as vasopressors, neuromuscular blockade, and hemodialysis on day 4 of MV; and other clinical variables, such as PaO 2 /FiO 2 < 200 mm Hg, platelet count < 100 × 10 9 /L, albumin < 3.5 g/dL, BUN >7 mmol/L, pH < 7.35, lactic acid > 2.0 mmol/L, and serum sodium ⩾ 145 mmol/L. 26 – 32 Other extraneous factors, including the perspectives of patients’ families or surrogates, physician–family communications, and the utilization of medical resources, could also be considered prognostic indicators. A model that includes these individualized parameters, rather than the m-NUTRIC score alone, may be more predictive of mortality in patients undergoing PAMV.…”

Predicting Mechanical Ventilation For More Than 7 Days In The Emergency Department

“…There was no difference in PaO 2 /FiO 2 ratio between the two patient groups; this value was found not to be a risk factor of PMV. Oh et al reported that the ventilator days in pneumonia was related to PaO 2 /FiO 2 ratio [23]. It has been reported that the PaO 2 /FiO 2 ratio may differ between patients with acute respiratory distress syndrome who survive versus those who do not, although it does not necessarily serve as an indicator of mortality because of variations in MV settings, the patients' condition, and patient posture.…”

Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation

“…Gattinoni and colleagues’ original equation for MP is based on volume-controlled ventilation with a linear increase in airway pressure and was validated in paralyzed patients [ 5 ]. Thus, this equation may not be useful in a significant number of mechanically ventilated patients because the use of pressure-regulated ventilation has been increasing [ 10 ], and restricted use of neuromuscular blocking agents (NMBAs) is advocated due to their detrimental effects [ 11 , 12 ].…”