Apache Ii Score as Predictor of Failure of Non-Invasive Mechanical Ventilation in the Emergency Department

Abstract

Objectives:To evaluate the APACHE II score as predictor of failure of noninvasive mechanical ventilation in the emergency department.Place and Duration This study was conducted in Ziauddin University Hospital Karachi from January 2022 to January 2023 Background:Patients in emergency department (ED) are more in need of ventilator support compared to other hospitalized patients. Early and appropriate use of noninvasive ventilation is very important in ED that not only decreases the need of endotracheal intubation (ETI) but also decreases the patient’s length of hospital stay, and rate of mortality.Thus, early identification of predictors for determining the failure of NIV is very important because it will help in selection of patient for NIV in ED, whereas patients with more chances of failure will be managed directly by ETI without any delay.Methods: A quasi experimental study on patients of grade III and IV of dyspnea according to NYHA (New York Heart Association) having age of ≥ 18 years were performed. Fifty consecutive patients were selected from emergency department (ED) of Ziauddin University Hospital Karachi.Patient vital signs and Arterial Blood Gas (ABG) were monitored at baseline and after one hour of noninvasive mechanical ventilation (NIV). Glasgow coma scale (GCS) score and APACHE II score were calculated and NIV success or failure was measured as outcome. Attached proforma was filled by researcher.Results: NIV was Successful in 39 (78.0%) patients and failed in 11 (22.0%) patients. Mean of APACHE-II scorewas 17.36  ± 9.78 (2-70). Mean of APACHE-II scorein NIVsuccessful cases was 14.18 ± 5.03 (2-20) and in failure cases was 28.64 ± 13.92 (21-70) with p-value of <0.001.Conclusion:Prevalence of success of noninvasive mechanical ventilation in the emergency department was high. APACHE II score is very much important in predicting success or failure of noninvasive mechanical ventilation. A cut-off of APACHE-II score≤ 20 shows the success and APACHE-II score> 20 shows the failure of noninvasive mechanical ventilation.