Clark and Lettieri developed a model for identifying a patient at risk for prolonged mechanical ventilation. This can help to identify a patient who may benefit from more aggressive management. The authors are from Walter Reed National Military Medical Center and the Uniformed Services University in Bethesda.
Outcome: mechanical ventilation > 14 days (prolonged)
Parameters:
(1) intubation in the MICU
(2) heart rate in beats per minute
(3) BUN in mg/dL
(4) pH
(5) serum creatinine in mg/dL
(6) serum bicarbonate in mEq/L
|
Parameter |
Finding |
Points |
|
intubated in the MICU |
no |
0 |
|
|
yes |
1 |
|
heart rate |
<= 110 beats per minute |
0 |
|
|
> 110 beats per minute |
1 |
|
BUN |
<= 25 mg/dL |
0 |
|
|
> 25 mg/dL |
1 |
|
pH |
>= 7.25 |
0 |
|
|
< 7.25 |
1 |
|
serum creatinne |
<= 2.0 mg/dL |
0 |
|
|
> 2.0 mg/dL |
1 |
|
bicarbonate |
>= 20 mEq/L |
0 |
|
|
< 20 mEq/L |
1 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
Performance:
• The area under the ROC curve was 0.754.
• A score >= 4 was 100% specific but 16% sensitive.
• A score of 1 was 60% specific and 81% sensitive.
Purpose: To identify a patient who may require prolonged mechanical ventilation based on the model of Clark and Lettieri.
Specialty: Critical Care, Emergency Medicine
Objective: risk factors
ICD-10: ,
