Description

Morganroth et al developed weaning criteria for patients who have received prolonged mechanical ventilation. Calculating an adverse event score for the patient was one step in the process of patient evaluation. The authors are from the University of Colorado Medical Center in Denver.


Parameters:

(1) heart rate mode (assumed to refer to pulse in beats per minute)

(2) blood pressure, minimum in mm Hg (assumed to refer to the systolic blood pressure)

(3) maximum body temperature in °C

(4) central venous pressure in cm H2O, or pulmonary capillary wedge pressure in mm Hg

(5) cardiac arrhythmias

(6) postural drainage and clapping

(7) secretion quantity (frequency of suctioning in hours)

(8) secretions, quality

(9) level of consciousness

(10) communication

(11) emotional status

(12) mobility

(13) calories per 24 hours

(14) vasopressors

(15) intravenously or intramuscularly administered antibiotics, number of drugs

(16) orally administered antibiotics, number of drugs

(17) sedatives, number of doses in 24 hours

(18) pain medications, number of doses in 24 hours

(19) steroid dosage

(20) aminophylline

(21) nebulized bronchodilators

 

Parameter

Finding

Points

heart rate mode

< 100 beats per minute

0

 

100 – 120 beats per minute

1

 

121 – 150 beats per minute

2

 

> 150 beats per minute

3

blood pressure minimum in mm Hg

> 100 mm Hg

0

 

90 – 100 mm Hg

1

 

61 – 89 mm Hg

3

 

<= 60 mm Hg

5

maximum body temperature in °C

>= 40°C

3

 

38.3 – 39.9°C

1

 

36.1 – 38.2°C

0

 

<= 36.0°C

3

central venous pressure or pulmonary capillary wedge pressure

CVP < 15 cm H2O

PCWP < 18 mm Hg

0

 

CVP >= 15 cm H2O

PCWP >= 18 mm Hg

2

cardiac arrhythmias

none

0

 

supraventricular tachycardia

1

 

supraventricular tachycardia with cardioversion

2

 

premature ventricular beats, > 6 per minute

1

 

ventricular tachycardia, nonsustained

2

 

ventricular tachycardia, sustained

4

postural drainage and clapping

yes

0

 

no

1

secretions, quantity

intervals > 4 hours

0

 

every 2 – 4 hours

1

 

more often than every 2 hours

3

secretions, quality

thin

0

 

mucousy

1

 

thick

2

level of consciousness

alert and oriented

0

 

lethargic, easily aroused

1

 

lethargic, difficult to arouse

3

 

comatose

4

communication

follows commands

0

 

does not follow commands

1

emotional status

calm

0

 

depressed and/or anxious

1

 

agitated

2

mobility

ambulatory or up in chair

0

 

bed rest

1

calories per 24 hours

> 2,000

0

 

1,001 – 2,000

1

 

<= 1,000

2

vasopressors required

no

0

 

yes

2

number of antibiotics administered IV or IM

0 – 1

0

 

2

1

 

>= 3

2

number of antibiotics administered orally

0 - 1

0

 

> = 2

1

sedatives, number of doses in 24 hours

0 – 1

0

 

2- 3

1

 

> 3

3

pain medication, number of doses in 24 hours

0 – 2

0

 

3

1

 

4 – 5

2

 

>= 6

3

corticosteroid dosage

none

0

 

< 1 gram every day

1

 

>= 1 gram every day

2

aminophylline therapy

yes

0

 

no

1

nebulized bronchodilators

yes

0

 

no

1

 

ventilator score =

= SUM(points for all 21 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 48

• The higher the score, the less likely that the patient will be able to be weaned.

• Interventions to reduce the score may increase the chance of successful weaning.

 

Combination with ventilator score:

• A sum of the (ventilator score) + (adverse factor score) <= 55 indicates a good chance of successful weaning, while a score > 55 is associated with a poor chance.

• The sensitivity of the combined score for predicting successful weaning was 93% with a specificity of 86%.


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