Listello and Sessler identified comorbid conditions in a patient with unplanned extubation in the ICU. This can be modified for a broader range of patients. The authors are from the Medical College of Virginia.


Original patient selection: unplanned extubation of a patient in the ICU



(1) history of COPD

(2) history of CHF

(3) renal dysfunction (serum creatinine above the upper limit of normal)

(4) hepatic dysfunction (serum total bilirubin above the upper limit of normal OR AST more than 2 times the upper limit of normal OR ALT above the upper limit of normal)

(5) neurologic disorder such as seizure, stroke or coma

(6) receiving antibiotics

(7) electrolyte abnormality (sodium, potassium, phosphate, calcium)



(1) changed history of COPD to history of COPD or significant lung disease OR respiratory dysfunction

(2) changed history of CHF to history of CHF OR cardiac dysfunction


comorbidity score =

= SUM(points for all 7 parameters)



• minimum score: 0

• maximum score: 7

• The higher the score the greater the comorbidity.


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