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Ressources et utilitaires

Scoring systems for ICU and surgical patients:

APACHE II (Acute Physiology And Chronic Health Evaluation)


Temperature (°C)
Mean Arterial Pressure (mmHg)
Heart Rate
Respiratory Rate
If FIO2 >= 0,5 : (A-a) O2
(Help)
If FIO2 < 0,5 : PaO2
If no A.B.Gs :
Serum HCO3-(mmol/L)
Arterial pH
Serum Sodium (mmol/L)
Serum Potassium (mmol/L)
Serum Creatinine
With Acute Renal Failure
Serum Creatinine
Without Acute Renal Failure
Ht (%)
W.B.C (x103/ mm3 )
Glasgow Coma Score
(Help)
Age
Apache II

Chronic Organ Insufficiency
(Help) immuno-compromised


Predicted death rate
  		Logit = -3,517+( Apache II) * 0,146
Predicted Death Rate =eLogit/(1+eLogit)

Predicted death rate (Adjusted)

 Logit = -3,517+( Apache II) * 0,146 + Diagnostic category weight
Predicted Death Rate =eLogit/(1+eLogit)
Diagnostic category weight (y)= (a point for decimals)


Nonoperative
y
Postoperative patients
y
y (if emergency)
Respiratory failure or insufficiency from: Multiple trauma -1.684
-1.081
Asthma / allergy
 -2.108 Admission due to chronic cardiovascular disease -1.376
-0.773
COPD
 -0.367 Peripheral vascular surgery -1.315
-0.712
Pulmonary edema (noncardiogenic)
 -0.251 Heart valve surgery -1.261
-0.658
Postrespiratory arrest
 -0.168 Craniotomy for neoplasm -1.245
-0.642
Aspiration / poisoning / Toxic
 -0.142 Renal surgery for neoplasm -1.204
-0.601
Pulmonary embolus
 -0.128 Renal Transplant -1.042
-0.439
Infection
 0 Head trauma -0.955
-0.352
Neoplasm
 0.891 Thoracic surgery for neoplasm -0.802
-0.199
Cardiovascular failure or insufficiency from : Craniotomy for ICH/ SDH/ SAH -0.788
-0.185
Hypertension
 -1.798 Laminectomy and other spinal cord surgery -0.699
-0.096
Rythm disturbance
 -1.368 Hemorrhagic shock -0.682
-0.079
Congestive heart failure.
 -0.424 GI Bleeding -0.617
-0.014
Hemorrhagic shock / hypovolemia
 0.493 GI surgery for neoplasm -0.248
0.355
Coronary artery disease
 -0.191 Respiratory insufficiency -0.140
0.463
Sepsis
 0.113 GI perforation / obstruction 0.060
0.663
Post cardiac arrest
 0.393 If not in one of the above, wich major vital organ system led to ICU admission post surgery
Cardiogenic shock
 -0.259 Neurologic -1.150
-0.574
Dissecting thoracic / abdomina aneurysm
 0.731 Cardiovascular -0.797
-0.194
Trauma Respiratory -0.610
-0.007
Multiple trauma
 - 1.228 Gastro-intestinal -0.613
-0.01
Head injury
 -0.517 Metabolic / renal -0.196
0.407
Neurologic
Seizure disorder
 -0.584
ICH/ SDH/ SAH
 0.723
Other
Drug overdose
 -3.353
Diabetic ketoacidosis
 -1.507
GI Bleeding
 0.334
If not in one of the groups above, wich major organ system was the principal reason for admission:
Metabolic / renal
 -0.885
Respiratory
 -0.890
Neurologic
 -0.759
Cardiovascular
 0.470
Gastrointestinal
 0.501

Ref : Knaus WA et al. APACHE II : A severity of disease classification system. Crit Care Med. 1985;13:818-29.

 

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(A-a)O2 Gradient ( mmHg )

(A-a)O2 Gradient ( KPa )

PaCO2 (A-a)O2 Gradient
 		(A-a)O2 Gradient
 		PaCO2
PaO2 PaO2
FIO2 (a point for decimals)
(ex: 0.6) 		FIO2 (a point for decimals)
(ex: 0.6)
Formula (simplified): (A-a)O2 Gradient = (( PAtm - PH2O) * FIO2 - ( PaCO2 / Resp.Quot )) - PaO2 With R.Q =1 , PAtm =760, PH2O = 47 (A-a)O2 Gradient =(760-47)*FIO2 - PaCO2 - Pa02 Formula (simplified): (A-a)O2 Gradient = (( PAtm - PH2O) * FIO2 - ( PaCO2 / Resp.Quot )) - PaO2 with RQ =1 , PAtm =100, PH2O = 6.2 (A-a)O2 Gradient =(100-6.2)*FIO2 - PaCO2 - Pa02
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Eyes Open Verbal Motor
Spontaneous
To speech
To pain
Absent
 Converses / Oriented
Converses / Disoriented
Inappropriate
Incomprehensible
Absent 		Obeys
Localizes pain
Withdraws (flexion)
Decorticate (flexion) rigidity
Decerebrate (extension) rigidity
Absent
Glasgow=

 

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Chronic Organ Insufficiency

Liver insufficiency Cardiovascular
Respiratory
Renal Immuno-depression
Biopsy proven cirrhosis
Documented portal hypertension,
Episodes of past upper GI bleeding attributed to portal hypertension
Prior episodes of hepatic failure / encephalopathy / coma.
NYHA Class IV
Chronic restrictive, obstructive or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties.
Documented chronic hypoxia, hypercapnia, secondary polycythemia , severe pulmonary hypertension (> 40 mmHg), or respirator dependency. 		Receiving chronic dialysis The patient has received therapy that suppresses resistance to infection e.g. immuno-suppression, chemotherapy, radiation, long term or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS.

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