The Experts below are selected from a list of 25569 Experts worldwide ranked by ideXlab platform

Daniel Y. Chu - One of the best experts on this subject based on the ideXlab platform.

R. Lefering - One of the best experts on this subject based on the ideXlab platform.

  • The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation.
    European journal of anaesthesiology, 2004
    Co-Authors: B. Schönhofer, J. J. Guo, S. Suchi, D. Köhler, R. Lefering
    Abstract:

    Background and objective: To examine the calibration of the prognostic system Acute Physiology and Chronic Health Evaluation Score (APACHE II) regarding hospital mortality and predicting weaning outcome after long-term mechanical ventilation of the lungs. Methods: Prospective observational cohort study performed in a respiratory intensive care unit including 246 patients whose lungs were ventilated for 42.1 ± 37.8 (median 30) days in the referring hospital. APACHE II (24 h after admission to our respiratory intensive care unit) and the cause of respiratory failure, underlying disease, prior duration of mechanical ventilation and gender were recorded. The predictive power was evaluated with sensitivity and specificity for different cut-off points and summarized in a receiver operating characteristic curve. Results: No difference was found between survivors (APACHE II 16.0 ± 4.3) and non-survivors (APACHE II 16.9 ± 5.1). In a mean time of 8.0 ± 10.3 days, 146 patients (59.3%) were successfully weaned (APACHE II 15.2 ± 3.5). One-hundred patients (40.7%) were considered unweanable (APACHE II 17.7 ± 5.3). Recalibration of APACHE II to predict weaning failure was possible, resulting in an area under the receiver operating characteristic curve (AUC) of 0.638. Furthermore the AUC improved to 0.723 by changing the weights of selected APACHE items and introducing external factors. Diagnostic accuracy fell from group with mechanical ventilation ≤25 days (AUC 0.770) to group with mechanical ventilation >50 days (AUC 0.517). Conclusions: APACHE II did not predict hospital mortality after long-term mechanical ventilation of the lungs. Not the original APACHE II but a recalibrated and adapted APACHE II can be useful to predict weaning outcome in patients with less than 25 days of prior lung ventilation.

Yong Taek Nam - One of the best experts on this subject based on the ideXlab platform.

  • Relationships between APACHE II and APACHE III Scores and Mortality Rate in Intensive Care Unit Patients
    Korean Journal of Anesthesiology, 1999
    Co-Authors: Shin Ok Koh, Ki Jun Kim, Eun Chi Bang, Yong Taek Nam
    Abstract:

    Background : The APACHE II score system that evaluates prognosis has been widely applied for ICU patients. As the advent of APACHE III approaches, a comparison of effectiveness between APACHE II and APACHE III is demanded. The purpose of this study is to evaluate the relationships between APACHE II score and mortality rates, and between APACHE III scores and mortality rates in intensive care unit patients. Methods : 289 adult ICU patients participated in this study. Their mortality rates and scores on APACHE II and APACHE III were calculated. The scores of the APACHE II and APACHE III systems were also compared between survivor and non-survivor groups. Results : APACHE II scores at admission and discharge were 9±5, 6±4 in the survivor group and 20±9, 28±11 in the non-survivor group. APACHE III scores at admission and discharge were 29±19, 20±14 in the survivor group 75±37, 111±41 in the non-survivor group. The odds ratio between the mortality rate and the APACHE II score was EXP (0.2167) and the odds ratio between mortality rate and APACHE III score was EXP (0.0621). The determinant coefficient (R2) was 0.73 between the APACHE II and APACHE III scores. Conclusions : The results showed that both the APACHE II and APACHE III score systems are effective in predicting mortality rates in intensive care unit patients. (Korean J Anesthesiol 1999; 37: 814∼818)

B. Schönhofer - One of the best experts on this subject based on the ideXlab platform.

  • The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation.
    European journal of anaesthesiology, 2004
    Co-Authors: B. Schönhofer, J. J. Guo, S. Suchi, D. Köhler, R. Lefering
    Abstract:

    Background and objective: To examine the calibration of the prognostic system Acute Physiology and Chronic Health Evaluation Score (APACHE II) regarding hospital mortality and predicting weaning outcome after long-term mechanical ventilation of the lungs. Methods: Prospective observational cohort study performed in a respiratory intensive care unit including 246 patients whose lungs were ventilated for 42.1 ± 37.8 (median 30) days in the referring hospital. APACHE II (24 h after admission to our respiratory intensive care unit) and the cause of respiratory failure, underlying disease, prior duration of mechanical ventilation and gender were recorded. The predictive power was evaluated with sensitivity and specificity for different cut-off points and summarized in a receiver operating characteristic curve. Results: No difference was found between survivors (APACHE II 16.0 ± 4.3) and non-survivors (APACHE II 16.9 ± 5.1). In a mean time of 8.0 ± 10.3 days, 146 patients (59.3%) were successfully weaned (APACHE II 15.2 ± 3.5). One-hundred patients (40.7%) were considered unweanable (APACHE II 17.7 ± 5.3). Recalibration of APACHE II to predict weaning failure was possible, resulting in an area under the receiver operating characteristic curve (AUC) of 0.638. Furthermore the AUC improved to 0.723 by changing the weights of selected APACHE items and introducing external factors. Diagnostic accuracy fell from group with mechanical ventilation ≤25 days (AUC 0.770) to group with mechanical ventilation >50 days (AUC 0.517). Conclusions: APACHE II did not predict hospital mortality after long-term mechanical ventilation of the lungs. Not the original APACHE II but a recalibrated and adapted APACHE II can be useful to predict weaning outcome in patients with less than 25 days of prior lung ventilation.

Kees H. Polderman - One of the best experts on this subject based on the ideXlab platform.

  • Inter-observer variability in APACHE II scoring: effect of strict guidelines and training.
    Intensive care medicine, 2001
    Co-Authors: Kees H. Polderman, Edward M. F. Jorna, Armand R. J. Girbes
    Abstract:

    Objective: To assess the effect of strict guidelines and a rigorous training program on variability in scoring the revised Acute Physiology and Chronic Health Evaluation (APACHE II). Design and setting: Prospective survey and intervention in the surgical ICU of a university teaching hospital. Measurements: Seven experienced intensivists and nine residents determined APACHE II scores in one set of patients before and in another set 4 months after a rigorous training program, following strict guidelines for using the APACHE II. Results: APACHE II scores were 14.3±4.4 before the training program (n=12) and 18.9±2.4 after (n=11). Interobserver agreement rates increased significantly from 59.7% to 76.5% and the interobserver reliability coefficient (weighted κ) from 0.72 to 0.85 after our training program was implemented. The changes were significantly greater in experienced intensivists than in less experienced residents, indicating that more experienced physicians profited to a greater degree from our training program. Conclusion: Interobserver variability in APACHE II scoring decreases markedly when strict guidelines and a regular training program are implemented, particularly among more experienced physicians. However, in our study a degree of variability (10–15%) persisted even in experienced intensivists with similar training, experience, and background, suggesting that a degree of variability is inherent in APACHE II scoring.

  • Intra-observer variability in APACHE II scoring
    Intensive care medicine, 2001
    Co-Authors: Kees H. Polderman, Herman M. T. Christiaans, Jos P.j. Wester, Jan Jaap Spijkstra, Armand R. J. Girbes
    Abstract:

    Although the APACHE II score is the most widely used scoring system in intensive care units worldwide, its reliability and variability have not been extensively studied. Differences in case-mix may complicate comparison and interpretation of results. We hypothesised that a degree of variability might be inherent to use of the APACHE II scoring system, and decided to assess intra-observer variability in APACHE II scoring as a potential indicator of inherent score variability. APACHE II scores were assessed twice from the charts of 11 patients by 14 physicians, with a time interval of 4 (range 3.5-4.5) months between the two assessments. Intra-observer was found to be approximately 15%. These findings are in agreement with previous observations regarding inter-observer variability in APACHE II scoring, and strongly suggest that there is an inherent score variability of about 15%.

  • Accuracy and reliability of APACHE II scoring in two intensive care units Problems and pitfalls in the use of APACHE II and suggestions for improvement.
    Anaesthesia, 2001
    Co-Authors: Kees H. Polderman, A. R. J. Girbes, L. G. Thijs, R.j.m. Strack Van Schijndel
    Abstract:

    Acute Physiology and Chronic Health Evaluation (APACHE) II scoring is widely used as an index of illness severity, for outcome prediction, in research protocols and to assess intensive care unit performance and quality of care. Despite its widespread use, little is known about the reliability and validity of APACHE II scores generated in everyday clinical practice. We retrospectively re-assessed APACHE II scores from the charts of 186 randomly selected patients admitted to our medical and surgical intensive care units. These 'new' scores were compared with the original scores calculated by the attending physician. We found that most scores calculated retrospectively were lower than the original scores; 51% of our patients would have received a lower score, 26% a higher score and only 23% would have remained unchanged. Overall, the original scores changed by an average of 6.4 points. We identified various sources of error and concluded that wide variability exists in APACHE II scoring in everyday clinical practice, with the score being generally overestimated. Accurate use of the APACHE II scoring system requires adherence to strict guidelines and regular training of medical staff using the system.

  • Interobserver variability in the use of APACHE II scores
    Lancet (London England), 1999
    Co-Authors: Kees H. Polderman, Lambert Thijs, Armand R. J. Girbes
    Abstract:

    2and the simplified acute physiology score (SAPS) are widely used to assess outcome and quality of care in intensive care units. In spite of the widespread use and general acceptance of these scoring systems, there is little information on their reliability and on inter-observer variability in their use. We assessed interobserver variation during application of the most frequently used scoring system, APACHE II, in our intensive care unit. Two groups of doctors were studied: residents (n=9) with limited experience of intensive care (average: 4 months), and intensivists (7), who should be experts in the use of scoring systems. Over 6 weeks, all doctors were given the charts of ten chosen patients and asked to assess APACHE II scores. We obtained 16 APACHE II scores of each individual patient. Analysis was with Student’s unpaired t test. There was wide variability between scores (mean 14, SD 6·0; table). There were no significant differences in score variations between intensivists and residents. The largest differences arose in the interpretation of data acquired in RESEARCH LETTERS the operating room (some took these data into account; others did not). Another cause of confusion arose in the interpretation of data which were inconsistent with the general trend: for example, tachycardia which was found only once during a 24-hour period was erroneously disregarded by some doctors. The accordance of chronic health points (2 or 5) was also a frequent source of problems. We conclude that assessment of APACHE II scores in individual patients varies widely; this applies both to less experienced doctors and to experts. Use of the APACHE II scoring system requires regular training, adherence to strict guidelines, and an understanding of which data should be used and which disregarded. Assessments of quality of medical care based on these scoring systems should be viewed with some care. 1 Kollef MH, Rainey TG. The role of outcomes research in the