Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES

Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit frominvasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients.Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It wasconducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a totalof 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examinedvia logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score(IMPRES) scoring system was developed.Results: The following cut-off scores were used to indicate mortality risk: 8, very highrisk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was93.3% for patients with total IMPRES scores of greater than 8 (P < 0.001).Conclusion: The present study included a large number of patients from various geographical areas of the country who were admittedto various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or electivesettings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broaderpopulation. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubatedor not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.

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  • 1. Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--A Groupe de Recherche Respiratoire en Reanimation Onco-hematologique study. Journal of Clinical Oncology 2013; 31 (22): 2810-2818.
  • 2. Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. British Journal of Anaesthesia 2012; 108 (3): 452-459.
  • 3. Soares M, Caruso P, Silva E, Teles JM, Lobo SM et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Critical Care Medicine 2010; 38 (1): 9-15.
  • 4. Soares M, Salluh JI, Spector N, Rocco JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs. Critical Care Medicine 2005; 33 (3): 520- 526.
  • 5. Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Critical Care Medicine 2000; 28 (5): 1322-1328.
  • 6. Cohen CA, Zagelbaum G, Gross D, Roussos C, Macklem PT. Clinical manifestations of inspiratory muscle fatigue. American Journal of Medicine 1982; 73 (3): 308-316.
  • 7. Slutsky AS. Mechanical ventilation. American College of Chest Physicians’ Consensus Conference. Chest 1993; 104 (6): 1833- 1859.
  • 8. Powers SK, Kavazis AN, Levine S. Prolonged mechanical ventilation alters diaphragmatic structure and function. Critical Care Medicine 2009; 37 (10 Suppl.): 347.
  • 9. Danis M, Devita M, Baily M, Beyda D, Chalfin D et al. Consensus statement of the Society of Critical Care Medicine’s Ethics Committee regarding futile and other possibly inadvisable treatments. Critical Care Medicine 1997; 25 (5): 887-891.
  • 10. No authors listed.] Consensus report on the ethics of foregoing lifesustaining treatments in the critically ill. Task Force on Ethics of the Society of Critical Care Medicine. Critical Care Medicine 1990; 18: 1435-1439.
  • 11. Santonocito C, Ristagno G, Gullo A, Weil MH. Do-notresuscitate order: a view throughout the world. Journal of Critical Care 2013; 28 (1): 14-21.
  • 12. Blank RH, Merrick JC. End-of-life Decision Making: A CrossNational Study. Cambridge, MA, USA: MIT Press; 2005.
  • 13. Azoulay E, Pene F, Darmon M, Lengline E, Benoit D et al. Managing critically ill hematology patients: time to think differently. Blood Reviews 2015; 29 (6): 359-367.
  • 14. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Medicine 1985; 13 (10): 818-829.
  • 15. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Medicine 1996; 22 (7): 707-710.
  • 16. [No authors listed.] A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 1995; 274 (20): 1591-1598.
  • 17. Capuzzo M, Valpondi V, Sgarbi A, Bortolazzi S, Pavoni V et al. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Medicine 2000; 26 (12): 1779-1785.
  • 18. Escarce JJ, Kelley MA. Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. JAMA 1990; 264 (18): 2389-2394.
  • 19. Ho KM, Dobb GJ, Knuiman M, Finn J, Lee KY et al. A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation II scores in predicting hospital mortality: a retrospective cohort study. Critical Care Medicine 2006; 10 (1): R4.
  • 20. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100 (6): 1619-1636.
  • 21. Wagner DP, Knaus WA, Harrell FE, Zimmerman JE, Watts C. Daily prognostic estimates for critically ill adults in intensive care units: results from a prospective, multicenter, inception cohort analysis. Critical Care Medicine 1994; 22 (9): 1359- 1372.
  • 22. Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsisrelated problems” of the European Society of Intensive Care Medicine. Critical Care Medicine 1998; 26 (11): 1793-1800.
  • 23. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270 (24): 2957-2963.
  • 24. Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Medicine 2005; 31 (10): 1345-1355.
  • 25. Higgins TL, Kramer AA, Nathanson BH, Copes W, Stark M et al. Prospective validation of the intensive care unit admission Mortality Probability Model (MPM0-III). Critical Care Medicine 2009; 37 (5): 1619-1623.
  • 26. Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M et al. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Critical Care Medicine 2007; 35 (3): 827-835.
  • 27. Lemeshow S, Le Gall JR. Modeling the severity of illness of ICU patients. A systems update. JAMA 1994; 272 (13): 1049-1055.
  • 28. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH et al. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993; 270 (20): 2478-2486.
  • 29. Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Critical Care Medicine 2006; 34 (5): 1297-1310.
  • 30. Costa e Silva VT, de Castro I, Liano F, Muriel A, RodriguezPalomares JR et al. Performance of the third-generation models of severity scoring systems (APACHE IV, SAPS 3 and MPMIII) in acute kidney injury critically ill patients. Nephrology, Dialysis, Transplantation 2011; 26 (12): 3894-3901.
  • 31. Maccariello E, Valente C, Nogueira L, Bonomo H, Ismael M et al. SAPS 3 scores at the start of renal replacement therapy predict mortality in critically ill patients with acute kidney injury. Kidney International 2010; 77 (1): 51-56.
  • 32. Soares M, Silva UV, Teles JM, Silva E, Caruso P et al. Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study. Intensive Care Medicine 2010; 36 (7): 1188- 1195.
  • 33. Lee MJ, Chen CJ, Lee KT, Shi HY. Trend analysis and outcome prediction in mechanically ventilated patients: a nationwide population-based study in Taiwan. PLoS One 2015; 10 (4): e0122618.
  • 34. Boumendil A, Aegerter P, Guidet B. Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. Journal of the American Geriatrics Society 2005; 53 (1): 88-93.
  • 35. Yu W, Ash AS, Levinsky NG, Moskowitz MA. Intensive care unit use and mortality in the elderly. Journal of General Internal Medicine 2000; 15 (2): 97-102.
  • 36. Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day survival. Chest 2000; 118 (4): 1100-1105.
  • 37. Marik PE. Management of the critically ill geriatric patient. Critical Care Medicine 2006; 34 (9 Suppl.): 176-182.
  • 38. Azoulay E, Mokart D, Rabbat A, Pene F, Kouatchet A et al. Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Critical Care Medicine 2008; 36 (1): 100-107.
  • 39. Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 2004; 126 (4): 1299-1306.
  • 40. Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD et al. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to requests for potentially inappropriate treatments in intensive care units. American Journal of Respiratory and Critical Care Medicine 2015; 191 (11): 1318-1330.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
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