Wednesday October 18, 2006
Take home message about ICU scores

Mutiple scores have been developed to predict severity, prognosis, and outcome of diseases in ICU. (See all scores here from icumedicus site). All of these scores have their own flaws and none of them are perfect, like lactic acid level, a significant serial marker in ICU is not part of even APACHE IV score (Glucose level is now included). It takes a lot of effort and trained staff to implement these scoring systems. So what's the significance of using these various scores?

These scores serve the purposes of assessing therapies, quality control and assurance, and of an economic evaluation of intensive care as a whole. Like using these scores, if your's ICU lenght of stay or mortality rate is more than the predicted - it requires your attention in assessing therapies and quality assurance. Although these scores (like MPM) have been said to predict mortality in individual patients but in real life, note (and note again !) that these scores SHOULD NOT be applied in individual patients to predict mortality. This may create a psychological bias towards an individual patient.

Dr. Jack Zimmerman and coll. , looked into data of 116,209 patients for predicting ICU length of stay with The APACHE IV scores and come to the same conclusion that: "The APACHE IV model provides clinically useful ICU length of stay predictions for critically ill patient groups, but its accuracy and utility are limited for individual patients. APACHE IV benchmarks for ICU stay are useful for assessing the efficiency of unit throughout and support examination of structural, managerial, and patient factors that affect ICU stay".



Reference: click to get abstract

A randomized, controlled trial of the role of weaning predictors in clinical decision making -Critical Care Medicine. 34(10):2530-2535, October 2006.

Tuesday October 17, 2006


Q; So what should be the target vancomycin trough (or random) level ?

A: This month a retrospective study of 102 patients with MRSA has been published into 'chest' looking into benefit of higher vancomycin trough or random level (more than 15 µg/mL). The stratification of the vancomycin trough levels yielded no relationship with hospital mortality. Study found no evidence that higher vanco trough levels correlated with hospital outcome.

'Vanco level' between 5 to 15 µg/mL seems to be a reasonable target range.


Reference: click to get abstract

Predictors of Mortality for Methicillin-Resistant Staphylococcus aureus Health-Care–Associated Pneumonia - Specific Evaluation of Vancomycin Pharmacokinetic Indices - Chest. 2006;130:947-955.