APACHE II

The Acute Physiology And Chronic Health Evaluation ( APACHE ), referred to in Germany as APACHE score, is a method used in intensive care units to predict the probability of survival of patients in an intensive care unit. This scoring system includes this information on a patient's age, current findings and anamnestic data.

Development

The APACHE method was developed from about 1978 by William A. Knaus at George Washington University Hospital and in 1981 with APACHE I used the first time. 1985 APACHE II introduced after it had been found that the complexity of APACHE I often prevented the practical application. 1991 appeared the successor APACHE III. In contrast to APACHE II APACHE III takes place in the evaluation with software help. APACHE III compares the input data with the stored characteristic values ​​of approximately 18,000 cases from 40 U.S. hospitals. The set of APACHE III prediction occurs with a probability of 95%. Recently also other risk scores, for example, the Simplified Acute Physiology Score ( SAPS ), II and 28 TISS used.

A 2001 published in Germany study found that APACHE II in the patient group studied more accurate predictions supplied as the newer APACHE III.

Recent studies have found that now occur about half of all deaths in U.S. intensive care for a conscious discontinuation. Proponents of scoring methods such as APACHE declare that the scoring method does not make these decisions themselves, but rather the doctors who have to make these decisions, assist in the best possible shape.

APACHE II

The APACHE II is composed of three groups of data:

  • The Acute Physiology Score
  • The Age Points
  • The Chronic Health Points

The formula is: APACHE II = ( Acute Physiology Score) ( Age Points ) ( Chronic Health Points )

The data to be collected for 24 hours, the worst value in each case for the calculation of the scores is used. As a study of more than 5800 intensive care patients resulted in about 80 % of all cases occurs by means of the APACHE II predicted development.

Acute Physiology Score

1) ventilation or spontaneous breathing

2) When the FiO2 is ≥ 0.5, the alveolar- arterial oxygen difference AaDO2 be considered. This is calculated from AaDO2 ( mmHg ) = PAO2 - PaO2 ( alveolar oxygen partial pressure - arterial oxygen partial pressure ) Alternatively, the value can also be read at the BGA device. In a FiO2 < 0.5, the arterial oxygen pressure ( PaO2 mmHg) is considered. The first value corresponds to the AaDO2, the second the paO2

3) In acute renal failure ( ARF ), the points must be doubled.

Age Point

According to the age of the patient, a point value is determined.

Chronic Health Score

1) The organ insufficiency or immunocompromised state must have been known before the current hospitalization and comply with the following criteria:

  • By biopsy secured cirrhosis and
  • Portal hypertension or
  • Upper gastrointestinal bleeding in prehistory, starting from a portal hypertension or
  • Previous episodes of hepatic failure / hepatic encephalopathy / hepatic coma
  • New York Heart Association Class IV
  • Chronic restrictive, obstructive or vascular -related diseases that are associated with a severe restriction on easy tasks (eg, inability to climb stairs or perform household) or
  • Chronic hypoxia, hypercapnia, acquired polycythemia, severe pulmonary hypertension ( > 40 mmHg ) or
  • Ventilator dependency
  • Chronic dialysis
  • When the patient is following a treatment before a weakening of the immune system. (For eg immunosuppression, chemotherapy, radiation, long-term or high-dose steroids)
  • Diseases that are associated with an immune deficiency (eg leukemia, lymphoma, AIDS)

Evaluation

Minimum: 0 points

Maximum: 71 points

Medical history SAPS II JAMA Surgery
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