A Study of the Relationship between APACHE II Scores and the Need for a Tracheostomy

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The purpose of this research was to determine if significant differences exist between the APACHE II scores of intubated mechanically ventilated patients who ultimately received a tracheostomy and those who did not. In addition to this inquiry, the study also investigated the possibility of a range of APACHE II scores, a particular age group, and the presence of chronic organ insufficiencies and their relationship to the tracheostomy result. Methodology was non-experimental, quantitative, and retrospective. It was observational in that the goal was to simply record and quantify the potential association between these variables. Data was obtained from patients at Bristol Regional Medical Center from January 1- August 31, 2011. Information was calculated using descriptive statistics and the t-test for independent samples. Participants included all intubated mechanically ventilated patients who were at least eighteen years of age with a documented APACHE II score in the allotted time frame. There were 468 total patients, 79 (16.9%) of which received a tracheostomy. The mean APACHE II score for patients who received a tracheostomy was 21.8354 as compared to the mean APACHE II score of 21.6735 for those who were extubated. There was no significant difference between the APACHE II scores of these groups. The tracheostomy group had the highest frequency of patients with APACHE II scores of less than 25 and a range of 20-29. 84.8% of tracheostomy patients had some form of chronic organ dysfunction. Respiratory failure was the most frequent admitting diagnosis for all 468 patients and respiratory insufficiency was the most prevalent co-morbidity for the tracheostomy patients. The age range that included more tracheostomy patients was 65-74. 40% of re-intubated patients eventually received a tracheostomy and 69.6% of tracheostomy patients had the procedure performed early (within the first seven days of intubation). The managerial team of this respiratory therapy department decided to stop calculating the APACHE II score on all intubated patients in an attempt to save time and staff resources.