The APACHE II Severity of Disease Classification System Physiologic Variable + 3 41 0 + 42 3 +4 Temperature - za | 30409, sassae | seas | saase rectal CC) ‘Mean Arterial sie | i01e | none 7o-108 5088 se Pressure (az He) ‘Heart Rate iw | wore [ens Toe see [os | se Respiratory Rate (conventlatel or zso | 3549 asst | aq | on | os s | 2500 | sso-see | 200-349 <200 2 Fi0;> 0Sure ADO: B.FiO, ¢ 0,5usa PeO: Arterial pH Tee questa | as ‘Serum Sodium 5 zis | 16017 | issse | so1se | 130169 nen | ius | sto (mmav) ‘Serum Potassium | ,_ se | as. 33. 252 2 > z ose ssse | ssa | 354 | 2529 225 ‘Serum Creatinine (aval, Double point 5 score for acute snl ‘ila 1s1e oss 208 ‘Hematocrit 260 sosee | sev9 [30459 20298 20 White Blood » nosee | asioe | 2209 129 a Count Ga 1000%me5 | *? ‘Glasgow-Coma- Saale ees) ‘Soore = 15 minus anual GCS ‘Serum HCO3 (venous, mmol, we if 20 ABG:) aLsLe 409 y ware | isare | as Total Acute Physiology Score | Sumot te 12 individual vaisble points APS ‘AgePoints | C= Chronic Health Points Saye points If the patient has a history of severe organ system insufficiency or is immunocompromised assign points as follows: S564 yous 3 points 45:54 yor 2 points 6574 yer S points 2 Fornonopantive or emergency postoperative patients ~ 5 points . b. For dlastive postoperative patients ~2 points 27S yens GS pointe APACHE II Score = Sum of A (APS points) + B (Age points) + C (Chronic Health points) (From: Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE Il a severity of disease classification system. Crit Care Med 1985;13(10):818-29)CPIS points 0 1 Tracheal Rare ‘Abundant secretions Chest X4ay Noinfiltrates Diffuse infiltrates Temperature (°C) >36Sand = >38.5 and 384 389 Leukocytes 24000and = <4000 or (per mn) <11,000 >11,000 PaQJFiO,ratio —_ >240 or ARDS Microbiology Negative 2 Abundant and purulent Localized 239 or <36 <4000 or >11,000 plus band forms >500 $240 and no evidence of ARDS Positive A score of more than 6 at baseline or after incorporating the Gram stains (CPIS gram) oF culture (CPIS culture) results is suggestive of pneumonia Table 3. The Berlin Definition of Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Timing Within 1 week of a known clinical insult or new or worsening respiratory symptoms. Chest imaging? Bilateral opacities—not fully explained by effusions, lobar/lung collapse, or nodules Origin of edema Respiratory failure not fully explained by cardiac failure or fluid overload Need objective assessment (eg, echocardiography) to exclude hydrostatic ‘edema if no risk factor present Oxygenation? Mid 200 mm Hg < Pa0./Fi0, = 800 mm Hg with PEEP or CPAP =5 cm H,O° Moderate 4100 mm Hg < Pa0./Fi0. = 200 mm Hg with PEEP =5 cm H.0 Severe Pa0./Fid. = 100 mm Ha with PEEP =5 om H.0. Abbreviations: CPAP, continuous posilive alway pressure; Fio., Iraction of inspired oxygen; Pao., parlial pressure of arterial oxygen; PEEP, positive end-expiratory pressure. ®Chest radiograph or computed tornography scan, If alttuce is higher than 1000 m, the correction factor shouldbe calculated as follows: [Pao./Fi0, > (barometric pressurer 760)) © This may be delivered noninvasively in the mild acute respiratory distress syndrome group.Table 1. Sequential [Sepsis Related] Organ Faure Assessment Score” score System ° 1 2 a 4 Respiration Fa0,/o,,mmtig 2400 (53.3) 400 (633) 300 (60) £200 (26.7) with «100 (13.3) with we) fespiatery apoort tesa spook coaguaton Potelets 10% =150 150 «100 <0 20 Bin malt <1220) 12.48 (2052) 20593101) 6 0-118(102-204) 12.0204) Coniovacer MAP 70mm Hg MAP <70 mm ig Doparin < or Doparine 5.1.15 Doparine 15 or Aobutaine (ay ose)* areplnepiiae S01. epnepine>0.1 rnorepinestrine<0.1° —ornorepinephrine >0.1° Central nervous system Sksspwcomscle 15 Bat 10-12 68 6 erat Gestinine, maid <.2 (110) 12.49 (110-170) 2034 (171-299) -35-49,(800-440) >5.0(440) (amavt) rine curt, mij 500 200 ‘Rbbreitions Fe, Faction of nspied oxygen MAP mean aera presse Pos partal pressure of oxygen * Reaptes tom Vinent eal?” ® Catecholamine doses are gv a plkgiminfor teat hour * Glasgow Coma Sale scores range fom 315, higher score indicates better neutoigentunction Table 1. Modified Ramsay Sedation Score’? ss Clinical Response 0 Residual neuromuscular blockade present; unable to assess level of sedation 1 Fully awake 2 Drowsy, but awakens spontaneously 3 Asleep, but arouses and responds appropriately to simple verbal commands 4 Asleep, unresponsive to commands, but arouses to shoulder tap or loud verbal stimulus. 5 Asleep and only responds to firm facial tap and loud verbal stimulus 6 Asleep and unresponsive to both firm facial tap and loud verbal stimulus If the subject was restless or agitated, 0.5 was added to the sedation score (SS) to determine the percent of time subjects were agitated.RIFLE and AKIN criteria for AKI RIFLE AKIN Cul GER Criteria Urine Output (UO) Criteria crettera Increased Crxt.5 Urine Output (UO) Criteria {UO «0.5 mikyt x6 Risk GFR decreases >25% ‘Stage 1 Increased Grx 2 tri \ eR decreases >50% Stage 2 Increased Crx 3 ‘ GFR decreases > 76% Flue cr2 tingid (vitae se oz08mois) Increased Crx 3] UO <03 mikgihe Stage 3 Persistont ARF = complate loss of renal function far > 4 wooks Pationts who recaive renal replacement therapy End Stage Renal {RRT) ae considered to have met the criteria for Disease sage 3 irrespective ofthe sage that they aren ‘atthe time of commencement of RT.