A re-evaluation of the ventilator score as an indicator of prognosis in the adult respiratory distress syndrome.
OBJECTIVE
To determine whether the ventilator score of Smith and Gordon (1986) can accurately predict outcome in patients with severe Adult Respiratory Distress Syndrome (ARDS).


METHODS
Retrospective study of data from case records and flow sheets.


METHODS
University Hospital Intensive Care Unit.


METHODS
Fifty-five patients with severe Adult Respiratory Distress Syndrome.


RESULTS
The ventilator score of Smith and Gordon (1986), based on a compound score of the patient's age, alveolar to arterial oxygen tension difference and mean peak airway pressure, was calculated daily for for each patient.  In contrast to the original report, a high ventilator score ( greater than 80) had a predictive value for death of only 59%, and a specificity of only 29%.  The use of a higher ventilator score ( greater than 100) resulted in a predictive value of only 70% with a specificity of 75%.  The use of inverse ratio ventilation was associated with a significant improvement in survival in those patients with ventilator scores greater than 100. This finding has not been reported previously.


CONCLUSIONS
The ventilator score does not provide a satisfactory predictor of outcome in ARDS and cannot be used as a prognostic tool. It may have some use as an indicator of the severity of respiratory failure.  A ventilator score greater than 100 may be an indication for the institution of inverse ratio ventilation.
Intensive Care Unit, University Hospital of South Manchester, Withington, UK.
S C
SC
Beards
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P
Nightingale
J D
JD
Edwards
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome