Nurse Bob's MICU/CCU Survival Guide
Critical Care Concepts
Apache II score
nurse bob


The Apache II is an attempt to standardize the prediction of mortality of ICU patients.  The following factors are considered and given a point value when calculating the Apache II score.    Totaling these values predicts the mortality rate of the ICU patient.  Generally the higher the point value the greater the mortality rate.

Age in years
under 44--------------------0 Points
45-54-----------------------2 Points

55-64-----------------------3 Points
65-74-----------------------5 Points
over 74---------------------6 Points





Point Value for Age----------_____

History
of severe organ insufficiency or immunocompromised?

Yes, and non-operative or emergency post-operative patient----------------------5 Points
Yes, and elective post-operative patient----------------------2 Points
No--------------------------0 Points


Point Value for History-------_____

Rectal Temperature
(Celsius)
over 40.9-------------------4 Points

39-40.9--------------------3 Points
38.5-38.9------------------1 Points

36-38.4--------------------0 Points
34-35.9--------------------1 Points

32-33.9--------------------2 Points
30-31.9--------------------3 Points

below 30-------------------4 Points

Point Value for Temperature-_____

Mean arterial pressure
(mm Hg)
over 159--------------------4 Points
130-159--------------------3 Points

110-129--------------------2 Points
70-109---------------------0 Points
50-69----------------------2 Points
below 50-------------------4 Points


Point Value for MAP---------_____

Heart rate
(ventricular response)
over 179--------------------4 Points
140-179--------------------3 Points
110-139--------------------2 Points
70-109---------------------0 Points
55-69----------------------2 Points
40-54----------------------3 Points

below 40-------------------4 Points

Point Value for Heart Rate----_____

Respiratory Rate
(non-ventilated or ventilated)
over 49---------------------4 Points
35-49-----------------------3 Points
25-34-----------------------1 Points
12-24-----------------------0 Points
10-11-----------------------1 Points
6-9-------------------------2 Points
below 6---------------------4 Points

Point Respiratory Rate--------_____

Oxygenation
(use PaO2 if FiO2 < 50%,
otherwise use A-a gradient)
A-a gradient over 499------4 Points
A-a gradient 350-499------3 Points
A-a gradient 200-349------2 Points
A-a below 200 (if FiO2
over 49%) or pO2 more than 70
(if FiO2 less than 50%)-----0 Points
pO2 = 61-70---------------1 Points

pO2 = 55-60---------------3 Points
pO2 below 55--------------4 Points

Point Value for Oxygenation--_____

Arterial pH
over 7.69-------------------4 Points
7.60-7.69-------------------3 Points
7.50-7.59-------------------1 Points
7.33-7.49-------------------0 Points
7.25-7.32-------------------2 Points

7.15-7.24-------------------3 Points
below 7.15-----------------4 Points





Point Value for pH----------_____

Serum sodium
(mMol/L)
over 179-------------------4 Points 
160-179-------------------3 Points
155-159-------------------2 Points
150-154-------------------1 Points
130-149-------------------0 Points
120-129-------------------2 Points
111-119-------------------3 Points
below 111-----------------4 Points



Point Value Sodium Level----_____

Serum potassium
(mMol/L)
over 6.9--------------------4 Points
6-6.9-----------------------3 Points
5.5-5.9---------------------1 Points
3.5-5.4---------------------0 Points
3-3.4-----------------------1 Points
2.5-2.9---------------------2 Points
below 2.5------------------4 Points


Point Value for K Level-------_____

Serum Creatinine
(mg/100 mL)
over 3.4 & acute renal fail---8 Points

2.0-3.4 & acute renal fail----6 Points
over 3.4 & chronic renal fail-4 Points
1.5-1.9 & acute renal fail----4 Points
2.0-3.4 and chronic---------3 Points
1.5-1.9 and chronic---------2 Points
0.6-1.4---------------------0 Points
below 0.6-------------------2 Points

Point Value for Creatinine----_____

Hematocrit
(%)
over 59.9-------------------4 Points
50-59.9---------------------2 Points
46-49.9---------------------1 Points
30-45.9---------------------0 Points
20-29.9---------------------2 Points
below 20-------------------4 Points



Point Value for Hematocrit---_____

White blood count
(total/cubic mm in 1000's)
over 39---------------------4 Points
20-39.9--------------------2 Points 
15-19.9--------------------1 Points 
3.0-14.9-------------------0 Points 
1.0-2.9---------------------2 Points 
below 1.0------------------4 Points

Point Value for WBC--------_____

15 minus the Glasgow Coma Score.







Point Value for 15-Glasgow--_____

Total of all Points  Apache Score_____
0-4        ~4% death rate   
5-9        ~8% death rate    Interpretation of
10-14    ~15% death rate   the Apache Score
15-19    ~25% death rate   
20-24    ~40% death rate   
25-29    ~55% death rate   
30-34    ~75% death rate   
over 34  ~85% death rate