Outcome Assessment Form - Care Fusion 3100B Pocket Manual

Outcome assessment form

The use of this form is not intended to encourage or deny the use of high
frequency oscillation. The following below is only a portion of the form. You can
find the Outcome Assessment Form to print and use on the CareFusion site at
carefusion.com/hfov/.
(zero points)
Days P/F < 200
Days of CMV
PaCO
2
Organ failures pulmonary only
PIP
Immune comp.
OI
OI trend
Oxygenation Index (OI) = [(FiO
Score: 1–7 Low anticipated mortality; 8–13 Moderate anticipated mortality; 14–19 High anticipated mortality
Low risk Moderate risk
(one point)
< 2 days 2 - 4 days
< 6 days
35 - 55 < 35
2 or more
< 38 39 - 49
No Yes
< 19 20-30
x 100) x mP
2
High risk
(two points)
5 - 6 days
> 7 days
55 - 80
> 50
31 - 40
Slowly
worsening
/PaO ]
aw
2
41
Max risk
(three points)
> than 7 days
> 80
> 41
Dramatically
worsening
Score