Ann Acad Med Singap
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Ann Acad Med Singap · May 1998
ReviewContributions of respiratory care practitioners to intensive care: a review.
Through the years, the professional practice of respiratory care has continually evolved to include management of critically ill patients. Although the functions and duties of respiratory care practitioners (RCPs) in this setting may vary across different institutions, it is widely recognised throughout the United States that RCPs contribute importantly to intensive care unit (ICU) outcomes. ⋯ Other ICU activities in which RCPs participate include assisting with bronchoscopy, obtaining haemodynamic measurement, and indirect calorimetry and supporting specialised techniques such as extracorporeal membrane oxygenation (ECMO) and continuous veno-venous haemofiltration and/or haemodiafiltration (CVVH/CVVHD). Based on the demonstrated impact of RCPs and their technical and cognitive training, a continuing role expansion for RCPs in the ICU is expected.
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Advances in medical technology have rendered the ability to provide prolonged physiologic support of incurable or terminally ill patients commonplace in the intensive care unit. In tandem, there has been a global shift in the intensivist's mindset from solely pursuing an unrelenting course of aggressive therapy, to a recognition of the limitations of intensive care and the appropriate discontinuance of nonbeneficial therapy. ⋯ A consensus on withholding or withdrawal of care is often then achieved. The process of foregoing or withdrawing life-sustaining therapy itself, must be carried out with sensitivity and empathy, with the primary goal of providing comfort and reducing suffering.
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The Western Pacific region has seen rapid recent economic development but variation in the provision and organisation of intensive care units (ICUs) between different countries remains. While Japan, Australia, New Zealand, Singapore, Taiwan, Korea and Hong Kong have well developed intensive care facilities, in other countries the more limited funding for healthcare can be reflected by differential availability of modern medical technology between the public and private sectors. Other factors important to intensive care include physician training, availability of other staff and whether intensive care is delivered in "open" or "closed" units. ⋯ Future development of intensive care in the region will parallel economic development. In most countries increasing patient expectations, ageing populations and "Western" diseases will increase demand for intensive care services. Only a few countries currently have recognised programmes of training and certification in intensive care but as more adopt this process it should lead to a clearer recognition and acceptance of the role of the intensivist.
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Ann Acad Med Singap · May 1998
Comparative StudyPredictors of long-term outcome in severe head injury.
Severe head injury is associated with significant morbidity and mortality. We conducted a retrospective study to assess the long-term outcome of these patients using the Glasgow Outcome Score (GOS) and evaluate the variables that might predict outcome. Data were collected from all post-traumatic neurosurgical patients with severe head injury (Glasgow Coma Scale 8 or less) admitted to the Surgical Intensive Care Unit over a 29-month period. ⋯ Patients with a poor outcome (defined as GOS scores of 1 to 3) had a significantly higher mean age, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and a lower Glasgow Coma Scale than those with a good outcome (GOS 4 to 5). The APACHE II score correlated better with outcome than the Glasgow Coma Scale or age. The APACHE II score may be used to prognosticate the long-term outcome in severe head injury.
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Ann Acad Med Singap · May 1998
Case ReportsCombined high-frequency ventilation (CHFV) in the treatment of acute lung injury--a case report.
A 22-year-old man was admitted to a district general hospital with chest injuries, a ruptured spleen and limb fractures, sustained in a road traffic accident. After an emergency splenectomy, the patient developed unilateral pulmonary oedema with hypoxaemia which was resistant to both conventional controlled mechanical ventilation (CMV) and independent lung ventilation (ILV). ⋯ Progressive weaning from ventilatory support was then possible over five days. CHFV is a valuable technique in the treatment of acute catastrophic lung injury and needs wider recognition.