Ann Acad Med Singap
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Ann Acad Med Singap · May 1998
Impact on quality of patient care and procedure use in the medical intensive care unit (MICU) following reorganisation.
We conducted this retrospective, cohort study to evaluate the quality of patient care and procedure use in the medical care unit (MICU) following reorganisation and staffing by an intensivist. Consecutive admissions to an adult MICU in a university affiliated hospital during two 3-month periods, August to October 1993 (Period 1, n = 112) and January to March 1994 (Period 2, n = 127) were analysed. In Period 1, the MICU was run under the open system in which patient care was provided by the individual attending physicians. ⋯ Reorganisation of the MICU in Period 2 resulted in reduced length of MICU stay for survivors. Hence, we believe that coverage by a dedicated ICU team and active respiratory care by a respiratory therapist during office hours were beneficial for the care of the critically ill. There was also a noticeable increase in the use of invasive monitoring.
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Ann Acad Med Singap · May 1998
Case ReportsFive paediatric case reports of the use of adenosine in supraventricular tachycardia.
The efficacy, safety and diagnostic usefulness of adenosine in the treatment of supraventricular tachycardia in children were prospectively studied over a 2-year period. Only patients who were stable and without hypotension were included. Adenosine was given at a dose of 0.1 mg/kg and increased to 0.2 mg/kg for the second and third doses if there was no response. ⋯ One out of 3 patients who were old enough to report side-effects, experienced chest discomfort and dizziness lasting 5 seconds. All side-effects were transient and mild. We concluded that adenosine is effective and safe in terminating supraventricular tachycardia in children after vagal manoeuvres have failed.
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Ann Acad Med Singap · May 1998
APACHE II and SAPS II are poorly calibrated in a Hong Kong intensive care unit.
This study seeks to determine if the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) model predictions are well calibrated in our adult Intensive Care Unit (ICU) patient population. 1064 successive ICU discharges were enrolled with 222 deaths at hospital discharge. APACHE II predicted 287.44 deaths, thus giving an APACHE II standardised mortality ratio (SMR) of 0.77 (95% confidence interval +/- 0.07). ⋯ The area under the Receiver Operating Characteristic plot for SAPS II risk of death was 0.87 (95% confidence interval +/- 0.028) while that for APACHE II risk of death was 0.88 (95% confidence interval +/- 0.026). Although the APACHE II and SAPS II models provide good discriminatory performance this study finds the APACHE II and SAPS II models to be poorly calibrated in that they over-predict mortality in our ICU population.
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Ann Acad Med Singap · May 1998
Comparative StudyA retrospective study of near-drowning victims admitted to the intensive care unit.
A retrospective study was conducted to evaluate the outcome of near-drowning patients admitted to the intensive care unit (ICU) comparing seawater and freshwater drownings. A chart review was used to identify near-drowning patients admitted to ICU from 1 April 1989 to 1 May 1996 for biodata, physiological data and outcome. Seventeen near-drowning patients were admitted to ICU over a period of nearly 7 years. ⋯ Patients that survived to hospital discharge had full neurological recovery and stayed an average of 4.5 days. We concluded that near-drowning victims that survive to be admitted to ICU have significant oxygenation defect with nearly half requiring ventilatory support. Mortality is appreciable, but those that survive to hospital discharge had full neurological recovery.
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Ann Acad Med Singap · May 1998
Audit of 2431 admissions to the Surgical Intensive Care Unit, Singapore General Hospital.
A prospective analysis of 2431 patients admitted to the Surgical Intensive Care Unit (SICU) of Singapore General Hospital was conducted between January 1994 and June 1997. All patients were followed up until hospital discharge. This ongoing project serves as both audit and quality assurance in the SICU. ⋯ Thirty (29%) died before the SICU discharge. SICU mortality was 9.46%, hospital mortality was 10.86% and standardised mortality ratio was 1.95. Computerised tools that analyse ICU utilisation patterns and outcomes have the potential to better target resources and so lower hospital costs, reducing futile medical care by selecting patients for appropriate expensive ICU care.