Ann Acad Med Singap
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Ann Acad Med Singap · May 2001
Randomized Controlled Trial Clinical TrialEffect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients.
We conducted this prospective randomised cross-over study to evaluate the effect of closed system (CS) versus open system (OS) endotracheal suctioning on heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), oxygen saturation (SpO2) and electrocardiogram (ECG) rhythm of patients on mechanical ventilation. ⋯ Our study shows that OS suctioning results in more adverse changes in cardiorespiratory parameters compared to CS suctioning.
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To highlight recent advances in neurological and neurosurgical intensive care. ⋯ Specialised neurointensive care units provide the best environment for the patient with acute brain injury. Outcome is frequently enhanced the clinicians skilled towards dealing with the whole spectrum of neurologic insults.
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Ann Acad Med Singap · May 2001
ReviewLimitation of life support in the critically ill: the Hong Kong perspective.
Patients admitted to the intensive care unit (ICU) may not benefit from the life support provided and it may result in prolonged and unnecessary suffering. Limiting life-support therapy in this situation is an ethically acceptable practice in Western countries. Statements produced by professional bodies have been generally made from a Western perspective. Cultural influences, aspects of management and resource limitations may create differences, yet there is little information available on the ethical decision making processes involved in limitation of life support in Asian countries. This article reviews the processes involved in the limitation of life support in critically ill intensive care patients in the predominantly Chinese population of Hong Kong. ⋯ Limitation of therapy in dying Chinese patients occurs in ICUs and, patients and relatives concur in 95% of cases with medical decisions to limit therapy in these patients. The importance of communication as well as a desire to participate in the decision-making process regarding limitation of therapy suggest similarities between Western and Asian expectations. More comprehensive data are required regarding end-of-life issues in the Asian context, especially in relation to the general population's perception as to the processes involved.
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The following article reviews the experience of using human simulators for medical education at the University of Pittsburgh in the Department of Anesthesiology and Critical Care Medicine. The intent of the authors is to provide the reader with an overview of 1) what human simulators can do, 2) the components of a simulation training facility, 3) some of the economic considerations in operating a simulation training facility, and 4) how this centre is made use of.
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Traditionally, outcome from intensive care has focused on mortality. The cost of intensive care and the limited resources devoted to patients who have a poor prognosis also raises questions about the utilisation of such resources. There is increasing pressure for outcome evaluation of intensive care to incorporate assessment of long-term survival and the quality of life in survivors. The principal objectives of this article were to examine current methods of assessing quality of life measures in critically ill patients surviving intensive care and to determine the quality of life of these survivors. ⋯ Assessment of outcome after intensive care should include health related quality of life measurements. A unifying framework is required to enhance communication between clinicians, administrators and investigators of quality of life research and also to enable more rational and effective decision making at the bedside. Patients who survive intensive care appear to enjoy a reasonable standard of quality of life. While their health status may not be as good, subjectively patients find this acceptable.