Ann Acad Med Singap
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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.
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Ann Acad Med Singap · May 1998
Clinical TrialOutcome of patients with traumatic brain injury managed on a standardised head injury protocol.
A standardised protocol in the management of severe head injury in our hospital enables pre-determined critical care-paths and consistent treatment regimes to be instituted. In Singapore there has been no previously reported data on the outcome of severely head injured patients. Over a 6-month period, 48 consecutive patients who were enrolled in our severe head injury protocol were prospectively studied. ⋯ The use of a protocol with standardised treatment goals in the management of traumatic brain injury allows for the optimal use of limited resources and provides consistency in treatment. Good outcome is related to early aggressive resuscitation to prevent hypotension and hypoxia, prompt evacuation of surgical mass lesions and the maintenance of an adequate cerebral perfusion pressure. Our results are comparable with that reported in other established neurotrauma systems.
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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.