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Singapore SPICE: Sedation Practices in Intensive Care Evaluation in Singapore - a prospective cohort study of the public healthcare system.

Abstract

INTRODUCTION

A study was conducted to describe the sedation practices of Singapore intensive care units (ICUs) in terms of drug use, sedation depth and the incidence of delirium in both early (< 48 hours) and late (> 48 hours) periods of ICU admission.

METHODS

A prospective multicentre cohort study was conducted on patients who were expected to be sedated and ventilated for over 24 hours in seven ICUs (surgical ICU, n = 4; medical ICU, n = 3) of four major public hospitals in Singapore. Patients were followed up to 28 days or until ICU discharge, with four hourly sedation monitoring and daily delirium assessment by trained nurses. Richmond Agitation and Sedation Score (RASS) and Confusion Assessment Method for Intensive Care (CAM-ICU) were used.

RESULTS

We enrolled 198 patients over a five-month period. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 25.3 ± 9.2 and 90.9% of hospital admissions were emergency. Patients were followed up for 1,417 ICU patient days, of which 396 days were in the early period and 1,021 days were in the late period. There were 7,354 RASS assessments performed. Propofol and fentanyl were the sedative agents of choice in the early and late periods, respectively. Patients were mostly in the light sedation range, especially in the late period. At least one episode of delirium was seen in 23.7% of patients.

CONCLUSION

Sedation practices in Singapore ICUs are characterised by light sedation depth and low incidence of delirium. This may be due to the drugs used.

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  • Authors+Show Affiliations

    ,

    Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore.

    ,

    Fast and Chronic Programmes, Alexandra Hospital, National University Hospital, National University Health System, Singapore.

    ,

    Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.

    ,

    Department of Medicine, Sengkang General Hospital, Singapore.

    ,

    Fast and Chronic Programmes, Alexandra Hospital, National University Hospital, National University Health System, Singapore.

    ,

    Department of Anaesthesia, National University Hospital, National University Health System, Singapore.

    ,

    Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.

    ,

    Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore.

    ,

    Australian New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

    ,

    School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.

    Department of Anaesthesia, Yong Loo Lin School of Medicine, National University Health System, Singapore.

    Source

    Singapore medical journal : 2019 Jun 14 pg

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31197381

    Citation

    Ng, Shin Yi, et al. "Singapore SPICE: Sedation Practices in Intensive Care Evaluation in Singapore - a Prospective Cohort Study of the Public Healthcare System." Singapore Medical Journal, 2019.
    Ng SY, Phua J, Wong YL, et al. Singapore SPICE: Sedation Practices in Intensive Care Evaluation in Singapore - a prospective cohort study of the public healthcare system. Singapore Med J. 2019.
    Ng, S. Y., Phua, J., Wong, Y. L., Kalyanasundaram, G., Mukhopadhyay, A., Lim, D., ... Ti, L. K. (2019). Singapore SPICE: Sedation Practices in Intensive Care Evaluation in Singapore - a prospective cohort study of the public healthcare system. Singapore Medical Journal, doi:10.11622/smedj.2019055.
    Ng SY, et al. Singapore SPICE: Sedation Practices in Intensive Care Evaluation in Singapore - a Prospective Cohort Study of the Public Healthcare System. Singapore Med J. 2019 Jun 14; PubMed PMID: 31197381.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Singapore SPICE: Sedation Practices in Intensive Care Evaluation in Singapore - a prospective cohort study of the public healthcare system. AU - Ng,Shin Yi, AU - Phua,Jason, AU - Wong,Yu Lin, AU - Kalyanasundaram,Ganesh, AU - Mukhopadhyay,Amartya, AU - Lim,Danny, AU - Chia,Naville, AU - Ho,Benjamin Choon Heng, AU - Bailey,Michael J, AU - Shehabi,Yahya, AU - Ti,Lian Kah, Y1 - 2019/06/14/ PY - 2019/6/15/entrez KW - delirium KW - intensive care unit KW - sedation JF - Singapore medical journal JO - Singapore Med J N2 - INTRODUCTION: A study was conducted to describe the sedation practices of Singapore intensive care units (ICUs) in terms of drug use, sedation depth and the incidence of delirium in both early (< 48 hours) and late (> 48 hours) periods of ICU admission. METHODS: A prospective multicentre cohort study was conducted on patients who were expected to be sedated and ventilated for over 24 hours in seven ICUs (surgical ICU, n = 4; medical ICU, n = 3) of four major public hospitals in Singapore. Patients were followed up to 28 days or until ICU discharge, with four hourly sedation monitoring and daily delirium assessment by trained nurses. Richmond Agitation and Sedation Score (RASS) and Confusion Assessment Method for Intensive Care (CAM-ICU) were used. RESULTS: We enrolled 198 patients over a five-month period. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 25.3 ± 9.2 and 90.9% of hospital admissions were emergency. Patients were followed up for 1,417 ICU patient days, of which 396 days were in the early period and 1,021 days were in the late period. There were 7,354 RASS assessments performed. Propofol and fentanyl were the sedative agents of choice in the early and late periods, respectively. Patients were mostly in the light sedation range, especially in the late period. At least one episode of delirium was seen in 23.7% of patients. CONCLUSION: Sedation practices in Singapore ICUs are characterised by light sedation depth and low incidence of delirium. This may be due to the drugs used. SN - 0037-5675 UR - https://www.unboundmedicine.com/medline/citation/31197381/Singapore_SPICE:_Sedation_Practices_in_Intensive_Care_Evaluation_in_Singapore_-_a_prospective_cohort_study_of_the_public_healthcare_system L2 - https://doi.org/10.11622/smedj.2019055 DB - PRIME DP - Unbound Medicine ER -