The Changi General Hospital is a new regional hospital in the eastern part of Singapore catering to a population of about 750 000. Planning of the hospital started since 1987 and construction began in 1992. This article is available only as a PDF. Please click on “Download PDF” on top...

Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence has been awarded to graduates of the critical care medicine fellowship programmes since 1987. This article is available only as a PDF. Please click on “Download...

Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular ionic shift from acid-base anomalies and tissue trauma. We report a rare and erstwhile unencountered cause of serum hyperkalaemia in our intensive care unit (ICU),...

The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been...

The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the role of medicine was “to do away with the suffering of the sick, to lessen the violence of their diseases, and to refuse to treat...

The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the use of renal replacement therapy) as well as in the epidemiology of this condition. Severe acute renal failure (SARF) is now most commonly seen in...

The intensive care unit (ICU) is a complex environment in which multidisciplinary expertise has been shown to enhance clinical outcomes. For example, the availability of full-time intensivists has been associated with improved survival. This article is available only as a PDF. Please click on “Download PDF” on top to view...

In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated by a labile humoral substance termed endothelium-derived relaxing factor (EDRF). This article is available only as a PDF. Please click on “Download PDF” on top to...

Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh et al in 1967. The original authors detailed the presence of tachypnoea, hypoxaemia, decreased respiratory compliance, bilateral pulmonary infiltrates and reported a survival rate of 42%. This article is available only as a PDF. Please click on “Download PDF” on...

Multisystem organ failure occurs in a large proportion of critically ill patients and is a major cause of death in this group of patients. The mechanisms responsible for the development of multisystem organ failure in the critically ill patient are unknown. This article is available only as a PDF. Please...

Central to the combined diagnostic and therapeutic approach to the critically ill subject is the evaluation of both the basal physiologic status and its subsequent change over time consequent to a therapeutic intervention. This article is available only as a PDF. Please click on “Download PDF” on top to view...

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and medical traditions. The Western Pacific Association of Critical Care Medicine (WAPCCM) includes countries from Japan in the north to Australia and New Zealand in the...

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s. Prolonged hand ventilation, and positive or negative pressure ventilation, enabled maintenance of oxygenation until some patients developed sufficient recovery or compensatory processes to enable separation...

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have reviewed its use for inguinal and genital surgery in children. This article is available only as a PDF. Please click on “Download PDF” on top to...

Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill of these infants would meet the criteria for the use of extracorporeal membrane oxygenation (ECMO). This article is available only as a PDF. Please click on...

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...

Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...

Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Diabetes insipidus (DI) is a syndrome characterised by the excretion of abnormally large volumes of dilute urine. It occurs uncommonly in neurosurgical patients, but is an important complication. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Trauma is the fifth commonest cause of death in Singapore. In 1996, trauma contributed to 5.4% of mortality. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute myocardial infarction, to save those with “hearts too good to die”. This article is available only as a PDF. Please click on “Download PDF” on top...

The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) scoring systems are widely used prognostic tools in Intensive Care Units (ICUs). These scoring systems calculate a “risk of death” (ROD) for ICU patients while adjusting for case-mix with severity...

The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU, Burns ICU, Medical ICU, Coronary Care Unit and Neonatal ICU. The SICU receives patients from various surgical disciplines (Table I). This article is available only as...

Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs) use about 15% of the total hospital cost or about 1% of the gross national product. This article is available only as a PDF. Please click...

Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have arrived at different paradigms—open versus closed models, specialty-based intensive care units (ICUs) versus general ICUs, internist versus pulmonologist or anaesthetist, and so forth. This article is...

Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome, and the public is increasingly conscious of its burden to society. A population survey conducted in Singapore in 2010 showed that 53 out of 1067...