This successful collaboration shows that shared transfusion protocols are feasible and potentially advantageous for hospitals sharing a central blood provider.

INTRODUCTIONA study was conducted to describe the sedation practices of intensive care units (ICUs) in Singapore 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. The Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) were used. RESULTSWe enrolled 198 patients over a five-month period. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 25.3 ± 9.2, and 90.9% were emergency hospital admissions. 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. 7,354 RASS assessments were 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, possibly due to the drugs used.

To decrease mortality from severe sepsis the Surviving Sepsis Campaign put forth multiple recommendations, some of which have been incorporated into a six-hour resuscitation bundle and a 24-hour management bundle 1,2. However, compliance with these guidelines remains poor in many countries 2-5. Many of these recommendations were based upon the results of randomised controlled trials of various clinical protocols. These include protocols for early goal-directed therapy for haemodynamic derangement 6 , glucose control 7 , lung-protective ventilation 8 , weaning from ventilatory support 9 and sedation management 10,11. To increase adherence to the Surviving Sepsis Campaign guidelines, there have been efforts by intensive care units (ICU) to implement protocols derived from the randomised controlled trial setting 12. To date, however, the impact of clinical protocols on real world practice and outcomes remains unclear. Multiple barriers to adherence to evidence-based protocols exist, including clinician knowledge, attitudes and behaviour 13. Various approaches have been employed to mount these barriers, including

No abstract

No abstract