Timing for initiation of continuous renal replacement therapy in patients with septic shock and acute kidney injury
Shum HP, Chan KC, Kwan MC, Yeung WT, Cheung WS, Yan WW
Poster presentation in 32nd International Symposium on Intensive Care and Emergency (2012)
Introduction: The optimal timing for initiation of renal replacement therapy (RRT) in septic acute kidney injury (AKI) remains controversial. The aim of this study is to investigate the impact of early versus late initiation of continuous RRT (CRRT), as defined using the simplified RIFLE classification, on organ dysfunction among patients with septic shock and AKI.
Methods: Patients were divided into early (sRIFLE Risk) or late (sRIFLE Injury or Failure) initiation of RRT. Patients with chronic kidney disease stage 5 or on dialysis were excluded.
Results: One hundred and twenty patients admitted within a 3.5-year period fulfilled inclusion criteria. Thirty-one (26%) underwent early, 89 (74%) had late CRRT. No significant difference was noted between the two groups with respect to change in total SOFA score/non-renal SOFA score in the first 24/48 hours after initiation of CRRT, vasopressor use, dialysis requirement and mortality (at 28 days, 3 months and 6 months). The change of nonrenal SOFA score 48 hours after CRRT correlated with the SOFA score at the start of CRRT (P = 0.034) and the APACHE IV risk of death (P = 0.000), but not the glomerular filtration rate (GFR) at the start of CRRT (P = 0.348). See Tables 1 and 2.
Conclusion: For septic shock with AKI, no significant difference in organ function and outcome was noted when the timing of initiation of CRRT was classified using sRIFLE criteria. Subsequent improvement of organ function correlated with initial SOFA and APACHE scores instead of the GFR (which determine sRIFLE class) on starting of CRRT. The use of more global assessment tools, such as the SOFA score, for stratification purposes on appropriate timing of CRRT warrants further investigation.
Extracorporeal membrane oxygenation (ECMO) in the treatment of severe pneumonia & ARDS
Presented at the HA convention 2011
Use of extracorporeal membrane oxygenation (ECMO) for treatment of respiratory failure in adults has received attention after the CESAR trial demonstrated a significant improvement in survival without severe disability in patients randomized to ECMO treatment compared to conventional ventilation (63% vs 47%; p=0.03). This technology has remained relatively new in Hong Kong until recently.
To describe the outcomes of patients in one ICU who received ECMO as salvage therapy for severe pneumonia and acute respiratory distress syndrome (ARDS) after failing conventional treatment.
Patients treated by ECMO for severe pneumonia in the Department of Intensive Care, PYNEH were retrieved by the Clinical Data Analysis and Reporting System (CDARS). Data was analyzed retrospectively.
From October 2009 to January 2011, 14 patients were treated by ECMO for severe pneumonia and ARDS: Influenza A (H1N1) 11 (78.6%), Metapneumovirus 1 (7.1%), Mycoplasma 1 (7.1%), unknown aetiology 1 (7.1%). The median (interquartile range; IQR) age was 42 (35-54). The median (IQR) APACHE II score and risk of death were 29 (18-33) and 0.67 (0.29-0.78). Six patients were referred from 2 public and 1 private hospitals. Two of them had desaturations despite high pressure and oxygen ventilation, and required cannulation at the referring hospitals and transferral on ECMO. All 14 patients survived and were discharged home after a median (IQR) ICU, acute general and convalescent stay of 16 (14-22), 28 (16-32) and 11 (0-22) days. The median (IQR) ECMO duration was 5 (4-6) days.
Objective: Results: 1. Concern and caring by ICU staff to patients = 72.9 2. Patient’s symptom management = 67.3 3. Concern and caring by ICU staff to patients’ families = 63.6 4. Nurses’ performance = 62.2 5. Doctors’ performance = 68.1 6. ICU atmosphere = 51.1 PART 2: FAMILY SATISFACTION WITH DECISION-MAKING AROUND CARE OF CRITICALLY ILL PATIENTS 1. Information needs = 58.0 2. Process of making decisions = 49.0 Conclusion: 2. Patients’ families were less satisfied with the information we provided (“frequency of communication with ICU doctors”, “ease of getting information” and “understanding of information”) and process of decision making (“being included and supported in the decision making process”, “has control over the care of family members”, “adequate time to have concerns addressed and questions answered”). 3. It is often assumed that paternalistic doctor-patient relationship is well accepted in Chinese society. This may no longer remain true in a modern metropolis like Hong Kong. 4. Families can be more actively involved in decision making on various treatment options. 5. Measures e.g. video show and pamphlets explaining general ICU care and procedures can be efficient ways to provide information to families in a busy ICU. Grace SM Lam, Arthur CW Lau. Prevention of ventilator-associated pneumonia (VAP) by novel endotracheal tube designs. Hong Kong Lung Foundation, Hong Kong Thoracic Society & ACCP (HK & Macau Chapter) Newsletter 2011 April, 32-35 Lam SM, Lau ACW. Alveolopleural or bronchopleural fistula – From the critical care physicians’ perspective. Hong Kong Lung Foundation, Hong Kong Thoracic Society & ACCP (HK & Macau Chapter) Newsletter 2009; 19(1): 22-24 Ernest NP Wong, Arthur CW Lau, Kenny KC Chan, HP Shum, Angus HY Lo, Anne KH Leung, WW Yan. Feasibility, cost-effectiveness and staff satisfaction of continuous hemofiltration using regional citrate anticoagulation and on-line prepared replacement solution for critically ill patients in the intensive care unit. Abstract, THE THIRTEENTH INTERNATIONAL CONFERENCE ON CONTINUOUS RENAL REPLACEMENT THERAPIES February 27- March 1, 2008 Hotel Del Coronado, San Diego CA Arthur C. W. LAU,1 Mary S. M. Ip,2 Christopher K. W. LAI,3 K. L. CHOO,4 K. S. TANG,5 Loretta Y. C. YAM,1 Moira CHAN-YEUNG2VARIABILITY OF THE PREVALENCE OF UNDIAGNOSED AIRFLOW OBSTRUCTION IN SMOKERS USING DIFFERENT DIAGNOSTIC CRITERIA. (APSR 2007)
ICU family satisfaction survey
Wu HL, Chan CS, Ho HC, Li C, Ma LH, So WY, Yan WW, Kwok N
Presented at the HA convention 2011
Providing professional care and establishing good rapport with patients is our mission. However, building a good relationship with patients’ family is equally important. This helps to relieve their anxiety and reduce potential complaints due to miscommunication.
This survey result can help to identify the strength and weakness concerning our care provided to patients and their families. The result can also help guiding us to prioritize the resources for improvement in the future.
The next-of-kin of patients admitted to Intensive Care Unit (ICU) of Pamela Youde Nethersole Eastern Hospital (PYNEH) within a 3 month period were contacted by phone and asked to complete a questionnaire: FS-ICU-24. A transformed score ranging from 0-100 will be given to each question/category. Higher score means better performance.
A total of 36 people were interviewed, with mean age 52.7 years old (range 22-88). 38.9% were male and 61.1% were female. The mean scores for each aspect are as follows:
PART 1: SATISFACTION WITH CARE
1. Patients’ next-of-kin were in general satisfied with the care provided by ICU to both patients and their families, especially the care provided to patients (72.9 vs 63.6).
Extracorporeal Life Support for Poisoning – A Case Report & Literature Review
Presented at the HKSCCM & HKACCN Annual Scientific Meeting 2009, Authors: Chan KC, Shum HP, Yan WW
With advancement of technology, there is a re-emerging interest of extracorporeal life support (ECLS) in very sick patients with reversible underlying problem, such as acute respiratory distress syndrome. Many poisonings are also very reversible, and ECLS has an additional part to play in enabling extracorporeal removal of toxins in haemodynamically unstable patients.
To review the literatures concerning the use of ECLS in supporting victims of poisonings and report our experience in the use of ECLS and high-volume haemodiafiltration (HVHDF) in a case of fatal paraquet poisoning.
Case History and Findings:
A young lady was admitted soon after ingestion of 21 grams of paraquat. Her vitals were stable on admission. Enteral charcoal, heamocharcoal perfusion, HVHDF and immuno-suppression were started. She developed respiratory failure in day 3. Veno-venous ECLS was started in attempt to minimize FiO2 and lung toxicity. We managed to keep the FiO2 at 0.21 for a week. HVHDF was continued for toxin removal. Unfortunately, she developed sepsis in the second week of ICU stay and she succumbed on day 14. There was only small amount of fibrosis in the post-mortum examination of the lungs. Search of PubMed yielded 23 case report or case series regarding use of veno-venous or veno-arterial ECLS for severe poisoning.
ECLS may have a role in supporting selected cases of severe poisoning with cardio-pulmonary failure.
Regional Citrate Anticoagulation in Predilution Continuous Venovenous Haemofiltration Using Prismocitrate 10/2 Solution
Shum HP, Chan KC, Yan WW Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
Poster Presentation on APCN 2011
INTRODUCTION: Regional citrate anticoagulation (RCA) for continuous renal replacement therapy is associated with longer filter-life and less bleeding events. Complexity of the regimen is the major hurdle preventing its wide spread applications.
OBJECTIVE: To investigate the feasibility of a simple predilution continuous venovenous haemofiltration (CVVH) protocol, utilizing a commercially-prepared citrate-containing replacement solution (Prismocitrate 10/2) for RCA
METHODS: Six patients with sepsis and acute renal failure were evaluated. The Prismaflex system (Gambro-Hospal) was used for predilution CVVH (Figure 1). Prismocitrate 10/2, running at 2500ml/h, was the main predilution replacement. 8.4% sodium bicarbonate solution was infused at 50ml/h in the first 2 hours, and then at 30ml/h, via the ‘Heparin port’ of the circuit (pre-filter). 10% calcium gluconate was infused via a separate central venous catheter to achieve an ionized calcium (iCa) level of 1-1.2mmol/L. The fluid withdrawal rate was adjusted to achieve the desired fluid balance. The circuit was run for 72-hours, unless there was filter clotting or the patient did not require further CRRT.
RESULTS: Six sessions of predilution CVVH, with total treatment duration of 336 hours, were performed. The post-dilution equivalent ultrafiltration rate was 34.2±3.2ml/kg/h (mean±SD). There was no filter clotting in all sessions. Pre-filter and post-filter iCa were 0.249±0.02mmol/L and 0.265±0.04mmol/L respectively. Arterial iCa was maintained at 1.04±0.13mmol/L, with a 10% calcium gluconate infusion of 16.6±1.5ml/h. The total-calcium to iCa ratio was 2.25±0.13. No patient has a sodium level ≥150mmol/L, or metabolic alkalosis (pH≥7.5), or any evidence of citrate toxicity.
CONCLUSIONS: This predilution CVVH protocol with RCA is safe, effective and easy to implement.
Quality Improvement Program (QIP) on Pressure Ulcer Prevention and Management in Intensive Care Unit (ICU)
Lau Y Y1, 2, Lo W P1, 2, Kwok L P1, 2, Chang L F1, 2, Liu S K1, 2, Tam Y F1, 2, Yeung M W1, 2, Li S C1, 2, Wong H Y1, 2
Department of Intensive care1, Pamela Youde Nethersole Eastern Hsopital2
Poster Presentation on The 3rd HKEC Quality & Safety Seminar 2009/10 - Better Health for All: Mission, Passion and Action on 6 March 2010 (Saturday)
Pressure ulcer is common in a variety of health care setting. In critical care unit, patients are at particular risk of developing pressure ulcer. However, the presence of pressure ulcer may contribute to adverse health outcomes in turn to increase mortality in patients. Moreover, the incidence of pressure ulcer is one of the quality signs of health centres. It has also a significant impact on healthcare costs. National organization recommends that quality improvement should be done for prevention and management of pressure ulcer. Use information from quality improvement data to determine the need for education and policy changes. A quality improvement program was implemented in intensive care unit in the year of 2009.
Purposes of the project
The aim of this program was (1) to reduce the incidence of pressure ulcer in ICU. (2) to enhance the standard care of pressure ulcer among critically ill adult patients.
The Quality Improvement Program (QIP) consisted of an audit on standard care of pressure ulcer. After the audit had been completed, an in service training was done on the poor compliance area which including assessment, skin care and documentation of pressure ulcer. Finally, an audit was done again to evaluate the effective of the training. Outcome measures were categorized as (1) Incidence rate of pressure ulcer, (2) Compliance rate of standard care of pressure ulcer
An audit on standard care of pressure ulcer was done by the first quarter in 2009. Result found that three areas in poor compliance rate with 74% on daily assessment; 70% on skin care; 76% on documentation of the pressure ulcer. After that an in service training was provided to fifty-six nurses to enhance the daily assessment, skin care and documentation of pressure ulcer by the second and third quarter in 2009. In addition, a training program of incontinence skin care was provided to twelve health care workers. After the implementation of the in service training, the audit was taken place again in the fourth quarter in 2009. Result found that there is a significantly improvement of the standard care of pressure ulcer. Average compliance rate is 96%. Result also found that the three areas with poor compliance rate in first quarter also got improving with 94% on daily assessment; 91% on skin care; 93% on documentation of the pressure ulcer.
On the other hand, the incidence rate of pressure ulcer was also monitoring through out the year of 2009. Result found that incidence rate was 5.7% (n = 7) in the first quarter and 5.8% (n = 7) in the second quarter. After the in service training program, reduction of the incidence rate was noted with 0.7% (n = 1) in third quarter and 0.7% (n = 2) in fourth quarter.
Pressure ulcer is preventable although it is common in a variety of health care setting. A significant reduction in the incidence rate of pressure ulcers occurred as the result of the QIP. It is also benefit to enhance the standard care of pressure ulcer. Periodical implement it in a variety of health care setting is recommended in future.
PYNEH Intensive Care Unit (ICU) admission characteristics, patient’s outcomes and performance from 2007 to September 2009 (8. Clinical Audit and Effectiveness). Poster presentation in HKEC quality and safety seminar in 2009/10.
Authors: Shum HP, Yan WW
Objective: To report Intensive Care Unit (ICU) admission characteristics, patient’s outcomes and performance from 2007 to September 2009.
Design: Retrospective, cohort study of prospectively collected data on index patient admissions.
Setting: Pamela Youde Nethersole Eastern Hospital, Intensive Care Unit
Patients: All patients admitted to ICU from 1 Jan 2007 to 30 Sep 2009. Patient’s age less than 16 years old, ICU stay less than 4 hours or those with unclear hospital outcome were excluded.
Main results: Among 3324 patients admitted during the study period, 110 patients (3.3%) were excluded for analysis. The ICU admission rate increased gradually from 1135 in 2007 to 1337 in 2009 (projected). The ratio of elective versus emergency admission remained quite static at around 0.2. However, patients who had significant co-morbidities increase rapidly. Medical, surgical and neuro-surgical cases accounted for > 90% of ICU admission. The mean (+/- SD) ICU length of stay decreased from 4.9 7.6 days in 2007 to 3.9 5.8 days in 2009, which was similar to Hospital Authority overall ICU average. Although ICU nursing manpower decreased from 71.5 in 2007 to 66 in 2009, ICU mortality improved from 14.7% to 12.9%. The hospital mortality also decreased from 21% in 2007 to 20.2% in 2009. Despite a slight increase of readmission rate from 6.4% in 2007 to 7.6% in 2009, the APACHE (Acute Physiology and Chronic Health Evaluation) IV Standardized mortality ratio (SMR) decreased from 0.76 in 2007 to 0.71 in 2009 which was favourable when compared with other major ICUs in Hong Kong.
Conclusion: The mean ICU length of stay decreased by one day and mortality decreased by 1.8% in around 3-years time. The APACHE IV SMR also showed significant improvement over time. These achievements could be due to improvement of nursing care, implementation of computer information system to decrease potential medication errors and emphasis of continuous on-job training and educations.
Ms Lau Yuk Yin, Grace. Quality Improvement Program (QIP) on Pressure Ulcer Prevention and Management in Intensive Care Unit (ICU)
(Clinical Audit and Effectiveness). Abstract, HKEC 3rd Quality & Safety Seminar 09/10
PYNEH intensive care unit consultation pattern and patients’ outcomes
Shum HP 1, Chan KC 1, Lau CW 1, Chan KW 1, Yan WW 1; 1 Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Poster presentation for Hospital Authority Convention 2009
Objective: To assess our ICU consultation pattern and determine factors associated with patients’ survival.
Design: Single-centre, prospective observational cohort study.
Setting: 20-beds medical-surgical intensive care unit (ICU) in a 1400-bed regional hospital.
Measurements and main results: The study lasted 9 months (Jan to Sept 2007). All patients were followed up till discharge or hospital death. 1346 consultations were included. 802 (59.6%) were male. Mean age was 65.7 ± 17.8 years. 402 (29.9%) occurred during weekday office hours (0800-1700), 586 (43.5%) at weekday non-office hours and 358 (26.6%) on weekends / Sundays/ public holidays. 900 (66.9%) were initiated for ICU support / opinion and 332 (24.7%) for post-operative care, 63 (4.7%) were trauma calls and 51 (3.8%) for resuscitation. 837 (62.2%) from general wards and 210 (15.6%) from Accident and Emergency Department. 647 (48.1%) from Medical Department, 386 (28.7%) from Surgical and 178 (13.2%) from Neurosurgical Department. 871 (64.7%) required intensive treatment or monitoring, 225 (16.7%) were considered “inappropriate” or “unnecessary” consultations because of low risk conditions or terminal / irreversible illness. 250 (18.6%) were those “borderline” cases with reduced likelihood of recovery. 858 (63.7%) consultations were admitted to ICU, 451 (33.5%) were rejected, 23 (1.7%) and 14 (1%) consultations were failed resuscitation and transferral to Cardiac Care Units or other hospitals. Hospital mortality was 27.3% (367 patients). 238 (52.7%) consultations rejected were considered too sick to benefit from ICU care (hospital mortality 62.2%) and 213 (47.2%) consultations were regarded too well to benefit from ICU care (hospital mortality 4.2%). Older age, rejection from ICU care, admission diagnosis, poorer ICU physician-predicted chance of long-term survival and higher Mortality Prediction Model II0 (MPMII0) predicted mortality were independent risk factors for hospital mortality (Table).
Conclusion: Among all factors independently associated hospital mortality, only “rejection from ICU care” was potentially modifiable. For those patients regarded too sick to benefit from ICU care, further investigation is needed to see whether ICU care could really provide potential survival benefit and quality of life if more of them are to be admitted.
Assessment of three hospital mortality prediction models in patients admitted to Pamela Youde Nethersole Eastern Hospital intensive care unit” – Free paper oral presentation at Annual Scientific Meeting of the Hong Kong Society of Critical Care Medicine and the Hong Kong Association of Critical Care Nurses 2009
Authors: Shum HP, Chan KC, Yan WW
Institution: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Tel: 25956488, 25956111
Objective: To assess the validity of mortality prediction systems in patients admitted to our intensive care unit (ICU). We included Acute Physiology and Health Evaluation (APACHE) II, APACHE IV and Simplified Acute Physiology Score (SAPS) II in our evaluation.
Design: A single centre prospective observational cohort study
Setting: General ICU in a tertiary regional hospital
Patients: All patients admitted to ICU in 2008 with ICU stay more than 4 hours and age >16 years old
Methods: The data necessary for mortality prediction were collected prospectively via the Clinical Management System. Predicted and actual mortality rates, and standardized mortality ratio (SMR) were calculated. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using Hosmer Lemeshow goodness of fit C-statistic.
Results: A total of 1194 consecutive ICU admissions occurred in 2008, of which 1117 met inclusion criteria. The SMR for APACHE II, APACHE IV and SAPS II was 0.62, 0.78 and 0.48 respectively. Discrimination was best for APACHE IV (area under ROC curve = 0.862), followed by APACHE II (0.826) and SAPS II (0.812). However, the difference is not statistically significant. Calibration was inadequate for APACHE IV (C-statistic 22.35, p=0.004) and SAPS II (C-statistic 17.14, p=0.029).
Conclusion: APACHE IV predictions of hospital mortality have good discrimination as compared with other models but it had inadequate calibration. Difference of patient’s characteristics may be the reason and customization of model should be considered.
Outcomes of Patients Discharged from the Intensive Car Unit at Night Time
Authors: Leung YW, Shum HP, Chan KC, Lau CW, Yan WW
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Background and Objectives:
The demand for Intensive Care Unit (ICU) service is high and increasing. When the need for ICU bed arises during tight bed status, sometimes patients have to be discharged from ICU at nighttime. Overseas studies showed that night time discharge had higher mortality. This study tried to look for any adverse outcomes associated with night time discharge in the ICU of Pamela Youde Nethersole Eastern Hospital, Hong Kong.
A retrospective study of all admissions in 2008 to our ICU was carried out. Daytime was defined as "0700-1959", and nighttime "2000-0659". Nighttime discharge was not our routine workflow unless there was urgent need for an ICU bed.
1162 out of the 1,258 admissions in 2008 had complete data. 152 (13.1%) died during ICU stay. Remaining 1,010 admissions were included for final analysis. 65 (6.4%) of discharge episodes occurred at nighttime. Compared with daytime discharge, nightime discharge showed no statistical difference in age, parent specialty, underlying co-morbidity, ICU length of stay (LOS), hospital LOS, APACHE II /IV scores and APACHE II/ IV risk of death. Elective ICU admissions and immediate post-operative cases were less likely to be discharged at night time. For daytime and nighttime discharge respectively, the hospital (8.1% vs. 9.2%, p=0.759), 3-month (10.7% vs. 13.8%, p=0.429) and 6-month mortality (15.2% vs. 13.8%, p=0.762) was similar, and so were readmission rates (7.2% vs. 7.7%, p=0.845).
In our ICU, nigthtime discharge, compared with daytime discharge, was not associated with adverse outcomes in terms of hospital, 3-month and 6-month mortality. There was also no difference in the readmission rate.
Acute poisoning in an intensive care unit and their outcomes (HA Convention 2009)
Lam SM1, Lau ACW1, Yan WW1 1Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Shum HP, Chan KKC, Lau ACW, Yan WW. PYNEH intensive care unit consultation pattern and patients' outcomes. HA Convention 2009.
Lam SM, Lau ACW, Yan WW. Acute poisoning in an intensive care unit and their outcomes. Hospital Authority Convention 2009 poster
Lam SM, Lau ACW, Yan WW. Medical thoracoscopy in the intensive care unit. Oral presentation at the Asian Intensive Care: Coming of Age Conference. Hong Kong 2009
Lam SM. What are the advantages and disadvantages of each aerosol delivery devices? Is there any benefit of one over another? Hong Kong Lung Foundation, Hong Kong Thoracic Society & ACCP (HK & Macau Chapter) Newsletter 2008; 18(2): 23-5
Henry C. Y. CHEUNG, Arthur C. W. Lau, Alfred Y. F. CHAN, H. P. SHUM, Grace S. M. LAM, Natalie Y. W. LEUNG, Angus H. Y. LO, Loletta K. Y. SO, W. W. YAN, Loretta Y. C. YAM CHARACTERISTICS AND OUTCOMES OF PULMONARY TUBERCULOSIS PATIENTS REQUIRING INTENSIVE CARE IN HONG KONG. (APSR 2007)
Shum HP, Chan KC, Yan WW. PYNEH ICU consultation pattern and performance. Poster presentation in HKEC quality and safety seminar (2007)
Shum HP, Chan CK, Lo SH, Mo KL; Wong KS. Late nephrologist referral of patients with advanced renal failure was associated with poorer short-term outcomes but no difference in 2-years morbidity and survival. Poster presentation in 11th Congress of the International Society of Peritoneal Dialysis (2006)
1. Concern and caring by ICU staff to patients = 72.9
2. Patient’s symptom management = 67.3
3. Concern and caring by ICU staff to patients’ families = 63.6
4. Nurses’ performance = 62.2
5. Doctors’ performance = 68.1
6. ICU atmosphere = 51.1
PART 2: FAMILY SATISFACTION WITH DECISION-MAKING AROUND CARE OF CRITICALLY ILL PATIENTS
1. Information needs = 58.0
2. Process of making decisions = 49.0
2. Patients’ families were less satisfied with the information we provided (“frequency of communication with ICU doctors”, “ease of getting information” and “understanding of information”) and process of decision making (“being included and supported in the decision making process”, “has control over the care of family members”, “adequate time to have concerns addressed and questions answered”).
3. It is often assumed that paternalistic doctor-patient relationship is well accepted in Chinese society. This may no longer remain true in a modern metropolis like Hong Kong.
4. Families can be more actively involved in decision making on various treatment options.
5. Measures e.g. video show and pamphlets explaining general ICU care and procedures can be efficient ways to provide information to families in a busy ICU.
Grace SM Lam, Arthur CW Lau. Prevention of ventilator-associated pneumonia (VAP) by novel endotracheal tube designs. Hong Kong Lung Foundation, Hong Kong Thoracic Society & ACCP (HK & Macau Chapter) Newsletter 2011 April, 32-35
Lam SM, Lau ACW. Alveolopleural or bronchopleural fistula – From the critical care physicians’ perspective. Hong Kong Lung Foundation, Hong Kong Thoracic Society & ACCP (HK & Macau Chapter) Newsletter 2009; 19(1): 22-24
Ernest NP Wong, Arthur CW Lau, Kenny KC Chan, HP Shum, Angus HY Lo, Anne KH Leung, WW Yan. Feasibility, cost-effectiveness and staff satisfaction of continuous hemofiltration using regional citrate anticoagulation and on-line prepared replacement solution for critically ill patients in the intensive care unit. Abstract, THE THIRTEENTH INTERNATIONAL CONFERENCE ON CONTINUOUS RENAL REPLACEMENT THERAPIES February 27- March 1, 2008 Hotel Del Coronado, San Diego CA
Arthur C. W. LAU,1 Mary S. M. Ip,2 Christopher K. W. LAI,3 K. L. CHOO,4 K. S. TANG,5 Loretta Y. C. YAM,1 Moira CHAN-YEUNG2VARIABILITY OF THE PREVALENCE OF UNDIAGNOSED AIRFLOW OBSTRUCTION IN SMOKERS USING DIFFERENT DIAGNOSTIC CRITERIA. (APSR 2007)
Ming-Lung Chuang, Hua Ting, Xing-Guo Sun, Arthur C.W. Lau, and Karlman Wasserman. Effect of Work Rate Increase and FIO2 on the Ventilation-CO2 Output Relationship. Abstract: International Union of Physiological Sciences Meeting in San Diego (Mar 31-Apr 5, 2005)
Lau ACW, So LKY, Liu HSY, Chim CS, Cheung NT, Chan H, Lam D, Cheung SL, Leung CSK, Yam LYC. Audit on a computerized nurse-operated triage system for the assignment of first appointments in the Medical Specialist Outpatient Department (SOPD) in Pamela Youde Nethersole Eastern Hospital. Abstract and oral presentation: HA Convention 2005
SO LKY, Lau ACW. Early and late outcomes of severe acute respiratory syndrome (SARS) treated with a standard protocol. Abstract: The 45th annual meeting of the Japanese Respiratory Society. The Journal of the Japananese Respiratory Society, v 43 supplement, Apr, 2005, p 111.
Johnny W Chan, Sai-On Ling, Agnes Lai, Fanny W Ko, Kam-Sing Tang, Arthur C Lau, Kahlin Choo, Wai-Cho Yu, Moira M Chan-Yeung, Mary S Ip. Determining the lower limits of normal of spirometric reference values for adult Chinese in Hong Kong. Abstract of CHEST 2005 at Montreal, Canada, Oct 29 – Nov 3, 2005.
Lau ACW. Ventilatory strategy in critical SARS. The 10th Congress of the Asian Pacific Society of Respirology and the 1st Joint Congress of the APSR/ACCP. Abstract of invited lecture. 13 Nov 2005.
Shum HP, Chan CK, Lo SH, Mo KL; Wong KS. Late Nephrologist referral of patients with Advanced renal failure was associated with poorer outcome and increased medical cost. Oral presentation in 2nd Asian Chapter Meeting of International Society for Peritoneal Dialysis (2005)
Lau ACW, So LKY, Miu FPL, Yung RWH, Poon E, Cheung TMT, Yam LYC. Analysis of the Long-term Treatment Outcomes of the Severe Acute Respiratory Syndrome in Pamela Youde Nethersole Eastern Hospital. Oral presentation and abstract, HK SARS Forum and HA Convention 8-11 May, 2004
Lau ACW. SARS: Respiratory Manifestation and Clinical Course. Abstract of invited lecture, HK SARS Forum and HA Convention 8-11 May, 2004
Poon E, Lau ACW, Yam LYC, Chan IYF, Chan MSM, Lau KY, So LKY, Cheung MT. Clinical and radiological predictors in patients with SARS. Abstract, HK SARS Forum and HA Convention 8-11 May, 2004
Mary S Ip1, Fanny W Ko2 , Arthur CW Lau3 , Wai Cho Yu4, Kam Shing Tang5 , Kahlin Choo6, Sai On Ling7, Johnny W Chan8, Moira Chan-Yeung1 on behalf of the Hong Kong Thoracic Society. Reference values of spirometry for adult Chinese in Hong Kong. Abstract to Asian Pacific Society of Respirology Symposium 2004
Arthur Chun-Wing Lau, Loretta Yin-Chun Yam, on behalf of the Hospital Authority SARS Collaborative Group (HASCOG. Prognostic Value of the PaO2/FiO2 (P/F) Ratio in Severe Acute Respiratory Syndrome. Abstract to Asian Pacific Society of Respirology Symposium 2004
Shum HP, Chan CK, Lo SH, Wong KS. Delayed initiation of dialysis in those referred early was associated with poorer short-term outcome and greater costs but no increased long-term morbidity. Poster presentation in 3rd World Congress of Nephrology (2004)
E Poon, CW Lau, LYC Yam, CW Lam, Messrs. M.M. Ho, K.M Leung, Grace Wong and C.S.K. Leung. Accessibility of Smoking Cessation Services: A Hospital Enquiry. Departments of Medicine, Pamela Youde Nethersole Eastern Hospital and Ruttonjee Hospital, HK, HK East Cluster Smoking Counseling and Cessation Centre. HA Convention 2003
FPL Miu, MT Cheung, KY Lau, KH Fung, LYC Yam, ACW Lau, LKY So, CK Ching, E Poon, YF Chan. Bronchial artery embolization in the treatment of massive haemoptysis. HKTS and ACCP, Annual Scientific Meeting 2003
L Yam, CW Lau, L So, H Liu, C Leung and Subspecialty Team Heads. Evaluation on implementation of SOP triage programme. Department of Medicine & SOPD, Pamela Youde Nethersole Eastern Hospital. HA Convention 2003
ACW Lau. Exercise physiology and respiratory medicine. Hong Kong College of Physicians and Hong Kong College of Paediatricians Joint Scientific Meeting, 11 – 12 October 2003. Abstract of invited lecture.
LYC Yam, ACW Lau, LKY So, HSY Liu, SL Cheung, CSK Leung. Towards sustainable medical specialist outpatient clinic management: A triage system for SOPD referrals. HA Convention, 2002
ACW Lau, Godwin Tat-Chi Leung, Pak-Tat Choi, Kwok-Wing Lo, and Loretta Yin-Chun Yam. Association between cardiopulmonary exercise testing (CPET) abnormalities and microalbuminuria in type 2 diabetic patients. Hong Kong Thoracic Society, Annual General Meeting, Mar 2002
ACW Lau, Kwok-Wing Lo, Godwin Tat-Chi Leung and Loretta Yin-Chun Yam. Cardiopulmonary exercise testing (CPET) in type 2 diabetic patients with normoalbuminuria and microalbuminuria. European Respiratory Society 22nd Annual Congress, Stockholm, 2002
E Poon, CW Lau, LYC Yam, CW Lam. An assessment of smoking in acute medical in-patients. British Thoracic Society Winter Meeting 2002
1999 and before
1. CW Lau, CH Lee, LYC Yam, CK Ching, MT Cheung. Oxygen Delivery in Hospital ‑ Quality and Cost. Hospital Authority Convention Abstract of Papers 1997: 76
2. CH Lee, CW Lau, LYC Yam, CK Ching, MT Cheung. Are pulse dose and continuous flow oxygen delivery systems equivalent in maintaining oxygen saturation?. HK Thoracic Society Abstract 1997
3. Cheung MT, Yam LYC, Lau CW, et al. Noninvasive positive pressure ventilation in acute respiratory failure: a Hong Kong experience. Proceedings of Chinese Society of Critical Care Medicine Inaugural Meeting 1997: 25 – 28
4. MT Cheung CW Lau, LYC Yam, et al. Non‑invasive positive pressure ventilation as primary ventilatory support for acute respiratory failure in Chinese Patients. European Society of Intensive Care Medicine, 11th Annual Congress Abstract. Intensive Care Med 1998; 24 (Suppl 1): S32
5. LYC Yam, MT Cheung, CW Lau, et al. Noninvasive positive pressure ventilation for acute respiratory failure, chronic obstructive pulmonary disease and other respiratory diseases. 5th Congress of the Asian Pacific Society of Respirology Abstract, Sydney, Australia. Respirology 1998; vol 3 (Suppl): A77
6. CW Lau, L Yam, et al. Predictive Factors for Frequent Hospital Readmission in COPD Patients. The XIX World Congress on Diseases of the Chest Abstract, Toronto. Chest 1998; 114(4): 320S
7. MT Cheung LYC Yam, CW Lau, et al. Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure. Abstract, Hong Kong Thoracic Society Abstract 1998
8. MT Cheung, CW Lau, LYC Yam, et al. Noninvasive positive pressure ventilation as primary ventilatory support for acute respiratory failure in Chinese patients. Abstract, European Society of Intensive Care Medicine, 11th Annual Congress, Stockholm, Sweden, 1998
9. MT Cheung, LYC Yam, CW Lau, et al. A preliminary report on use of noninvasive positive pressure ventilation in acute respiratory failure management. (Abstract, The Hospital Authority Convention 1998)
10. Cheung MT, Lau CW, Yam LYC et al. ‘Noninvasive positive pressure ventilation as primary ventilatory support for acute respiratory failure in Chinese patients.’ Int Care Med 1998; 24: Suppl 1. S32
11. CW Lau, E Poon, LYC Yam, et al. Chronic obstructive pulmonary disease COPD and early unplanned readmissions to HA hospitals. Hospital Authority Convention Abstract of Papers 1999: P1 – 23: 48
12. CW Lau, LYC Yam, et al. Time to First Readmission after Hospital Discharge from Acute Exacerbation of Chronic Obstructive Pulmonary Disease COPD. Abstract, 20th Eastern Region Conference of the International Union Against Tuberculosis and Lung Diseases (IUATLD), Hong Kong, 1999
13. LKY So, CW Lau, CK Ching, LYC Yam, MT Cheung, E Poon. A 4.5‑year experience of managing patients with severe acute asthmatic attack. Abstract
14. MT Cheung LYC Yam, CW Lau, et al. Treatment of acute respiratory failure due to chronic obstructive pulmonary disease and other respiratory diseases. Hospital Authority Convention Abstract, 1999
15. MT Cheung, LYC Yam, CW Lau, et al. A 30‑month experience of noninvasive positive pressure ventilation for acute respiratory failure. Abstract, 20th Eastern Region Conference of the International Union Against Tuberculosis and Lung Disease (IUATLD), Hong Kong, 4 ‑ 7 June 1999
16. LKY So, CK Ching, CW Lau, et al. Comparison between mechanical ventilated and non‑ventilated patients with severe asthmatic attacks. Abstract, 20th Eastern Region Conference of the International Union Against Tuberculosis and Lung Disease (IUATLD), Hong Kong, 4 ‑ 7 June 1999
17. CK Ching, L Yam, L So, CW Lau, MT Cheung. Risk factors for mechanical ventilation in patients with severe asthma. Chest, Oct 1999 (Abstract).
ICU family satisfaction survey
Wu HL, Chan CS, Ho HC, Li C, Ma LH, So WY, Yan WW, Kwok N
Presented at the HA convention 2011