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Singapore Med J. 2019 Jun 14. doi: 10.11622/smedj.2019055. [Epub ahead of print]

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

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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.
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.



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.


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.


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.


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


delirium; intensive care unit; sedation

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