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OBJECTIVES: To evaluate the hospital outcome and health-related quality of life (HRQOL) in adult patients admitted to intensive care units (ICUs) in Barbados. METHODS: A prospective observational study was done in the medical and surgical intensive care units of the Queen Elizabeth Hospital, Barbados, to evaluate the outcomes and HRQOL in adult patients. The acute physiology and chronic health evaluation (APACHE) IV score was applied on admission to one hundred and fifty patients admitted to the ICUs. The HRQOL was evaluated by using Short Form 36 (SF-36) in 63 survivors, three months after ICU discharge. RESULTS: There was no significant difference between medical and surgical ICUs with respect to age, gender, APACHE IV scores, 90-day mortality, and length of stay. The mean (± SD) APACHE IV score was 42.6 (± 23.7). The observed mortality was 32.7% and the standardized mortality ratio (SMR) was 1.85. The APACHE IV scores were significantly higher in non-survivors compared to survivors (p < 0.001). Patients with APACHE IV of > 45, and who were ventilated in the first 24 hours had the highest mortality (66%). The mean ICU length of stay was 7.2 days. CONCLUSION: In this study, the SF-36 scores in all eight dimensions indicated that the HRQOL in the majority of the survivors was average or above average. There was a significant negative correlation between APACHE IV score and the SF-36 score.

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HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis, but which usually resolves after delivery. We report a case of HELLP syndrome with subcapsular hematoma of the liver causing extrapericardial cardiac tamponade. The subcapsular hematoma and cardiac tamponade were managed conservatively.

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Video assisted thoracoscopic surgery (VATS) is now an established technique for diagnostic and therapeutic intervention in patients with thoracic pathology at the Queen Elizabeth Hospital (QEH). This article reviews the experience with 50 patients over the period May 1996 to February 2003, looking at various factors and outcomes in an attempt to ascertain the viability of this procedure at this institution. It serves as a follow-up article to the publication of the initial experience in 1999 (1). There were 24 males and 26 females included in the study. Video assisted thoracoscopic surgery was used for diagnosis in 27 cases (54%), therapeutic indication in 17 cases (34%) and as both a diagnostic and therapeutic modality in six cases (12%). In 92% of cases, the operations were completed thoracoscopically with a conversion rate of 8%. The morbidity and mortality rates were 18% and 2% respectively. Video assisted thoracoscopic surgery is an effective tool for the treatment and investigation of selected thoracic pathology at the QEH with complications and mortality rates comparable to other institutions (2, 3).

Assuntos

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Video assisted thoracoscopic surgery (VATS) is now an established technique for diagnostic and therapeutic intervention in patients with thoracic pathology at the Queen Elizabeth Hospital (QEH). This article reviews the experience with 50 patients over the period May 1996 to February 2003, looking at various factors and outcomes in an attempt to ascertain the viability of this procedure at this institution. It serves as a follow-up article to the publication of the initial experience in 1999 (1). There were 24 males and 26 females included in the study. Video assisted thoracoscopic surgery was used for diagnosis in 27 cases (54), therapeutic indication in 17 cases (34) and as both a diagnostic and therapeutic modality in six cases (12). In 92of cases, the operations were completed thoracoscopically with a conversion rate of 8. The morbidity and mortality rates were 18and 2respectively. Video assisted thoracoscopic surgery is an effective tool for the treatment and investigation of selected thoracic pathology at the QEH with complications and mortality rates comparable to other institutions (2, 3).

La cirugía toracoscópica asistida por video (CTAV) es ya una técnica establecida para el diagnóstico y la intervención terapéutica de pacientes con patologías toráxicas en el Hospital Queen Elizabeth. Este articulo pasa revista a nuestra experiencia con 50 pacientes en el transcurso del período de mayo de 1996 a febrero de 2003, prestando atención a varios factores y resultados en un intento por corroborar la viabilidad de ese procedimiento en nuestra institución. El trabajo sirve como un artículo de seguimiento a la publicación de nuestra experiencia en el año 1999(1). El estudio abarcó 24 hombres y 26 mujeres. La CTAV se usó para el diagnóstico en 27 casos (54%), como indicación terapéutica en 17 casos (34%), tanto en la modalidad de diagnóstico como en la terapéutica en seis casos (12%). En el 92% de los casos, las operaciones fueron completadas toracoscópicamente con una tasa de conversión de 8%. Las tasas de morbilidad y mortalidad fueron 18% y 2% respectivamente. La CTAV resultó ser un instrumento efectivo para el tratamiento y la investigación de patologías toráxicas seleccionadas en nuestra institución, con complicaciones y tasas de mortalidad comparables a la de otras (2) (3).

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To evaluate and compare the outcome of open-heart surgery in elderly patients with a concurrent group of younger patients in a developing country, data of all adult patients who underwent open-heart surgery during the period of 3 years from January 1999 to December 2001 were collected prospectively. Demographic data such as age and gender, other data such as preoperative diagnoses, comorbid illnesses, type of surgery, time of cardio-pulmonary bypass, length of stay and hospital outcome were recorded. The characteristics of patients above the age of 65 years were compared with a concurrent cohort of patients aged less than 65 years. One hundred and forty-five adult patients underwent open-heart surgeries in 3 years, and the overall mortality rate was 4.8%. The much common surgeries were coronary artery bypass grafting, valve repair/replacement surgery and surgery for adult congenital heart diseases. Forty-five (31%) patients were above the age of 65 years. The mortality rate was 2.2% for patients who were aged 65 years and above, in comparison with that of the concurrent cohort of younger patients (6%). This was probably because of more number of surgeries for congenital heart diseases in the latter group. However, even with other surgeries such as coronary artery bypass grafting, the elderly group of patients did equally well as the younger group. Elderly patients tolerate cardiac surgery well, and age should not be an exclusive criterion to decide against open-heart surgery.

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To evaluate and compare the outcome of open-heart surgery in elderly patients with a concurrent group of younger patients in a developing country, data of all adult patients who underwent open-heart surgery during the period of 3 years from January 1999 to December 2001 were collected prospectively. Demographic data such as age and gender, other data such as preoperative diagnoses, comorbid illnesses, type of surgery, time of cardio-pulmonary bypass, length of stay and hospital outcome were recorded. The characteristics of patients above the age of 65 years were compared with a concurrent cohort of patients aged less than 65 years. One hundred and forty-five adult patients underwent open-heart surgeries in 3 years, and the overall mortality rate was 4.8 per cent. The much common surgeries were coronary artery bypass grafting, valve repair/replacement surgery and surgery for adult congenital heart diseases. Forty-five (31 per cent) patients were above the age of 65 years. The mortality rate was 2.2 per cent for patients who were aged 65 years and above, in comparison with that of the concurrent cohort of younger patients (6 per cent). This was probably because of more number of surgeries for congenital heart diseases in the latter group. However, even with other surgeries such as coronary artery bypass grafting, the elderly group of patients did equally well as the younger group. Elderly patients tolerate cardiac surgery well, and age should not be an exclusive criterion to decide against open-heart surgery.

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PURPOSE: To describe the anaesthesia services in Barbados: to present the major challenges confronting the Anaesthesia Department of the government-owned Queen Elizabeth Hospital (QEH): and to describe the Department's approaches to optimise safety and cost-effectiveness of anaesthesia at QEH. SOURCE OF INFORMATION: Authors (KBS, HSLM, RAH), who collectively provided more than 50 yr of anaesthesia at QEH; the Dean (ERW) of the University of West Indies Medical School (Barbados campus); archives of Barbados; and records of QEH. PRINCIPAL FINDINGS: The government of Barbados provides modern health care services to all of its citizens, primarily at QEH. Barbados, however, has tight financial constraints, infrastructural limitations, and a bureaucratic administration that predispose QEH's Anaesthesia Department to unexpected depletions of drugs and disposable supplies, sporadic shortages of personnel and functioning equipment, and occasional quality assurance problems. To deal with such problems, the Anaesthesia Department has implemented several pro-active measures: establishing an audit system to prevent depletion of imported drugs and supplies: training local personnel to maintain equipment: purchasing an oxygen concentrator to reduce oxygen costs: decreasing nitrous oxide use (expensive in Barbados): and initiating its own quality and safety standards. CONCLUSION: Continuous delivery of high quality, cost-effective anaesthesia care requires thoughtful planning by administrators and judicious resource allocations. Health care administrators and clinical departments need to work together closely to establish a framework that enables departments to play a major role in determining how the institution's limited financial resources are best allocated to meet the departmental priorities.

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Heart disease represents the leading cause of death in Barbados and the Organization of Eastern Caribbean States (OECS). The North Shore University Hospital, N.Y., through its Lifeline Programme offered the only regular outlet for approximately 450 patients who had cardiac surgery there between 1982 and 1992. A changing US health care policy, however, predicted an end to this programme and in 1989 a decision was made to develop a cardiac catheterisation and an open heart surgical programme at the Queen Elizabeth Hospital (QEH) in Barbados, to serve Barbados and the OECS. This programme was implemented in December 1993 and between then and September 1995, 231 patients, aged two weeks to 75 years, underwent cardiac catheterisation. Of these patients, 186 were suspected of having coronary artery disease (CAD), 21 of having congenital heart disease (CHD) and 24 of having valvular disease. Fifteen patients were from countries other than Barbados, 70 have had open heart surgery (with a surgical mortality of 2.8 percent) and 12 have had closed heart procedures. One hundred and twenty-four (124) trans-oesophageal echocardiograms were done. A successful cardiac surgical programme has been set up at the QEH in Barbados with the cooperation of the Government and the private sector. The results are excellent and the spinoffs to the hospital have been many. In particular, a significant improvement in "critical care". What is more important, however, the programme has been set up at a "low" cost and is cost-effective, saving the country significant foreign exchange. Plans are in place to introduce Interventional Cardiology in the near future (AU)

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