The need for ventilatory support is one of the commonest indications for admission into the intensive care unit (ICU). Despite the usefulness of mechanical ventilation, its damaging effect on the lungs has also been widely recognized.The study was a prospective, case-controlled survey of all mechanically ventilated patients admitted in our ICU from November 2013 to April 2014. For every ventilated patient, a non-ventilated similar patient served as a control.A total of 128 patients were admitted into the ICU over the six month period and 44 patients constituting 34.4% were mechanically ventilated. The average duration of mechanical ventilation was 12.30 ± 10.10 days. Duration of mechanical ventilation, use of arterial blood gas measurement and ionotropic support had significant effect on weaning from ventilation with p values of 0.005, 0.05 and <0.001 respectively. Mechanically ventilated patients had >4 times chance of death than non-ventilated patients.Mechanical ventilation though a useful therapeutic intervention in the ICU is associated with increased mortality. Duration of ventilation, use of arterial blood gas (ABG) and need for ionotropic support influenced successful weaning off ventilator. It may be expedient therefore to weigh the risk: benefit assessment of mechanical ventilation before commencement in the ICU.

This is an attempt to provide a useful mnemonic, "HEAD" for the management of TBI in the ICU. Literature Review Resuscitation Initial assessment: at the emergency room Traumatic brain injury (TBI) accounts for about 30-50% of all trauma-related deaths with a male predominance. It can be classified on the basis of neurological assessment using Glasgow Coma Score into, mild (13/15), moderate (9-12/15) and severe (3-8/15). Moderate to severe TBI often require admission to the Intensive care unit (ICU). Mnemonics have been found to be useful in remembering systematic management of clinical conditions especially for the young and inexperienced physician. This is an attempt to provide a useful mnemonic, "HEAD" for the management of TBI in the ICU.

Introduction:The management and outcome of elderly patients aged 65 years and above admitted to the intensive care unit (ICU) are often complicated by the presence of co-morbidities and reduced physiological reserve.Methodology: This was a retrospective, case-control study. Patients aged 65 years and above admitted to the unit from January 2012 to June 2013 were included in the study. Admission and discharge register in the ICU was examined. A patient before and after each elderly patient were recruited to serve as controls in the study.Result: Seventy-nine (79) elderly patients were admitted to the ICU and it constituted 12.6% of total ICU admission with a mortality rate of 49.6%. Male: female ratio was 2:1. Postoperative care constituted the highest indication for ICU admission (41.8%) followed by cerebrovascular accident (stroke), 12.6%. Younger patients were about twice more likely to be mechanically ventilated than elderly patients. (p=0.05, OR=1.855) Conclusion:The mortality rate of elderly patients admitted to the ICU was high. Appropriate admission criteria and protocol for the management of elderly patients in the ICU should, therefore, be developed to improve outcome.Z

Reversal of residual muscle paralysis is usually done at the end of a General Anaesthesia with Relaxant Technique (GART) before extubation. However, some patients may have inadequate reversal of their residual muscle paralysis. This may lead to persistent muscle paralysis despite the patient being awake from anaesthesia. A scenario of “I can’t breathe” therefore comes to play which is scary and discomforting to the affected patients. We hereby present two cases of inadequate reversal of residual muscle paralysis in our patients who underwent different procedures under general anaesthesia. The aim of this presentation is to highlight the need for adequate reversal of residual muscle paralysis, the need to routinely monitor neuromuscular function during general anaesthesia and to review the existing literature.

Negative Pressure Pulmonary Oedema (NPPO) is an uncommon, potentially life-threatening complication of general anesthesia. It is said to even be less common with the use of a laryngeal mask airway (LMA).Mortality can be as high as 11 -40%. We present a 31 year old man who presented for emergency appendectomy under general anaesthesia with LMA who was managed in the ICU with judicious use of frusemide and positive pressure ventilation and was subsequently discharged after 48 hours.