6 6 6 6.6 6.0 Malaysia Registry of Intensive Care 2015

57 SECTION C: INTERVENTIONS 1. Non-invasive ventilation 2. Invasive ventilation 3. Reintubation 4. Tracheostomy 5. Renal replacement therapy 6. WithdrawalWithholding therapy 58 Table 23 : Invasive ventilation, non-invasive ventilation and reintubation, by category of ICU 2015 ICUs Adm 1000 n Adm 500 - 999 n Adm 500 n UMMC n Total n Invasive ventilation 18366 74.6 5741 75.2 4264 70.6 929 71.8 29300 74.0 Non-invasive ventilation 4603 18.7 1645 21.6 887 14.7 388 30.1 7523 19.0 Reintubation 1237 6.7 354 6.2 200 4.7 85 9.2 1876 6.4 Non-invasive ventilation Refers to the continuous use of a non-invasive ven tilator for ≥ 1 hour during ICU stay Reintubation Refers to reintubation after intended or accidental extubation The reintubation rate for MOH hospitals was 6.3 in 2015. Figure 14 : Invasive ventilation, by category of ICU 2015 10 20 30 40 50 60 70 80 90 100 ≥1000 admission 500-999 admission 500 admission UMMC P e rc e n tage o f a d m is si o n ... ... Without Invasive Ventilation 75 and 72 of ICU admissions in MOH hospitals and UMMC received invasive mechanical ventilation respectively. 59 Figure 15 : Non-invasive ventilation, by category of ICU 2015 10 20 30 40 50 60 70 80 90 100 ≥1000 admission 500-999 admission 500 admission UMMC P er ce n tag e o f ad m is si o n ...... Without Non invasive ventilation Figure 16 : Non-invasive ventilation, MOH hospitals 2005 – 2015 5.1 4.7 11.4 12.1 14.3 21.7 22.3 14.4 13.3 18.6 18.6 5 10 15 20 25 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year P er ce n tag e o f n o n -i n v as iv e v en ti lat io n ...... ...... The percentage of patients receiving non-invasive ventilation in MOH ICUs increased by almost six fold from 3.7 in 2004 to 22.3 in 2013. This percentage decreased to 18.6 in 2014 and 2015. 30 of ICU admissions in UMMC received non-invasive ventilation. 60 Figure 17 : Reintubation, by category of ICU 2015 10 20 30 40 50 60 70 80 90 100 Adm ≥ 1000 Adm 500-999 Adm 500 UMMC P e r c e n tage o f a d m is s io n ... ... Reintubation No reintubation Figure 18 : Reintubation, MOH hospitals 2004 – 2015 6.3 8.7 9.5 10.3 8.8 9.8 6.7 6.9 6.6 6.9 6.3 6.4 2 4 6 8 10 12 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year P e rc e n tag e o f ad m is si o n s...... The overall reintubation rate in MOH participating centres and UMMC in 2015 was 6.3 and 9.2 respectively. 61 Table 24 : Duration of invasive mechanical ventilation, by individual hospital 2011 – 2015 Hospital Mean + SD days 2011 2012 2013 2014 2015 AS 3.6 + 4.8 4.8  6.0 4.1  5.5 3.9  5.5 3.8  5.0 PP 5.1 + 7.1 5.2  7.8 5.4  7.0 5.5  7.1 5.9  8.4 IPH 5.3 + 7.2 5.1  6.7 5.2  8.2 3.8  6.4 5.7  8.5 KL 3.9 + 5.8 4.5  7.1 4.4  7.4 4.6  7.1 5.2  8.3 SLG 4.5 + 6.3 4.9  5.9 4.3  5.4 4.8  6.4 5.7  9.0 KLG 2.9 + 4.3 2.7  4.5 2.5  5.7 2.5  3.9 3.0  5.5 SBN 5.1 + 7.4 4.9  6.8 6.1  8.9 5.1  7.1 5.7  7.5 MLK 4.0 + 1.7 4.3  5.7 4.6  6.7 4.9  6.9 4.4  6.2 JB 4.8 + 6.3 4.9  6.2 4.3  5.5 5.1  6.6 5.1  6.0 KTN 4.9 + 7.1 5.6  6.9 5.0  6.5 5.1  8.2 5.7  8.7 KT 3.5 + 4.6 3.4  4.6 3.9  4.9 3.8  4.9 3.5  5.8 KB 3.9 + 7.3 3.6  6.3 4.0  6.6 3.8  6.4 5.2  11.2 KCH 5.4 + 7.4 5.0  7.2 4.4  6.6 3.7  6.2 4.1  6.1 KK 5.2 + 7.0 5.5  7.2 5.9  8.8 5.3  9.0 6.3  13.2 SP 3.9 + 5.3 3.9  4.0 4.3  5.9 4.2  6.2 4.1  6.1 PJY 3.3 + 5.5 3.1  4.9 3.5  5.4 3.6  6.9 3.5  5.6 MUR 5.1 + 8.1 3.8  6.8 2.9  4.4 3.5  5.1 3.2  5.5 TI 3.7 + 5.8 4.0  8.0 2.5  3.0 2.4  3.0 1.8  2.8 TPG 7.3 + 9.6 5.2  8.0 4.1  5.3 4.6  6.8 5.6  7.4 SJ 4.0 + 6.3 4.3  7.2 6.4  9.7 5.5  2.6 5.0  7.2 KJG 4.8 + 15.3 4.9  7.3 4.1  5.0 4.5  5.5 3.5  4.8 KGR 3.5 + 6.3 3.8  6.5 3.6  7.0 3.5  5.2 3.7  4.5 SJMC 2.9 + 4.7 2.5  4.1 4.8  5.1 2.9  3.2 - TML 5.5 + 8.9 4.9  6.7 4.6  8.2 4.7  6.6 4.8  6.3 KP 5.6 + 8.2 5.0  7.5 4.9  7.0 4.3  5.9 4.3  6.4 SMJ 3.0 + 4.9 3.2  4.1 2.9  4.3 2.6  4.0 2.6  4.9 BP 4.4 + 6.1 5.2  6.4 4.4  6.0 4.4  5.1 3.7  4.5 TW 2.9 + 3.9 3.2  6.3 4.1  6.3 4.1  6.1 3.8  7.0 MRI 4.6 + 5.3 4.7  5.4 4.4  5.3 4.2  5.5 4.8  5.3 KLM 3.6 + 5.6 3.3  4.3 3.2  4.8 3.2  4.8 3.9  5.4 SDG 4.6 + 6.0 4.5  5.4 4.3  6.1 4.3  6.9 5.4  8.2 SB 5.1 + 7.0 5.3  9.1 5.5  7.7 6.2  6.8 4.4  7.5 DKS 6.3 + 11.2 5.2  8.1 4.3  6.2 3.3  5.2 5.0  8.1 SI 7.1 + 13.6 5.9  10.3 5.5  8.7 4.9  8.0 4.9  8.1 SBL 6.2 + 7.0 5.7  6.3 5.8 7.6 5.4  5.5 5.1  5.7 AMP 5.1 + 7.7 4.4  5.9 4.8  6.3 4.9  6.6 4.0  5.4 LIK 1.8 + 2.2 3.6  5.2 2.7  3.8 3.2  6.1 3.9  8.1 UMMC - 8.1  11.4 6.0  8.2 6.1  8.8 6.4  9.3 LKW - 4.2  7.6 4.2  5.9 4.1  4.5 3.6  3.8 62 BM - - 6.2  9.1 6.6  6.4 4.9  6.2 SLR - 5.3  6.3 5.7  8.1 6.6  10.0 7.5  15.7 PD - 2.8  3.4 2.7  3.0 3.9  9.5 3.0  3.6 KKR - 4.8  6.3 5.3  7.6 5.4  8.0 3.6  5.1 SGT - 4.3  7.1 3.0  4.0 2.5  2.5 2.4  2.5 TM - - 3.7  4.6 4.7  6.6 3.3  4.3 KEM - - 3.1  2.2 5.2  6.1 2.9  2.6 KLP - - 2.1  4.0 3.3  4.7 5.0  8.5 LAB - 4.6  6.6 3.8  5.2 4.3  5.3 5.3  6.2 KEN - - 6.7  9.8 5.2  5.7 4.2  7.7 BIN - 6.2  8.3 4.3  5.0 3.9  4.6 3.8  5.3 LD - 5.2  14.0 5.4  6.7 5.1  5.6 6.4  9.7 Total 4.6 + 7.1 4.5  6.8 4.5  6.6

4.9  6.6 4.7  7.3

The average duration of mechanical ventilation was 4.7 days in 2015. TI had the shortest average duration of invasive mechanical ventilation at 1.8 days while SLR had the longest average duration at 7.5 days. Table 25 : Renal replacement therapy and modalities of therapy, by category of ICU 2015 ICUs Adm ≥ 1000 n Adm 500 - 999 n Adm 500 n UMMC n Total n Renal replacement therapy 3820 15.5 1199 15.7 656 10.9 316 24.5 5991 15.2 Intermittent haemodialysis 2662 62.9 933 74.5 554 81.8 93 27.4 4242 65.3 CRRT 1465 34.6 306 24.4 73 10.8 245 72.3 2089 32.1 Peritoneal dialysis 102 2.4 14 1.1 50 7.4 1 0.3 167 2.6 Total 4229 100 1253 100 677 100 339 100 6498 100 63 Figure 19 : Renal replacement therapy, by category of ICU 2015 Figure 20 : Modalities of renal replacement therapy, by category of ICU 2015 10 20 30 40 50 60 70 80 90 100 Adm ≥ 1000 Adm 500-999 Adm 500 UMMC P e r c e n ta g e o f r e n a l r e p la c e m e n t th e r a p y .. .. .. . CRRT Intermittent hemodialysis Peritoneal dialysis In MOH ICUs, 14.8 of admissions received renal replacement therapy in 2015. These patients comprise of those with acute kidney injury and chronic kidney disease. The worldwide prevalence of acute renal replacement therapy in ICUs is approximately 4 or two thirds of those with acute kidney injury [9]. Half of patients 49.3 admitted with acute kidney injury underwent renal replacement therapy. Intermittent haemodialysis and continuous renal replacement therapy were the most common modalities of renal replacement therapy performed in MOH ICUs and UMMC respectively