Tuen Mun Hospital announces incident involving patient's ventilator identified as not being in normal operating mode
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The spokesperson for Tuen Mun Hospital made the following announcement today (August 13) regarding an incident involving a patient's ventilator that was identified as not being in normal operating mode:
On August 7, a 48-year-old male patient was admitted to the hospital's Intensive Care Unit (ICU) with acute necrotising pancreatitis, complicated by acute kidney injury and respiratory failure. He was started on continuous renal replacement therapy. As the patient's condition remained critical, healthcare staff intubated him and connected him to a mechanical ventilator on August 10 to assist with his breathing.
At about 7am yesterday (August 12), healthcare staff made adjustments to the ventilator and replaced the respiratory circuit. After four minutes, the patient developed oxygen desaturation, triggering the alarm system. Healthcare staff attended to the patient correspondingly. During this period, the patient suffered a cardiac arrest. The clinical team initiated resuscitation promptly, and the patient's heartbeat was restored two minutes later. During the resuscitation, it was discovered that the ventilator was not in normal operating mode, and the staff rectified the equipment's operation mode immediately to enable resumption of normal operation.
The patient was conscious and able to respond to the instructions of the healthcare staff after the event. A thorough assessment and relevant examinations have been conducted, showing that patient's vital signs were stable. A Computerised Tomography Scan has been done, and the clinical team has initially determined that the incident had no significant impact on his overall condition. The clinical team will continue to closely monitor the patient's clinical condition and provide appropriate treatment.
The hospital is very concerned about the incident and met with the patient's family to explain the details of the incident. The hospital will maintain close communication with the family, offering all possible assistance and follow-up care. The patient is still hospitalised in ICU due to his underlying diseases.
The hospital has reported the incident to the Hospital Authority Head Office through the Advance Incident Reporting System. The hospital will investigate the reasons why the ventilator was not in normal operating mode and make recommendations to prevent recurrence of similar events.
Ends/Wednesday, August 13, 2025
Issued at HKT 18:50
Issued at HKT 18:50
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