Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.
Humans ; Climate Change ; Delivery of Health Care ; Singapore ; Conservation of Natural Resources ; Sustainable Development ; Environment

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), although, associated with poor patient compliance. Conversely, high flow, humidified, temperature-regulated nasal insufflation of oxygen or air is well tolerated.CASE: We describe our experience of three patients with known or suspected moderate to severe OSA who were poorly compliant to CPAP therapy and received high flow nasal insufflation (HFNI) postoperatively. None had significant episodes of desaturation (SpO₂ < 95%) and all patients uniformly reported superior comfort levels than with the CPAP therapy. HFNI generates small amounts of positive end-expiratory pharyngeal pressure, increases inspiratory airflow and decreases dead space ventilation. Due to the open system, less difficulty with the patient-mask interface and improved patient comfort is experienced. These factors help prevent hypopnea and lead to enhanced sleep continuity.CONCLUSIONS: HFNI may be a promising alternative to CPAP therapy in the perioperative setting.
Continuous Positive Airway Pressure ; Humans ; Insufflation ; Oxygen ; Patient Compliance ; Sleep Apnea, Obstructive ; Ventilation

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), although, associated with poor patient compliance. Conversely, high flow, humidified, temperature-regulated nasal insufflation of oxygen or air is well tolerated.CASE: We describe our experience of three patients with known or suspected moderate to severe OSA who were poorly compliant to CPAP therapy and received high flow nasal insufflation (HFNI) postoperatively. None had significant episodes of desaturation (SpOâ‚‚< 95%) and all patients uniformly reported superior comfort levels than with the CPAP therapy. HFNI generates small amounts of positive end-expiratory pharyngeal pressure, increases inspiratory airflow and decreases dead space ventilation. Due to the open system, less difficulty with the patient-mask interface and improved patient comfort is experienced. These factors help prevent hypopnea and lead to enhanced sleep continuity. CONCLUSIONS HFNI may be a promising alternative to CPAP therapy in the perioperative setting.