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April 2, 2015

Concise Critical Appraisal

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome
Predicting Weaning-Induced Cardiac Dysfunction

Education

Register Now for ICU Liberation Webcasts
Death by Neurological Criteria Webcast Now Available On Demand
Register for ECMO Management Course
Project Dispatch Webcast to Explore Patient-Centered Outcomes in Brain Death
Special Surgery and Anesthesiology Sessions at MCCBRC
Register for ECMO Management Course

SCCM News

Last Call: Apply Now for SCCM Awards
Wear Blue Tomorrow to Support Critical Care
Tragedy in Nepal: Disaster Resources, Ways to Donate
Check Out the Latest Issue of Critical Connections
Apply Now for THRIVE Support Group Network Funding
Surviving Sepsis Campaign Six-Hour Bundle Revised
Critical Connections Seeks Your Thoughts, Insights and Success Stories
Participate in ICU Liberation’s ABCDEF Improvement Collaborative
Application Deadline Nearing for Grant-Funded ICU Liberation Collaborative
Nominate an FCCM Colleague for MCCM Designation
Predicting Weaning-Induced Cardiac Dysfunction

Weaning-induced cardiac dysfunction is one of the most frequent and treatable causes of weaning failure. Dres et al initiated a study to determine whether the presence of cardiac preload independence before a spontaneous breathing trial (SBT) is associated with weaning failure related to cardiac dysfunction.

They found that detection of cardiac preload independence by passive leg raising (PLR) performed before an SBT reliably predicted the occurrence of weaning-induced cardiac dysfunction. These study results provide compelling support for using PLR as an assessment tool for SBT failure. It is now a matter of waiting for confirmatory studies.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

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Driving Pressure and Survival in the Acute Respiratory Distress Syndrome

Protective lung strategies—low tidal volumes (Vt), increased positive end-expiratory pressures (PEEP) and lower plateau pressures (Pplat)—have been the mainstay of acute respiratory distress syndrome (ARDS) treatment, thought to confer survival benefit by reducing mechanical damage to the lungs. However, strategies can conflict, and the net negative effect of sacrificing one parameter for another is unclear. Because respiratory-system compliance (Crs) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), Amato et al hypothesized that driving pressure (ΔP = Vt/Crs), in which Vt is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than Vt or PEEP in patients with ARDS who are not actively breathing.

They found that driving pressure was the ventilation variable that best stratified risk. Decreases in driving pressure owing to changes in ventilator settings were strongly associated with increased survival.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

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Register Now for ICU Liberation Webcasts

In the month of May, the Society of Critical Care Medicine (SCCM) will feature two webcasts from the ICU Liberation series. Registration is complimentary for all participants.

Road Map for Implementing the New ABCDEF Bundle in Your ICU
Tuesday, May 12, 2015
2:00 p.m. Central Time
Register online today

Mary Ann Barnes-Daly, RN, BSN, CCRN, DC, clinical performance improvement consultant at Sutter Health, and Juliana Barr, MD, FCCM, associate professor of anesthesiology, perioperative and pain medicine at Stanford University and staff anesthesiologist and intensivist at VA Palo Alto Health Care System, will provide a strategy for intensive care unit (ICU) teams striving to implement the new ABCDEF bundle. Faculty will examine the new element of the bundle: family engagement and empowerment. The bundle includes:

A = Assess, Prevent and Manage Pain
B = Both Spontaneous Awakening Trials and Spontaneous Breathing Trials
C = Choice of Sedation
D = Delirium: Assess, Prevent and Manage
E = Early Mobility and Exercise
F = Family Engagement and Empowerment

Learning Objectives

  • Review elements of the new ABCDEF bundle
  • Develop a mental model for successful implementation of bundle elements in an ICU

Successfully Overcoming Assessment and Treatment Challenges for ICU Pain
Thursday, May 28, 2015
1:00 p.m. Central Time
Register online today

Pain management in the ICU may be difficult because of a patient’s severity of injury and unstable health status. During this session, Céline Gélinas, PhD, RN, associate professor of nursing at McGill University, Aaron M. Joffe, DO, associate professor, Department of Anesthesiology & Pain Medicine at Harborview Medical Center, and Kathleen Puntillo, RN, PhD, FAAN, FCCM, professor emerita of nursing, at University of California, San Francisco, will provide an overview of the landscape of pain assessment and management in ICU patients within the context of the ABCDEF bundle and offer suggestions for interventions. The presentation will conclude with a question-and-answer segment.

Learning Objectives

  • Describe the importance of pain assessment and analgesic management within the framework of the ABCDEF bundle
  • Discuss the assessment of pain in non-communicative patients through use of the Critical-Care Pain Observation Tool (CPOT)
  • Evaluate pharmacological options for treating pain in critically ill patients
  • Provide answers to frequently asked questions about pain assessment and management challenges that occur in critical care practice

The ICU Liberation Initiative aims to engage clinicians in improving practice and patient outcomes related to pain, agitation, delirium, and early mobility.

If you have any questions regarding either webcast, please contact SCCM Customer Service at +1 847 827-6888.

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Register for ECMO Management Course

Attend the Society of Critical Care Medicine’s (SCCM) intense two-day ECMO Management course and explore the basic management principles common to extracorporeal membrane oxygenation (ECMO) programs for both adult and pediatric patients.

Led by expert faculty, this course will provide a comprehensive overview of ECMO programs. Participants will rotate through lectures and simulation scenarios. Each simulation group will have a maximum of 10 participants and two facilitators. Topics include: basic physiology of ECMO, equipment and patient selection, and economic and ethical considerations.

This course will be held August 28 and 29, 2015, at the University of Arizona Center for Simulation and Innovation in Phoenix, Arizona, USA.

Register online today with your customer ID and password. Please contact SCCM Customer Service at +1 847 827-6888 with any questions.

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Death by Neurological Criteria Webcast Now Available On Demand

The recent webcast, Death by Neurological Criteria: Diagnosis and Management, is now available for On Demand purchase. This webcast from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series aims to improve participants’ confidence and knowledge in determining death by neurological criteria (DNC) by reviewing the most up-to-date research and processes.

Death by Neurological Criteria: Diagnosis and Management On Demand allows you to access a video containing the slide presentations and synchronized speaker audio from the event. Enjoy this access from the comfort and convenience of your home or office and review the content on your own time and at your own pace. This is the next best thing to attending the live event. Following your purchase, you can access the materials as often as you like by logging into www.MySCCM.org.

Death by Neurological Criteria: Diagnosis and Management On Demand is available for purchase in the SCCM store. The registration rate is just $35 for members ($45 for nonmembers).

If you participated in the live event, your subscription to the On Demand service was included in your registration fee. The materials can be accessed by logging into www.MySCCM.org with your customer ID and password.

The Controversies in Critical Care webcast series is intended to provide insight into topics in critical care medicine for which no clear consensus or unequivocal evidence is available to guide practice decisions.

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Special Surgery and Anesthesiology Sessions at MCCBRC

The Society of Critical Care Medicine’s (SCCM) Adult Multiprofessional Critical Care Board Review Course (MCCBRC) is the preferred resource for critical care professionals seeking a comprehensive review of content focused on the diagnosis, monitoring and management of critically ill patients.

New in 2015, special afternoon concurrent sessions have been specifically designed to review surgery and anesthesiology. Topics include: transplant, gastrointestinal and cardiovascular surgery, and pre-, intra- and postoperative anesthesia.

The 2015 Adult MCCBRC will be held August 11 to 15, 2015, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register online using your customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

To view the complete line of board prep and review products, visit www.sccm.org/adultboardreview.

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Project Dispatch Webcast to Explore Patient-Centered Outcomes in Brain Death

The upcoming webcast, Understanding Brain Death: From Experts to Laypersons, will explore the understanding of brain death by experts and the lay community and provide insight on how interactions with patients and families can contribute to patient-centered outcomes.

This collaborative webcast from the Society of Critical Care Medicine’s (SCCM) Emergency Medicine Section and Project Dispatch will be presented by experts Isaac Tawil, MD, FCCM, Chair of the Emergency Medicine Section and Associate Professor of Emergency Medicine and Intensive Care at the University of New Mexico Health Sciences Center, and David Seder, MD, FCCM, Director of Neurocritical Care at Maine Medical Center.

Learning Objectives

  • Review medical literature on understandings of brain death among clinicians and laypersons
  • Discuss interventions to improve the understanding and clinical evaluation of brain death
  • Review the guidelines and challenges of brain death determination
  • Discuss patient-centered outcomes

This 60-minute webcast will take place on Wednesday, April 8, 2015, at 2:00 p.m. Central Time.

Register online today using your Customer ID and password. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

This webcast was organized by SCCM’s Project Dispatch in collaboration with the Emergency Medicine Section. Project Dispatch focuses on the patient and family experience. The initiative highlights a number of patient-centered care approaches to encourage awareness and adoption at the bedside among SCCM’s members. This project is supported by grant number R18HS21940 from AHRQ. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.

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Last Call: Apply Now for SCCM Awards

The Society of Critical Care Medicine (SCCM) offers numerous awards that recognize dedication and contributions to the field in a variety of areas. Nominate yourself or a colleague, or recognize your entire intensive care unit (ICU) team. Most award recipients receive complimentary registration to the 46th Critical Care Congress. Apply for these opportunities by August 1, 2016.

Dr. Joseph and Rae Brown Award – Recognize an SCCM member who has advanced multiprofessional quality care at the regional or local level through exceptional leadership contributions that have furthered the vision and mission of chapters or affiliates.

Grenvik Family Award for Ethics – Acknowledge an SCCM member who has made significant contributions toward addressing ethical problems in critical care.

Norma J. Shoemaker Award for Critical Care Nursing Excellence – Recognize an SCCM nurse member who demonstrates excellence in clinical practice, education and/or administration in the field of critical care.

Barry A. Shapiro Memorial Award for Excellence in Critical Care Management – Nominate an SCCM member who has made significant contributions to the design and/or implementation of evidence-based practices that have improved clinical, operational or fiscal outcomes.

Family-Centered Care Innovation Award – Commend an ICU team that has succeeded in instituting a novel approach to compassionate care and has a desire to share that innovation with other teams.

Dharmapuri Vidyasagar Award for Excellence in Pediatric Critical Care Medicine – Recognize an individual for sustained exemplary and pioneering achievement in the care of critically ill and injured infants and children.

THRIVE Innovation Award – Recognize an individual, team or center for innovation in partnership that addresses the needs of survivors of critical illness, including the family, to optimize recovery through novel paradigms of care delivery, improved coordination of care and/or the design and implementation of virtual or in-person support groups.

Safar Global Partner Award – Recognize individuals and/or institutions making material contributions to SCCM’s achievement of its international strategic priorities.

ICU Design Citation Applications Due August 15

Submit your application for the ICU Design Citation, which is co-sponsored by the Society of Critical Care Medicine, the American Association of Critical-Care Nurses and the American Institute of Architects Academy of Architecture for Health. The award recognizes an operating critical care unit designed with attention to both functional and humanitarian issues.

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Wear Blue Tomorrow to Support Critical Care

You are encouraged to wear blue tomorrow in celebration of National Critical Care Awareness and Recognition Month (NCCARM)!

Also, remember to share your photos on Twitter using #NCCARM, or post them to the Society’s Facebook page. We’d especially love to see any photos of you and your ICU team reuniting with former patients and their families! You can also send your pictures to criticalconnections@sccm.org.

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Register for ECMO Management Course

Explore the basic management principles common to extracorporeal membrane oxygenation (ECMO) programs for both adult and pediatric patients with the Society of Critical Care Medicine’s (SCCM) ECMO Management course.

Led by expert faculty, this intense two-day simulation course will provide a comprehensive overview of ECMO programs. Participants will rotate through lectures and simulation scenarios. Each simulation group will have a maximum of 10 participants and two facilitators.

Learning Objectives

  • Identify the different components of the ECMO circuit and diagnose equipment malfunction
  • Determine the optimal ECMO settings in diseases commonly treated by ECMO
  • Recognize and manage the most common ECMO emergencies

This course will be held August 28 and 29, 2015, at the University of Arizona Center for Simulation and Innovation in Phoenix, Arizona, USA.

Register online today with your customer ID and password. Please contact SCCM Customer Service at +1 847 827-6888 with any questions.

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Tragedy in Nepal: Disaster Resources, Ways to Donate

On behalf of its membership, the Society of Critical Care Medicine (SCCM) has reached out to those affected by the devastating earthquake and avalanche in Nepal, offering our deepest condolences and assistance in response efforts.

The Society maintains a website with various emergency response resources at www.sccm.org/disaster. There is also a thread on the SCCM Disaster eCommunity site specific to the situation in Nepal. This is a great forum for sharing pertinent resources and information.

At this time, there is no call for critical care volunteers, but the Society will continue to communicate with those in the affected region and do everything possible to assist in the effort. To learn more about critical care development in Nepal and ways to donate to relief efforts, please visit www.nccdfnepal.org. To the many SCCM members who have already contacted our headquarters offering to go to Nepal, thank you. And to those that have chosen to assist through other means, your efforts are very much appreciated and admired by your colleagues worldwide.

You are encouraged to listen to the recent iCritical Care podcast centering on post-disaster efforts in Nepal. Donation opportunities are also discussed.

SCCM Pod-272 Tragedy in Nepal: Post-Disaster Efforts, Ways to Help

In this podcast, Margaret Parker, MD, MCCM, speaks with Laura Hawryluck, MD, FRCPC, about Nepal’s critical care infrastructure and how it has been affected by the earthquake. They also discuss the post-disaster efforts and ways the critical care community can help. As noted in the podcast, those interested in contributing to the Nepal Critical Care Development Foundation can find more information at http://www.indiegogo.com/projects/nepal-icu-care-box. The Society has contributed to the relief efforts in this manner and encourages its members to do likewise as they are inclined and able. For additional information, contact Dr. Hawryluck at laura.hawryluck@gmail.com. Dr. Hawryluck works as a critical care physician at the University Health Network in Toronto, Ontario, Canada.

Pediatric Universal Life-Saving Effort, a nonprofit organization, is also raising funds for the Nepal relief efforts. Society members are encouraged to donate.

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Apply Now for THRIVE Support Group Network Funding

In support of the THRIVE initiative, the Society of Critical Care Medicine (SCCM) is proud to fund the first round of seed grants to foster an international network of in-person support groups linking survivors of critical illness and their families. These groups will offer survivors mutual support and the opportunity to share solutions to the challenges of recovery after an intensive care unit (ICU) stay.

Via a brief, expedited application process, SCCM will select up to five sites to inaugurate the initial networks. Participation is open to institutions that already have a support group in place, as well as those that wish to establish a new support system for patients. Participants will join together in regular calls to share knowledge about nurturing such groups and helping them grow. The goal of these grants is not to fund ICU follow-up clinics but rather to develop peer-support models with strong survivor co-leadership as the foundation for growing an international network. SCCM expects to add additional groups in each of the next two years.

Applications are due June 15, 2015.

If you have any questions, please contact SCCM staff partner Adair Andrews at aandrews@sccm.org.

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Check Out the Latest Issue of Critical Connections

You are encouraged to check out the latest issue of Critical Connections, which centers on team science as it relates to the practice of critical care medicine.

Topics covered include:

Using Teamwork to Improve Patient Outcomes

Assessing Teamwork and Communication in the Health Professions

Can Team Training Save Lives?

The Role of Simulation in Promoting Multidisciplinary Teamwork

Also, read a revised version of Billing Basics: Billing for Critical Care, which clarifies and expands upon information presented in a previous installment.

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Surviving Sepsis Campaign Six-Hour Bundle Revised

The leadership of the Surviving Sepsis Campaign (SSC) has believed since its inception that both the SSC guidelines and the SSC performance improvement indicators will evolve as new evidence improves our understanding of how best to care for patients with severe sepsis and septic shock.

With publication of the results of the Protocolized Care for Early Septic Shock (ProCESS) trial, the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial, and the Protocolised Management in Sepsis (ProMISe) trial, the SSC Executive Committee has revised elements of the six-hour bundle.

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Critical Connections Seeks Your Thoughts, Insights and Success Stories

Critical Connections editor, Sandra L. Kane-Gill, PharmD, MS, FCCM, wants to hear from readers with their insights, ideas and success stories centered on several topics to be featured this year. Give us a window into your daily practice by sharing items such as your guideline implementation success stories, your new patient-centered care initiatives or your team’s approach to targeted temperature management.

Submit your contributions on the upcoming topics using these specific eCommunity links: cardiac arrest and targeted temperature management; patient and family outreach and care; implementation of the Surviving Sepsis Campaign guidelines; and implementation of the pain, agitation and delirium (PAD) guidelines.

Select posts will be shared with the critical care community via the Society’s various communications channels, including upcoming issues of Critical Connections.

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