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August 16, 2013

Concise Critical Appraisal

Steroids for In-Hospital Cardiac Arrest
Can Surfactant Improve Outcomes in Pediatric ALI/ARDS?

Education

Webcast on Pediatric Guidelines from the SSC
New Webcast Series Provides Resources on Patient-Centered Care Initiatives
Registration Now Open for January 2014 Ultrasound Course
Explore San Francisco at Congress with SCCM’s Organized Tours
Access Webcasts from the 42nd Critical Care Congress
Critical Care Training Offered to Pharmacists

SCCM News

SCCM Wants Your Input on the Pain, Agitation, and Delirium Guidelines
New Critical Care Medicine Certification Pathway Announced
Listen to the Latest iCritical Care Podcasts
Join the Sepsis Point Prevalence Study November 7
Steroids for In-Hospital Cardiac Arrest

Neurologically favorable survival after cardiac arrest remains dismal, with a prevalence of severe disability ranging from 25% to 50%.  In previous preliminary work by Mentzelopoulos et al, patients resuscitated with vasopressin, steroids, and epinephrine (VSE) had less organ dysfunction and improved survival.  The question of whether the addition of steroids is beneficial in terms of neurologically favorable outcomes was addressed in the recent study led by Spyros Mentzelopoulos, MD, and colleagues at three centers in Greece.

This study was a multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial.  Patients with in-hospital cardiac arrest requiring vasopressors were included.  The control group was  treated according to the European Resuscitation Council (ERC) 2005 Guidelines, with a saline placebo provided in lieu of the steroid.  Patients in the experimental group (VSE group) received arginine vasopressin, epinephrine, and one dose of methylprednisolone (40 mg).  Surviving patients in the VSE group received stress-dose hydrocortisone (300 mg /day) for up to seven days post-arrest. The primary endpoint was return of spontaneous circulation for 20 minutes or longer and survival to hospital discharge with a favorable neurological recovery as assessed by the Glasgow-Pittsburgh Cerebral Performance Category.  Several secondary endpoints were also studied, including complications related to steroids.  Multivariable regression techniques, including a Cox regression analysis, were used to analyze data.
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Can Surfactant Improve Outcomes in Pediatric ALI/ARDS?

Surfactant depletion and dysfunction play an important role in the pathophysiology of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Reports have detailed impairments in surfactant activity related both to dilutional effects from leaking alveolar proteins and effects from chemical alterations by phospholipases and reactive oxygen species. Additionally, the content of large surfactant aggregates and surfactant proteins A and B, necessary to maintain alveolar integrity, are reduced secondary to problems with processing and metabolism.

As such, the notion that repletion of surfactant could improve outcomes in adult and pediatric patients with ARDS has been studied in a number of investigations. The authors of a trial published in the September issue of Pediatric Critical Care Medicine detail some of these works, explaining that most successes have been in small trials whose results were not replicated in larger ones.

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SCCM Wants Your Input on the Pain, Agitation, and Delirium Guidelines

The Society of Critical Care Medicine is conducting a brief survey of practitioners  to assess access to and implementation of “Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit,” published in the January 2013 issue of Critical Care Medicine.  Your input will help the Society in its efforts to understand the current state of practice. Please respond to this three-question survey about these guidelines by Friday, August 23.

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Webcast on Pediatric Guidelines from the SSC

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Too often we have heard of a usually healthy child’s complaints being attributed to “just the flu” or “he seemed out of sorts,” when early recognition of sepsis symptoms can mean the difference between life and death.  Overall mortality from sepsis is much lower in children than in adults in the well-resourced setting, but specific concerns related to age-specific factors must be top of mind when treating a pediatric patient with severe sepsis or septic shock.

The Society of Critical Care Medicine’s (SCCM) webcast, Pediatric Guidelines from the Surviving Sepsis Campaign (SSC): Considerations for Care, will take place on Thursday, September 19, 2013, from 10:00 a.m. to 11:00 a.m. Central Time. SCCM Past-President Margaret M. Parker, MD, will present an hour-long program focused on applying the SSC guidelines in the pediatric population. Attendees will be able to:

  • Apply the key recommendations of the Surviving Sepsis Campaign to the care of the pediatric sepsis patient
  • Describe the special considerations in the guidelines for care of pediatric sepsis patients and the differences between adult and pediatric patients
  • Utilize data from central line placement to benefit the patient’s care

This event, part of SCCM’s SSC webcast series, provides strategies for successful application of the SSC guidelines. An initiative of the European Society of Intensive Care Medicine (ESICM) and SCCM, the SSC aims to improve the management, diagnosis and treatment of sepsis in order to reduce its high mortality rate.

Register online today. Registration is complimentary for all participants. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

This program is supported by the Gordon and Betty Moore Foundation

Moore

sq-Quality-Project-Dispatch v1_0There’s Still Time to Register for End-of-Life Care Webcast
Registration is still open for the inaugural Project Dispatch series webcast, Improving End-of-Life Care through Better Clinician-Patient Communication, which will take place on Tuesday, September 10, 2013, at 11:00 a.m. Central Time. J. Randall Curtis, MD, MPH, from the University of Washington in Seattle, will review the importance of his Patient Centered Outcomes Research Institute-funded study that focuses on ensuring patients receive the care they desire through improved patient-clinician communication. today. This webcast is support by the U.S. Agency for Healthcare Research and Quality.

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New Critical Care Medicine Certification Pathway Announced

A co-sponsored pathway to critical care medicine certification from the American Board of Anesthesiology (ABA) and the American Board of Emergency Medicine (ABEM) has been approved. The American Board of Medical Specialties approved a formal training pathway as well as a limited grandfathering pathway (expiring 2018). The new pathway requires that the emergency medicine/critical care medicine candidate complete two years of critical care fellowship training at an approved anesthesiology/critical care medicine site. (These programs must apply and be approved for a two-year track.) The fellowship curriculum allows latitude for multidisciplinary clinical exposure but requires specific surgical critical care time (both during the first year and by completion of the training cycle).

This new pathway to certification joins the existing one co-sponsored by ABEM and American Board of Internal Medicine, as well as the pathway to surgical critical care through the American Board of Surgery.

The landscape for emergency medicine/critical care medicine has changed significantly over the past two years with multiple opportunities for training and formal certification. An archived presentation detailing the routes to certification is available in the Professional Development Knowledge Line at LearnICU.org.

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New Webcast Series Provides Resources on Patient-Centered Care Initiatives

sq-Quality-Project-Dispatch v1_0Join your colleagues on Tuesday, September 10, 2013, for the first event in the Society of Critical Care Medicine’s (SCCM) newly developed, non-CME webcast series in support of the new Project Dispatch –Disseminating Patient-Centered Outcomes Research to Healthcare Professionals. This webcast series is complimentary for all participants.

Made possible through a grant from the Agency for Healthcare Research and Quality (AHRQ), SCCM’s Project Dispatch aims to improve the quality, effectiveness, accessibility and cost-effectiveness of healthcare in the United States by developing and distributing resources for critical care clinicians focused on patient-centered research.

During the webcast, Improving End-of-Life Care through Better Clinician-Patient Communications, J. Randall Curtis, MD, MPH, will review the importance of his PCORI-funded study that focuses on ensuring patients receive the care they desire through improved patient-clinician communication.

Dr. Curtis will:

  • Explain the goals of the study focusing on the importance of improved clinician-patient communication in  end-of-life care
  • Review the study’s approach
  • Share insights about improved communication to meet patient and family desires

This webcast will be held at 11:00 a.m. Central Time. View additional time zones.

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

 

Registration is still open for the Sepsis in Maternal Healthcare Settings webcast, which will take place on Tuesday, August 20, 2013, at 1:00 p.m. Central Time.  Brenda Downs, MSN, RN, ACNS-BC, and Jeanne Sheffield, MD, will present an overview of the considerations unique to sepsis in labor and delivery.  Register online today.

Moore

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Registration Now Open for January 2014 Ultrasound Course

Ultrasonography has become an invaluable tool in the management of critically ill and injured patients due to its portability, ease of use and accurate evaluation. Ultrasound is relatively inexpensive and presents little threat to patients and practitioners. With demand for ultrasound on the rise and new developments in technology, it is imperative that critical care practitioners stay up to date in this advanced modality.

Obtain the latest ultrasound information available at the Society of Critical Care Medicine’s (SCCM) popular course, Fundamentals of Critical Care Ultrasound, to be held January 8 and 9, 2014, at the San Francisco Marriott Marquis in San Francisco, California, USA.  At the conclusion of this course, participants will be able to:

  • Demonstrate a foundation of ultrasound knowledge
  • Practice acquisition of high-quality images via hands-on exercises
  • Demonstrate image interpretation and utilization of ultrasound as a diagnostic tool

Register online today using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

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Listen to the Latest iCritical Care Podcasts

Subscribe on iTunes to the iCritical Care Podcasts or check out the latest releases at www.sccm.org/iCriticalCare.

SCCM Pod-222: Therapeutic Hypothermia in Children
Michael Weinstein, MD, FACS, FCCP, speaks with Philip E. Empey, PharmD, PhD, BCPS, about his Young Investigator Award-winning abstract, “Phenytoin Concentrations Are Elevated in Children Receiving Therapeutic Hypothermia Following Traumatic Brain Injury,” which he presented on during the 42nd Critical Care Congress in San Juan, Puerto Rico. His research found that therapeutic hypothermia significantly reduced phenytoin elimination in children with severe traumatic brain injury, leading to increased, supratherapeutic drug levels for an extended time after cooling. Dr. Empey is an Assistant Professor of Pharmacy and Therapeutics at the University of Pittsburgh in Pennsylvania. Released: 7/24/13

SCCM Pod-221: Improving Patient and Family Satisfaction in the Surgical ICU
Michael Weinstein, MD, FACS, FCCP, speaks with Matthew Lissauer, MD, FACS, to discuss his surgical intensive care unit’s efforts to improve the care provided to critically ill and injured patients and their families. His efforts were rewarded when his institution received the Society of Critical Care Medicine’s 2013 Patient and Family-Centered Care Award. Their efforts have led to a noticeable improvement in communication, patient satisfaction, collegiality, and discussion of issues with people who aren’t often in the ICU. Dr. Lissauer is an assistant professor of surgery at the University of Maryland School of Medicine. Clinically, he is an acute care surgeon, surgical intensivist and the Medical Director of the Surgical Intensive Care Unit at the R Adams Cowley Shock Trauma Center of the University of Maryland Medical Center in Baltimore, Maryland.

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Explore San Francisco at Congress with SCCM’s Organized Tours

San Francisco, California, USA, is known for its blend of cultures, incredible landmarks and fascinating history. Make the most of this vibrant city during the Society of Critical Care Medicine’s 43nd Critical Care Congress by participating in one of the following tours:

The City and the Bay
Visit the many landmarks that make San Francisco “Everybody’s Favorite City.” 

Magical Marin: Muir Woods and Sausalito
Cross the Golden Gate Bridge for a wonderful morning in stunning Marin County.  Tour Muir Woods and visit the charming town of Sausalito.

The Best of California Wine Country
Enjoy two very different wineries on this all-day wine country experience.

Chinatown Discovery: A Walking Excursion (with Dim Sum Lunch)
Walk through San Francisco’s renowned Chinatown; visit exotic shops and enjoy a traditional dim sum lunch.

Emphasis on Art: Legion of Honor and de Young Museum
Experience the history behind the California Palace of the Legion of Honor and the de Young houses.

For additional details, or to register for tours, visit www.sccm.org/congress.

The Society’s Congress, to be held January 9 through 13, 2014, is the largest multiprofessional critical care event of the year, drawing physicians, nurses, pharmacists, respiratory therapists, students, and other care providers from around the world. The diverse lineup of educational sessions presented at Congress reflects the most current evidence-based information available.  Register for Congress online by using your customer ID  and password, or contact SCCM Customer Service at +1 847 827-6888.

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Access Webcasts from the 42nd Critical Care Congress

Several videos featuring the industry-supported sessions from the Society’s Critical Care Congress in San Juan, Puerto Rico, are now available free of charge at LearnICU.org. Access these presentations and earn continuing education credit:

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Critical Care Training Offered to Pharmacists

The American Society of Health-System Pharmacists’ Research and Education Foundation is offering a Critical Care Traineeship to pharmacists who would like specialized training in caring for critically ill or injured patients. During this five-month educational experience, pharmacists will be trained to develop and maintain specialized services for the management of critically ill patients. Trainees will receive intensive distance and experiential training that prepares them to participate within multiprofessional teams as the health professional responsible and accountable for patients’ medication-related outcomes. The deadline to apply is October 15, 2013.

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Join the Sepsis Point Prevalence Study November 7

The Surviving Sepsis Campaign (SSC) will conduct a point prevalence study, the International Multicentre PREvalence Study on Sepsis (IMPRESS), on November 7, 2013, to better understand the global burden of severe sepsis and septic shock in adult patients. Conducted by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, under the framework of the SSC, IMPRESS aims to help clinicians and researchers better understand the global burden of sepsis. De-identified patient-level data will be collected on patients presenting to a participating intensive care unit (ICU) or emergency department with severe sepsis or septic shock within a 24-hour period, midnight to midnight on November 7, 2013. Data collected as part of routine clinical care, including hospital and ICU characteristics, patient characteristics, severity of illness, adherence to SSC bundle elements, and mortality, will be used for this study.

Interested hospitals from all countries are encouraged to visit www.impress-ssc.com for further details or to register for the study. Instructions and information on institutional review board approvals are also provided.

Stay up to date on SSC events and resources at www.survivingsepsis.org. Recent updates include:

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IHI - Rethinking Critical Care: Reducing Patient Harm from Sedation, Immobility, and Delirium