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December 5, 2013

Concise Critical Appraisal

Are Age-Specific Thresholds for Cerebral Perfusion Pressure Associated with Outcomes in Pediatric Traumatic Brain Injury?


Webcast Debates Ethics of Mandatory Vaccinations
It’s Not Too Late to Attend the 43rd Critical Care Congress


Members of the Society of Critical Care Medicine Recognized
Listen to the Latest iCritical Care Podcasts
Are Age-Specific Thresholds for Cerebral Perfusion Pressure Associated with Outcomes in Pediatric Traumatic Brain Injury?

Pediatric traumatic brain injury (TBI) remains the leading cause of mortality in children younger than 19 years. Most people think that the secondary brain injury following TBI occurs in the setting of elevated intracranial pressure (ICP) and diminished cerebral perfusion pressure (CPP). These physiologic measurements are thought to affect outcomes, so current guidelines recommend treatment of both elevated ICPs and decreased CPPs, although the thresholds for CPPs have not been well established in children. Although a smaller study looked at CPP in children with TBI, this work by Allen et al is the largest study to date that attempts to determine these thresholds.

Using a prospective, observational cohort, the authors examined data from TBI-trac, an online data repository run by the Brain Trauma Foundation. This databank collects information about patients with severe TBI and uses these data to track guideline compliance at 22 different trauma centers and for research. In this report, the authors reviewed the data on patients treated between 2000 and 2008.

In all, the authors studied 2074 records and divided the patients into categories based on age: 0-5 years (55 patients), 6-11 years (65 patients), 12-17 years (197 patients), and 18 years or older (1757 patients). They subsequently defined high and low CPP thresholds for each age group to determine if these thresholds impacted short-term survival. For those in the youngest group, the authors chose 30 mm Hg for a low CPP threshold (CPP-L) and 40 mm Hg for a high threshold (CPP-H). For subjects in the group 6-11 years, the CPP-L was 35 mm Hg and the CPP-H was 50 mm Hg. For the subjects 12 years or older, the CPP-L selected was 50 mm Hg and the CPP-H was 60 mm Hg. CPP values between the high and low thresholds were labeled as CPP-B.

Read more…

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Webcast Debates Ethics of Mandatory Vaccinations

sq-CCC_206x86Vaccinations have become a routine part of elective preventative care. However, the controversy surrounding vaccines and their use is only growing. One hot topic is the ethical implications of healthcare policies that implement mandatory vaccinations for intensive care unit (ICU) personnel.

In the inaugural webcast of the Society of Critical Care Medicine's (SCCM) new series, Controversies in Critical Care, Kristen Feemster, MD, MPH, MSHP, and Douglas Naylor Jr., MD, FCCM, will debate the evidence and ethical arguments surrounding these policies. Their opinions about the potential impact of such policies on the well-being of patients and healthcare personnel will be discussed, as well as the impact on the healthcare system and society as a whole.

Learning Objectives

  • Identify those vaccinations that are currently "a mandatory treatment" for healthcare providers working in ICU environments
  • Review the current literature and evidence in support of mandatory vaccinations for healthcare providers
  • Detail the federal or local policies that establish the legal framework for instituting this practice
  • Explore the practical and ethical arguments favoring or opposing mandatory vaccinations for ICU personnel
  • Develop a plan of action for vaccination of ICU personnel using an informed opinion on the implications of mandatory vaccinations

The webcast, Ethical Debate about Mandatory Vaccinations in ICU Personnel, will take place on Friday, December 20, 2013, at 3:00 p.m. Central Time (view additional time zones).

Register online today. The registration fee for this 60-minute webcast is $30 for SCCM members and $40 for nonmembers. Participants will receive 1 hour of continuing education credit. Please contact SCCM Customer Service at +1 847 827-6888 to inquire about the $200 group rate for institutions that will host multiple participants.

The Controversies in Critical Care webcast series is a joint project between the SCCM Research Committee and the American College of Critical Care Medicine’s Ethics Committee. This series is intended to provide insight into topics in critical care medicine for which no clear consensus or unequivocal evidence guides practice decisions.

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It’s Not Too Late to Attend the 43rd Critical Care Congress

sq-CongressAlthough the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress is right around the corner, it’s not too late to participate. Registration will be accepted on site at the Moscone Center South. An SCCM staff member will be available to assist you at the SCCM Registration Desk, located in the South Lobby of the Moscone Center beginning Tuesday, January 7, 2014, from 4:00 p.m. to 7:00 p.m.

Download the Congress App
Prepare for the 43rd Critical Care Congress by downloading the Congress App to access the complete schedule of events, create your schedule, view the list of speakers, and much more. Point your mobile web browser to to access this handy tool. Search “SCCM” in Google Play or the iTunes store.

Play Click to Win a $500 Apple Gift Card
Participate in a friendly competition with fellow Congress attendees. Click is a scavenger hunt-like game built into the Congress App. Players complete photo challenges by taking pictures and submitting them via email to earn points. A leaderboard tracks everyone’s points and rank in the game. Get a head start before you even leave for Congress. Download the app, sign up and get started!

Taking place in San Francisco, California, USA, January 9 to 13, 2014, the 43rd Critical Care Congress offers attendees innovative learning opportunities from a diverse set of thought leaders from around the world. For more information, SCCM Customer Service.

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Members of the Society of Critical Care Medicine Recognized

The European Journal of Clinical Investigation has compiled a list of the most influential biomedical researchers, and several members of the Society of Critical Care Medicine were recognized. Congratulations to the following members on their recognition:

Deborah Cook, MD
Gabriel Nunez
Russel J. Reiter, MD
Paul M. Ridker, MD
Robert M. Strieter, MD
Csaba Szabo, MD, PhD
Jean-Louis Vincent, MD, PhD, FCCM
Ralph Weissleder, MD, PhD

The journal examined 15,153,100 authors from Scopus citation data from 1996 through 2011 and selected the top 400 based on citation and h-index. According to the list’s compilers, "Ranking of scientists is explicitly not the main purpose of this list. Rather, we wanted to identify a pool of researchers who have had sustained success in highly influential work." The list was created for an ongoing survey of highly cited researchers.

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Listen to the Latest iCritical Care Podcasts

If you haven't checked out our iCritical Care Podcasts, listen to the latest releases and subscribe! Loyal listeners and newcomers, be sure to rate us on iTunes. Learn more at

SCCM Pod-231: Family Presence: Evidence vs. Emotion

Margaret Parker, MD, FCCM speaks with Cathie Guzzetta, RN, PhD, HNC, FAAN, Director of Holistic Nursing Consultants at Children's National Medical Center in Washington, DC. Dr. Guzzetta has been mentoring nurses and physicians in conducting family presence research and developing family presence programs since the mid-1990s. She will discuss Family Presence during CPR and invasive procedures. This podcast made possible through a grant from the Agency for Healthcare Research and Quality in support of Project Dispatch — Disseminating Patient-Centered Outcomes Research to Healthcare Professionals. Learn more at (Project Dispatch)

SCCM Pod-230: Pulmonary Artery Catheters in ICU Patients

Michael Weinstein, MD, FACS, FCCP, speaks with Hayley Beth Gershengorn, MD, lead author on an article published in the August Critical Care Medicine, "Understanding Changes in Established Practice: Pulmonary Artery Catheter Use in Critically Ill Patients." Study investigators found that use of pulmonary artery catheters in intensive care unit (ICU) patients has declined with significant variation across units, with most removal occurring in non-surgical ICUs and patients. Dr. Gershengorn is an Intensivist and Pulmonary Physician at Beth Israel Medical Center in New York, New York. She is also Assistant Professor of Pulmonary Medicine at the Albert Einstein College of Medicine of Yeshiva University. (Crit Care Med. 2013; 41[12] 2667-2676

SCCM Pod-229: Lifetime Achievement Award, Sepsis Research

Michael Weinstein, MD, FACS, FCCP, speaks with Mitchell P. Fink, MD, FCCM, who is the 2013 recipient of the Society of Critical Care Medicine's Lifetime Achievement Award; he discusses his background in critical care, as well as his research endeavors in sepsis and the future of this disease. Dr. Fink is Vice Chair of the Department of Surgery at the David Geffen School of Medicine at UCLA, and Co-Director of the Multidisciplinary Program for Critical Care Medicine at Ronald Reagan UCLA Medical Center in Los Angeles, California, USA. He also serves as Professor in Residence in the Department of Surgery and the Department of Anesthesiology at UCLA.

SCCM Pod-228 CCM: Screening Criteria for Palliative Care

Michael Weinstein, MD, FACS, FCCP, speaks with Judith Nelson, MD, JD, lead author on an article published in the October issue of Critical Care Medicine, "Choosing and Using Screening Criteria for Palliative Care Consultation in the Intensive Care Unit: A Report from the IPAL-ICU (Improving Palliative Care in the ICU) Advisory Board." The authors found that use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Dr. Nelson is professor of medicine in the Division of Pulmonary, Critical Care and Sleep Medicine and the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York, New York, USA. She is also the director of the IPAL-ICU Project. (Crit Care Med. 2013;41(10):2318-2327.)

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