Critical eConnections SCCM.org
SCCM.org  |   My SCCM  |   Learn ICU  |   Patients & Families

February 20, 2014

Concise Critical Appraisal

Is Tight Glucose Control Beneficial for Critically Ill Children?
Mortality and Predictors of Death Among Survivors of ARDS

Education

Webcast to Review Consent for Research
Pre-Congress Educational Sessions Now Available On Demand
Self-Directed Ultrasound Now Available

SCCM News

Help Change the Face of Patient Care
Drug Shortage Alert: Electrolyte Medication
Participate in an International Study on Mechanical Ventilation
Mortality and Predictors of Death Among Survivors of ARDS

Modern intensive care unit interventions such as low-tidal volume mechanical ventilation may result in short-term improvements in acute respiratory distress syndrome (ARDS) survival, but less is known about the epidemiology of long-term survival. Chen Wang et al conducted a study to quantify the gap between in-hospital and 1-year ARDS mortality rates, and to identify risk factors and causes of death at one year among patients with ARDS.

Patients were selected from an ongoing prospective, multi-unit acute lung injury (ALI) biomarker study (VALID) at a single institution (Vanderbilt University Medical Center, Nashville, TN, USA). Those who met the American European Consensus Committee criteria for ALI/ARDs were included. A sensitivity analysis was also performed to include patients who met the Berlin criteria for ARDS. All were followed until death or for at least 1 year after study enrollment. Logistic regression was used to analyze associations between risk factors and death.
Read more…

Tags: , ,
Back to Top
Is Tight Glucose Control Beneficial for Critically Ill Children?

The detrimental effects of hyperglycemia in critically ill patients has been well described in the literature. However, the benfefits of maintaining normoglycemia using insulin infusions has been controversial. In 2009, The New England Journal of Medicine published a study by the NICE-SUGAR Study Investigators that appeared to answer the question about risks and benefits of intensive insulin therapy. Studying more than 6,000 subjects, the authors showed an increase in mortality in critically ill adults who underwent intensive glucose control, compared to those who underwent conventional control of their blood sugars. Interestingly, in the same year, a pediatric study was published in Lancet by Vlasselaers et al that demonstrated a decrease in mortality and length of pediatric intensive care unit (PICU) stay in those patients who had intensive glucose control, compared to the conventional therapy. Though it should be noted that while this study randomized 700 children, it was a single-center trial whose subjects were primarily children who had undergone cardiac surgery (around 75%).

In this study by Macrae et al, the authors randomized more than 1,300 critically ill children from 13 centers to undergo either tight glucose control (maintaining blood glucose levels between 72-126 mg/dl) or conventional therapy (infusing insulin only in patients whose blood glucose levels were over 216 mg/dl until they dropped to 180 mg/dl). The authors recruited children between the ages of 36 weeks of corrected gestational age and 16 years of age. Like the the Vlasselaers study, a predominance of subjects underwent cardiac surgery compared to other reasons for PICU admission (around 60% and 40%, respectivley). The aims of this study were to assess whether tight glycemic control could reduce morbidity and mortality rates and associated costs for critically ill children compared to conventional therapy.

Read more…

Tags: , ,
Back to Top
Webcast to Review Consent for Research

Researchers are at the forefront of advancing knowledge that can be leveraged to treat disease, to improve quality of care, and to enhance patient experiences and outcomes. In the upcoming webcast, Consent for Research in the ICU, from the Controversies in Critical Care series, John Whitcomb, PhD, RN, CCRN, FCCM, Dan Thompson, MD, MA, FCCM, and Alex Kon, MD, FCCM, will discuss the different challenges in pediatric and adult consent for research and present the difficulties for consent in complex research in critically ill patients.

Learning Objectives

  • Discuss the fundamentals of consent for research
  • Explain the issues of consent for research when the patients cannot consent for themselves
  • Describe the difference between pediatric and adult consent for research
  • Explore the problems for consent in complex research in critically ill patients

This webcast will take place on Friday, April 25, 2014, at 1:00 p.m. Central Time.

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 of 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 there is no clear consensus or unequivocal evidence for guiding practice decisions.

Tags: , ,
Back to Top
Pre-Congress Educational Sessions Now Available On Demand

Now you can experience the stimulating pre-Congress educational sessions from the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress as if you were there.

The following On Demand courses are available for purchase:

The On Demand versions of the pre-Congress educational sessions give you access to videos containing both slides and lectures in a searchable format, making it the next best thing to attending the live event. Once you’ve purchased an On Demand course, you can access the material as often as you like by logging into MySCCM.org.

If you were a registrant for a pre-Congress educational session, your Congress On Demand subscription now includes complimentary access to that session. Your subscription to this service can be accessed by logging into MySCCM.org with your Customer ID and password.

Tags:
Back to Top
Self-Directed Ultrasound Now Available

The Society of Critical Care Medicine’s (SCCM) new Self-Directed Critical Care Ultrasound training courses allow you to learn at your own pace from the comfort and convenience of your home or office. Choose from the following:

Self-Directed Critical Care Ultrasound

Self-Directed Critical Care Ultrasound provides a relaxed learning experience with access to the same didactic sessions from the live version of the Critical Care Ultrasound course. This course includes 4 modules with synchronized speaker audio and pre- and post-tests are utilized to assess your knowledge. 8.5 hours of CE is available for nurses and physicians.

Self-Directed Critical Care Ultrasound with Simulation

Benefit from all of the features provided with the Self-Directed Critical Care Ultrasound course, plus enhance your learning experience with a hand-held simulation sensor that transforms your personal computer into your own ultrasound training solution and includes links to specific case-based simulations that allow you to practice the techniques presented in the didactic lectures. The cases cover a broad spectrum of normal and pathologic cases.

For more product details or to make a purchase, visit the SCCM Online Store.

Tags:
Back to Top
Help Change the Face of Patient Care

Liberate your patients from the harmful effects of pain, agitation and delirium in the ICU and improve their long-term outcomes. Among the resources available at www.ICULiberation.org is a newly added presentation from the 43rd Critical Care Congress from Alison S. Clay, MD, who shares her experience and recovery as an intensive care unit patient.

In addition, the site offers the Pain, Agitation and Delirium Guidelines and numerous tools related to the assessment, treatment and prevention of these conditions.

Tags:
Back to Top
Drug Shortage Alert: Electrolyte Medication

The Society of Critical Care Medicine’s Drug Shortages Task Force has produced a comprehensive guide for assessing and responding to shortages of sodium acetate injection, concentrated sodium chloride, potassium acetate and chloride injection, phosphate injection, calcium chloride and gluconate injection, and magnesium sulfate injection. Manufacturers report a number of reasons for these shortages, including increased demand, manufacturing delays, suspended production, and discontinuation by the manufacturer.

The alert Electrolyte Medication Shortages includes information on the shortage’s impact in intensive care units, including suggested management strategies, pharmacotherapeutic considerations, and safety concerns. The recommendations are based on a combination of current evidence, clinical experience from multiple clinicians, and the need for conservation during these shortages.

Visit www.sccm.org/currentissues to access all Drug Shortage Alerts, including those addressing:

  • Intravenous Sodium Bicarbonate
  • Web Resources
  • Intravenous Loop Diuretics
  • General Considerations

John Lewin, MBA, PharmD, and other members of the Drug Shortage Task Force discuss safe and consistent management of drug shortages as well as on additional resources and strategies.

Tags: ,
Back to Top
Participate in an International Study on Mechanical Ventilation

The International Observational Study Investigators are looking at mechanical ventilation (MV) discontinuation practices internationally in intensive care units. The goal of the study is to characterize practice variation in weaning critically ill adults from invasive MV, as well as the influence of selected discontinuation strategies on important outcomes. Each unit  will be asked to collect data on at least 10 consecutive discontinuation events — one event (e.g., tracheostomy, direct extubation, initial successful spontaneous breathing trial) per patient receiving invasive ventilation for at least 24 hours and all patients who die before any attempt at MV discontinuation. Those interested in participating should email ioswean@smh.ca.

Tags: , ,
Back to Top

Hamilton Medical – Reduced time on the ventilator with ASV