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July 3, 2013

Concise Critical Appraisal

Clopidogrel in Infants with Systemic-to-Pulmonary-Artery Shunts
HES Solutions Warrant Additional Box Warning

Education

Critical Connections Features Congress Review

SCCM News

Discounted Rates for Adult MCCBRC Ends Soon
Webcast Will Explore the Impact of Coding for Sepsis
Clopidogrel in Infants with Systemic-to-Pulmonary-Artery Shunts

Medications approved for adults often have additional uses in pediatric patients. Such is the case — as described by Wessel and colleagues — for clopidogrel, an agent that blocks the P2Y12 component of adenosine diphosphate (ADP) receptors on the surface of platelets. ADP receptors prevent the activation of the glycoprotein IIb/IIIa receptor complex, thereby reducing aggregation. Clopidogrel is used most commonly as a prophylactic antiplatelet therapy in adults with atherosclerotic cardiovascular disease, but is increasingly employed in the pediatric population, particularly in those with cardiac disease. Pediatric cardiovascular practitioners are using clopidogrel (along with the standard aspirin) to prevent the thrombosis of systemic-to-pulmonary-artery shunts in patients with complex cyanotic heart disease; however, the safety and efficacy of this practice have never been looked at prospectively. In the June 20 issue of The New England Journal of Medicine, investigators created a multicenter, event-driven trial to evaluate clopidogrel’s effect on infants.

A total of 906 subjects were enrolled, 467 in the clopidogrel group and 439 in the placebo group. The authors found that adding clopidogrel to conventional therapies (i.e., aspirin) did not affect mortality from any cause or shunt-thrombosis-related morbidity. Although  no statistically significant differences were detected in total subjects with adverse events,  the authors found more neurologic events in the clopidogrel group versus the placebo group. Read the full Concise Critical Appraisal.

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HES Solutions Warrant Additional Box Warning

The U.S. Food and Drug Administration (FDA) has found data that indicate an increased risk of mortality and renal injury requiring renal replacement therapy in critically ill adult patients treated with hydroxyethyl starch (HES) solutions. HES solutions are used for the treatment of hypovolemia when plasma volume expansion is indicated. After a public workshop, the FDA concluded that HES solutions should not be used in this patient population, and a Boxed Warning to include the risk of mortality and severe renal injury is warranted. In addition, the FDA reviewed a meta-analysis of studies conducted in patients undergoing open heart surgery in association with cardiopulmonary bypass and determined that an additional warning about excessive bleeding was needed in the Warnings and Precautions Section of the package insert. The FDA has created a list of recommendations for patients and healthcare providers to consider before use of HES solutions.

PDR Drug Alerts provides immediate, electronic delivery of safety information from the U.S. Food and Drug Administration. Society of Critical Care Medicine members can sign up to receive complimentary alerts as well as updates reflecting labeling changes.

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Critical Connections Features Congress Review

The June/July issue of Critical Connections features review articles from the 42nd Critical Care Congress:

Claim CE credit by ordering the Congress Review at the SCCM store at www.sccm.org/congressreview13. There is no cost for this transaction.

The latest issue also offers a preview of the 43rd Critical Care Congress, to be held January 9 to 13, 2014, in San Francisco, California, USA. Check out our pre-Congress educational sessions, popular events and sightseeing activities, as well as information on hotels and travel.

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Discounted Rates for Adult MCCBRC Ends Soon

Discounted registration rates for the Society of Critical Care Medicine’s (SCCM) upcoming Adult Multiprofessional Critical Care Board Review Course (MCCBRC) are only available until Wednesday, July 17, 2013. Register online today using your Customer ID  and password, or contact SCCM Customer Service at +1 847 827-6888, to take advantage of special pricing.

The 2013 Adult MCCBRC will be held at the JW Marriott, August 10 to 14, in Washington, DC, USA. Reserve your housing by Wednesday, July 10, 2013, to receive low rates on your hotel stay. Reservations made after this day may not receive SCCM’s discounted hotel rate.

Led by founding directors Joseph E. Parrillo, MD, MCCM, and Henry Masur, MD, FCCM, the Adult MCCBRC offers four-and-a-half days of expert guidance on the core areas of critical care medicine. Whether you need to certify, recertify, or simply review, this course provides an excellent update and thorough overview of the field.

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Webcast Will Explore the Impact of Coding for Sepsis

surviving sepsisCoding for severe sepsis and septic shock is a complex, highly nuanced skill that has wide implications for generating data to support the effort to reduce mortality from sepsis. Too often, coding is not clinically congruent with the incidence or severity of sepsis, in turn, providing misleading reports on the metrics of an institution’s patient population.

The Society of Critical Care Medicine’s (SCCM) webcast, Sepsis: Impact of Coding Upon Metrics, will take place on July 11, 2013, at 2 p.m. Central Time. Paul Evans, RHIA, CCS, CCDS, CCS-P, will provide insight into how actions by all members of the sepsis team affect the generation of valuable data from coding. Topics to be covered include:

  • Requirements by physicians that support accurate data collection
  • Impact of key terms on risk-adjusted mortality data
  • How sepsis should be coded
  • Tips to support sepsis coding

This event, part of SCCM’s Surviving Sepsis Campaign (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. No CME is available. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

Programs are supported by the Gordon and Betty Moore Foundation:

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