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July 3, 2014

Concise Critical Appraisal

Tracheostomy in Mechanically Ventilated Children
Early Antibiotic Administration in Severe Sepsis and Septic Shock

Education

Advanced Critical Care Ultrasound: Reduced Registration Deadline Nearing
Self-Directed Pediatric Fundamental Critical Care Support is Now Available
Discounted Rates for Adult and Pediatric MCCBRC End Soon
Participate in Pre- and Post-Congress Educational Sessions
Register for Webcast on Improving Patient Care and Transitions
Webcast on Presenting Patient-Centered Outcomes Data to Improve Care

SCCM News

Registration Now Open for the 44th Critical Care Congress
Exchange Ideas and Resources in SCCM’s Disaster eCommunity
Samuel A. Tisherman Leads Groundbreaking Clinical Trial
Military Personnel Take Advantage of PFCCS Course
Surviving Sepsis, ICU Liberation Offer Guidelines in Numerous Languages
Weinberg Surgical Intensive Care Unit Wins Family-Centered Care Award
ICU Liberation Releases Informative Presentations
Project Dispatch Offers up Complimentary Educational Material
Early Antibiotic Administration in Severe Sepsis and Septic Shock

Several retrospective studies have demonstrated improved survival when antibiotics are administered early in septic shock and severe sepsis. However, the results of the recent Protocolized Care for Early Septic Shock (ProCESS) trial have prompted intense debate in the critical care community regarding which elements of sepsis resuscitation bundles are most beneficial. Ferrer and colleagues sought to analyze the association between timing of antibiotic administration and mortality. The authors also evaluated whether an optimal time window for empiric antibiotic administration can be determined.

Using the database compiled for the Surviving Sepsis Campaign (SSC), the authors examined data entered between January 2005 and February 2010. Specifically, they analyzed data from 17,990 of 28,150 patients in the SSC database with severe sepsis and septic shock. They found that delay in antibiotic administration was associated with increased in-hospital mortality. As with any retrospective study, there is potential for residual confounding. In addition, appropriateness of antibiotics was not captured in this work. Despite these limitations, the strength of association demonstrated in this study appears to support current SSC guidelines.

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.

In the most recent issue of Critical Connections, SCCM President J. Christopher Farmer, MD, FCCM, also touches on the debate and controversy of the ProCESS trial.

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Tracheostomy in Mechanically Ventilated Children

The decision to perform a tracheostomy in a ventilated, intensive care unit (ICU) patient is a difficult one regardless of the patient’s age, but it is especially trying in children. There is little in the literature describing the indications for tracheostomy in pediatric patients, and its use in ventilated children is significantly less than in ventilated adults. In a retrospective, cohort study by Wakeham et al, the authors sought to describe the current tracheostomy practices in children, specifically examining frequency, timing and other clinical/demographic factors. Ultimately, the authors examined data on more than 13,000 mechanically ventilated pediatric intensive care unit (PICU) patients from a multisite PICU database and noted that 872 patients (6.6%) had tracheostomy tubes placed.

The investigators found that demographic and clinical characteristics are associated with the frequency and timing of tracheostomy among PICU patients requiring prolonged mechanical ventilation. They also found that frequency and timing varied significantly among PICUs independent of these characteristics. While this is the first multicenter study describing tracheostomy practices in the United States, it may provide more questions than answers due to its retrospective nature. On what are PICU practitioners basing their tracheostomy decisions?  For example, are these decisions predicated solely on clinical characteristics, or are practitioners influenced by available resources or personal beliefs about the practice?  Also, why do PICUs have such differences in tracheostomy timing? These questions need to be addressed in other multicenter studies to provide guidance for PICU practitioners.

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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Self-Directed Pediatric Fundamental Critical Care Support is Now Available

Self-Directed Pediatric Fundamental Critical Care Support (PFCCS) provides a relaxed learning experience with access to the same didactic sessions found in the live version of the Second Edition PFCCS course. Learn at your own pace from the comfort and convenience of your home or office and then assess your knowledge through the use of pre- and post-tests.

Self-Directed PFCCS includes 16 modules with synchronized speaker audio and the PFCCS textbook (English), which is an excellent desktop reference. Physicians, nurses, pharmacists, dieticians, physician assistants, and respiratory therapists are eligible to receive 6.5 hours of continuing education credit.

Self-Directed PFCCS is available for purchase in the SCCM store.

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Advanced Critical Care Ultrasound: Reduced Registration Deadline Nearing

Register for the Society of Critical Care Medicine’s (SCCM) popular Advanced Critical Care Ultrasound course by Wednesday, July 16, 2014, to take advantage of a discounted registration rate. Seats are filling fast, and this course will soon be sold out. Advanced Critical Care Ultrasound is intended for those who have previously attended an ultrasound course or are experienced with basic skills and procedures.

This course will help you expand your fundamental skills and knowledge and focus on the specialty-specific use of echocardiography in the management of the critically ill patient. Participants learn to capture important cardiovascular information for the noninvasive management of the hemodynamically unstable patient.

Course Learning Objectives

  • Describe the use of echocardiography in the assessment of hemodynamic parameters
  • Perform the quantitative assessment of left ventricular systolic function
  • Recognize the regional wall motion abnormalities
  • Describe the basic assessment of valvular pathology
  • Describe the limitations of echocardiography in intensive care unit settings
  • Describe the use of ultrasonography for evaluation of pulmonary edema

Advanced Critical Care Ultrasound will be held August 19, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA.

Secure your seat and register online today for Advanced Critical Care Ultrasound using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

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Participate in Pre- and Post-Congress Educational Sessions

The Society of Critical Care Medicine’s (SCCM) 44th Critical Care Congress will be packed with essential clinical information to keep you well-informed on the latest groundbreaking research and developments in critical care. The pre- and post-Congress educational sessions reflect the most up-to-date topics and evidence-based information so you can incorporate the latest clinical treatments and administrative strategies into your everyday practice. Space for each course is limited, so register early to guarantee your top choices.

Pre-Congress Educational Sessions

Half-Day
Saturday, January 17

  • 2015 Coding and Billing
  • Advanced Practice Providers: Administration, Leadership and Outcomes
  • Critical Care Skills Lab

Full-Day
Friday, January 16 and Saturday, January 17

  • Current Concepts in Adult Critical Care
  • Current Concepts in Pediatric Critical Care
  • ECMO Management
  • Veterinary Critical Care

Saturday, January 17

  • Acute Kidney Injury and Renal Replacement Therapies
  • Airway Management in the Critically Ill
  • Critical Care of the Patient with Liver Disease
  • Critical Care Pharmacotherapy: Challenges and Controversies
  • Fundamental Critical Care Support (FCCS) Instructor Course
  • Fundamental Disaster Management (FDM) Instructor Course
  • Pediatric Fundamental Critical Care Support (PFCCS) Instructor Course

Post-Congress Educational Sessions

Full-Day
Wednesday, January 21 and Thursday, January 22

  • Critical Care Ultrasound
  • Critical Care Ultrasound – Pediatric

Mark your calendar and join more than 6,000 members of the critical care community in the Valley of the Sun for SCCM’s 44th Critical Care Congress, to be held January 17 to 21, 2015, in Phoenix, Arizona, USA. The 2015 Congress will provide unique opportunities to network with leadership in critical care and enjoy enlightened and innovative learning experiences that highlight the most up-to-date, evidence-based developments in critical care medicine.

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

For information on hotel and travel reservations, visit www.sccm.org/Congress.

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Discounted Rates for Adult and Pediatric MCCBRC End Soon

Discounted registration rates for the Society of Critical Care Medicine’s (SCCM) upcoming Multiprofessional Critical Care Board Review Courses (MCCBRC) are only available until Wednesday, July 16, 2014. To take advantage of special pricing, register online for the Adult or Pediatric MCCBRC using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

The 2014 Adult and Pediatric MCCBRC will be held August 12 to 16, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Reserve your housing by Monday, July 14, 2014, to receive low rates on your hotel stay. Reservations made after this date may not receive SCCM’s discounted hotel rate. For more details on hotel and travel, visit the Adult or Pediatric course page.

These 4.5-day courses provide the most comprehensive review in the diagnosis, monitoring and management of critically ill patients. The courses include interactive board preparation sessions and feature practice board questions, answers and rationales. World-class faculty focus on preparing fellows and attendings for their critical care certification and recertification. These courses also provide an excellent update for any critical care professional seeking the most current review of the field.

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Register for Webcast on Improving Patient Care and Transitions

Through patient satisfaction data and feedback from a formal rounding survey, the medical intensive care unit (ICU) at the Medical University of South Carolina developed a patient- and family-centered transfer brochure to help reduce the psychological and physiological problems that can materialize after an ICU stay. These problems include posttraumatic stress disorder, which can affect a patient’s recovery and quality of life.

During Collaborating with Families to Improve Patient Care and Transitions, the latest webcast from the Society of Critical Care Medicine’s (SCCM) Project Dispatch series, Andrea Meaburn, RN, MSN, ANP-BC, CCRN, CHPN, will share the medical ICU staff’s experience in creating a comprehensive transfer brochure. She will discuss how the brochure supports patients and families and how it fits into their broader patient-centered care approach. Ms. Meaburn’s presentation will be followed by an opportunity for audience questions. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

Learning Objectives

  • Define the concerns patients and families have about transfer from the ICU
  • Identify ways to alleviate patient and family stress to improve outcomes
  • Deploy strategies that lead to a less stressful experience
  • Evaluate the effectiveness of these efforts

This 60-minute webcast will take place on Wednesday, August 27, 2014, at 12:00 p.m. Central Time.

Register online today using your Customer ID and password.

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

This webcast was organized by the Society of Critical Care Medicine’s Project Dispatch.  Project Dispatch aims to improve the quality, efficacy, accessibility, and cost-effectiveness of healthcare in the United States by developing and distributing resources for critical care clinicians focused on patient-centered research. 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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Webcast on Presenting Patient-Centered Outcomes Data to Improve Care

sq-Quality-Project-Dispatch v1_0Registration is now open for Presenting Patient-Centered Outcomes Data to Improve Care, the latest webcast from the Society of Critical Care Medicine’s (SCCM) Project Dispatch series. Patient-reported outcome measures and results have become a regular part of healthcare. Clinical trials and other research studies often examine symptoms, quality of life and the impact of a specific health condition and its treatment from the patient’s perspective. This information can be used to inform treatment decisions. In addition, clinics are now routinely asking patients to complete questionnaires and are using this information to help identify and address issues related to patient functioning and well-being. Thus, patient-reported outcome data can be invaluable in managing and tailoring an individual patient’s care. Given the potential to aid both patients and clinicians, it is vital to develop best practices for presenting patient-reported outcome data in a consistent way so that the information is meaningful and useful to patients and clinicians.

Claire Snyder, PhD, from The Johns Hopkins University School of Medicine, will share her experience in the area of patient-reported outcomes research, as well as early results from her Patient-Centered Outcomes Research Institute-funded project.  Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

Learning Objectives

  • Describe ways that patient-reported outcomes can be used to promote patient-centered care
  • Identify barriers to patients’ and clinicians’ understanding and use of patient-reported outcome data in practice
  • Present initial results regarding best practices for presenting patient-reported outcome data, as well as key challenges that require further exploration

This 60-minute webcast will take place on Thursday, July 31, 2014, at 12:00 p.m. Central Time.

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

This webcast was organized by the Society of Critical Care Medicine’s Project Dispatch.  Project Dispatch aims to improve the quality, efficacy, accessibility, and cost-effectiveness of healthcare in the United States by developing and distributing resources for critical care clinicians focused on patient-centered research. 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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Exchange Ideas and Resources in SCCM’s Disaster eCommunity

The Society of Critical Care Medicine (SCCM) is poised to respond to natural and man-made disasters and emergencies by providing a variety of resources to the critical care community. One such resource is the Society’s eCommunity, which has a forum dedicated to disaster response.

Interested parties are encouraged to visit this forum to share valuable resources or offer insight on a variety of disaster-related topics, including the recent Ebola outbreak. You can subscribe to the Disaster eCommunity to stay abreast of recent postings.

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Registration Now Open for the 44th Critical Care Congress

sq-CongressRegistration is now open for the Society of Critical Care Medicine’s (SCCM) 44th Critical Care Congress, to be held January 17 to 21, 2015, in Phoenix, Arizona, USA, the city symbolic of its mission.

SCCM’s first logo was composed of a triangle with a phoenix in the center. The triangle represented SCCM’s three-pronged purpose — education, research and patient care. The mythical phoenix symbolized immortality and invincibility. Together, these images were a reminder that the central focus of all SCCM initiatives is to provide quality care to patients, with the ultimate goal of healing and survival.

The Society has continued to promote its purpose and make a difference in the world of critical care. This five-day event will offer opportunities to explore breakthroughs in research, share creative and stimulating ideas, make valuable connections, and obtain inspired perspectives from all members of the multidisciplinary, multiprofessional critical care team. The program will include:

  • Cutting-edge educational sessions
  • Hands-on workshops
  • Compelling plenary sessions
  • Captivating symposia

Register Early and Save!

Early registration and reservations are recommended. Early-bird registration is offered through November 12, 2014, and can save participants as much as 20% off Congress tuition. For information on hotel and travel reservations and available discounts, visit www.sccm.org/Congress.

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

Get updates, RSVP and connect with attending colleagues on Facebook.

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Samuel A. Tisherman Leads Groundbreaking Clinical Trial

Tisherman_SamuelThe New York Times recently spotlighted a clinical trial, led by Society of Critical Care Medicine (SCCM) Council Member Samuel A. Tisherman, MD, FCCM, that will test an innovative hypothermia procedure on dying trauma patients.

As part of the trial, doctors at the University of Pittsburgh Medical Center will drain trauma patients’ blood and replace it with a cold saline solution, inducing hypothermia and slowing metabolism in an effort to buy valuable time to repair the victims’ wounds.

Doctors will be performing the procedure only on patients who arrive at the emergency room with “catastrophic penetrating trauma” and who have lost so much blood that they have gone into cardiac arrest, according to the article. At normal body temperatures, surgeons usually must restore blood flow within five minutes to avoid brain damage.

In these situations, less than one in 10 survive, according to Tisherman. Improving those odds for patients is the impetus behind the trial.

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Military Personnel Take Advantage of PFCCS Course

PFCCCOURSE-1More than 60 members of the United States military recently took advantage of the Society of Critical Care Medicine’s (SCCM) Pediatric Fundamental Critical Care Support (PFCCS) course held in Japan at the U.S. Naval Hospital Okinawa.

Healthcare personnel from the Army, Navy and Air Force learned best practices for treating and managing critically ill pediatric patients. Led by an all-military instructor team, course participants gleaned pertinent knowledge from interactive lectures, small-group skill stations and high-fidelity simulations. The motivated students worked their way through case presentations involving respiratory failure, hypovolemic shock, electrolyte abnormalities, pediatric trauma, and post-operative care.

“I wish I had this course before I deployed,” said Air Force Capt. Debbie Dorsey, who served as a flight nurse at Camp Bastion in Afghanistan.

This sentiment was echoed by other students who noted that military personnel often encounter critically ill children in war zones and areas impacted by man-made and natural disasters.

Looking to learn at your own pace from the comfort and convenience of your home or office? Self-Directed Pediatric Fundamental Critical Care Support (PFCCS) is available for purchase in the SCCM store.

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Weinberg Surgical Intensive Care Unit Wins Family-Centered Care Award

family centered edit 2The Weinberg surgical intensive care unit (WICU) at The Johns Hopkins Hospital in Baltimore, Maryland, USA, received this year’s Family-Centered Care Innovation Award in recognition of the unit’s novel and effective methods for providing care to critically ill and injured patients and their families.

From its inception, the WICU has acknowledged the vital role of “the expert in the room” — the patient’s family. To this end, the unit has offered round-the-clock visiting hours and included families on daily rounds. During these rounds, family members are encouraged to join a standing circle with physicians and nurses, sometimes around the patient’s bed. The WICU staff also will bring family members to the bedside during emergency situations, if they wish.

From 2008 to 2010, the WICU team developed and launched the Family Meeting Project, in which the family of any patient who has been on the unit for more than seven days meets formally with the patient’s surgeon, intensivist, nurse, and social worker for a status update and to discuss care goals and next steps. Families can continue to request these meetings, since care goals and outcomes may shift the longer patients remain in the intensive care unit (ICU).

Building on the Family Meeting Project, the WICU Family Involvement Menu was created and piloted. As part of this initiative, family members are invited to choose from 10 daily care activities in which they can participate, with options ranging from shaving or feeding assistance to pillow repositioning or range-of-motion exercises. The family is also encouraged to suggest any assistance that may not be listed. Nurses provide instruction and supervision for all daily care, although family members often become adept enough to handle the activities on their own. To develop the menu, staff were asked to reflect on what they would want if they were ICU patients and to consider the most appropriate for family participation. At the same time, the WICU team surveyed 12 families on their interest in becoming more involved in their loved ones’ daily needs.

The results have been “nothing short of stunning,” said team leader and former WICU nurse clinician Rhonda Malone Wyskiel, BSN, RN.

It is time again to nominate a unit or program for the Society of Critical Care Medicine’s (SCCM) Family-Centered Care Innovation Award.  If you know a unit or program that demonstrates novel, effective methods for providing care to critically ill and injured patients and their families, nominate them today.

Additional SCCM Awards

The Society offers numerous awards that recognize dedication and contributions to the field of critical care. Nominate yourself or a colleague, or recognize your entire ICU team. Most award recipients receive a complimentary registration to the 44th Critical Care Congress. Apply for these opportunities by August 1, 2014.

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Surviving Sepsis, ICU Liberation Offer Guidelines in Numerous Languages

The Society of Critical Care Medicine’s American College of Critical Care Medicine offers numerous guidelines to help ensure consistent, evidence-based care of critical care patients using the most up-to-date and relevant knowledge available.

The most recent guidelines released relate to the Surviving Sepsis Campaign and the ICU Liberation initiative. Both initiatives are dedicated to improving care worldwide, with the Surviving Sepsis Campaign aimed at reducing sepsis mortality and ICU Liberation focused on providing tools and resources to assess, treat and prevent pain, agitation and delirium (PAD). These guidelines have been translated into various languages to ensure worldwide distribution.

ICU Liberation (PAD Guidelines)

Japanese Guidelines Translation

Surviving Sepsis Campaign (2012 Guidelines)

Chinese Guidelines Translation

French Guidelines Translation

German Guidelines Translation

Japanese Guidelines Translation

Persian Guidelines Translation

Portuguese Guidelines Translation

Spanish Guidelines Translation

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ICU Liberation Releases Informative Presentations

The ICU Liberation initiative is focused on providing tools and resources to assess, treat and prevent pain, agitation and delirium (PAD). The following presentations — delivered at the Society of Critical Care Medicine’s 43rd Critical Care Congress — feature leaders from the initiative discussing the nuances of PAD guideline implementation and strategies for improving patient outcomes. In addition, one of the presentations features a patient sharing his intensive care unit survivor experience.

Remember to regularly check the ICU Liberation YouTube playlist for the latest available presentations.

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