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

June 5, 2014

Concise Critical Appraisal

What Effect Do Corticosteroids Have on the Genomic Response of Pediatric Septic Shock?
Benefits of the ABCDE Bundle in ICU Patients
Nitric Oxide Synthase: Key Factor for Vascular Dysfunction in Sepsis

Education

Register Now for Webcasts on Corticosteroids and Pet and Music Therapy
No Cost, Online CME Activities from the 43rd Critical Care Congress
Board Review: Early Registration Deadline Approaching
Upcoming Webcasts on Corticosteroids and Pet and Music Therapy
Early-Bird Rates for Critical Care Ultrasound Courses End Soon
New Edition of Compensation of Critical Care Professionals Available

SCCM News

Submit Your Abstract for SCCM’s 44th Critical Care Congress
Help Further the Mission of Project Dispatch
Deborah J. Cook Receives Prestigious Grenvik Family Award for Ethics
New CDC Website Features Surviving Sepsis Campaign
New Award Recognizes Excellence in Pediatric Critical Care Medicine
Sign-on Letter: Detect and Protect Against Antibiotic Resistance Initiative
Sandra Swoboda Wins Nursing Excellence Award
Benefits of the ABCDE Bundle in ICU Patients

The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle has been proposed as a strategy to reduce delirium, liberate patients from the ventilator and improve outcomes for intensive care unit (ICU) patients. Balas and colleagues conducted a prospective before-after study at a tertiary medical center to determine the safety and impact of the ABCDE bundle implementation for ICU patients.

They found that critically ill patients managed with the ABCDE bundle spent more days breathing without assistance and experienced less delirium than patients treated with usual care. Some of the limitations of this study are the small sample size and the inclusion of nonventilated and oncology/hematology patients. Although the patient population was small, it represented a heterogeneous population, with more than 40% of patients having had surgery.  Ultimately, multicomponent ventilator liberation and “animation” strategies such as the ABCDE bundle are likely to become an integral component of ICU care if the safety and effectiveness demonstrated in this study can be reproduced.

To learn more about reducing delirium and improving care for ICU patients, visit www.iculiberation.org.

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.

Tags: , |
Back to Top
What Effect Do Corticosteroids Have on the Genomic Response of Pediatric Septic Shock?

The use of steroids in patients with inotrope/pressor–resistant septic shock is controversial in both adult and pediatric populations. While these patients’ hemodynamics may improve with adjunctive steroid treatment, the metabolic and immune costs may negate a definitive survival benefit. However, little has been written about the effects glucocorticoids have on global gene expression in patients with septic shock. Wong and colleagues address this topic by using a transcriptomics approach to characterize the genomic response of pediatric patients in septic shock who have received glucocorticoids. They found that the administration of corticosteroids in pediatric septic shock is associated with additional repression of genes corresponding to adaptive immunity. They did not comment on actual immune suppression, though, as qualitative evaluations of immunity were not performed.

Ultimately, steroid use in catecholamine-resistant septic shock — even in seemingly low doses — can have significant consequences in a patient’s ability to fight an initial infection or even subsequent nosocomial infections unrelated to the patient’s illness severity or infecting organism. This fact, coupled with the absence of definitive outcome benefits, should give pediatric critical care practitioners pause before prescribing steroids in children with septic shock.

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.

Tags: , , , |
Back to Top
Nitric Oxide Synthase: Key Factor for Vascular Dysfunction in Sepsis

Previous experimental work has demonstrated that excessive nitric oxide (NO) is produced during sepsis and is a key mechanism for vascular dysfunction. The amount of NO produced appears to be directly related to hypotension and decreased responsiveness to vasoconstrictors. Three nitric oxide synthase (NOS) isoforms may contribute to hypotension during sepsis, but most studies suggest that the majority of NO is produced by nitric oxide synthase 2 (NOS-2). Nardi and colleagues sought to define the contribution of nitric oxide synthase 1 (NOS-1) and its relationship with the main vascular effector of NO, soluble guanylate cyclase (sGC), in an animal model of sepsis.

The investigators found that NO production by NOS-1 has an important role in sepsis-induced vascular dysfunction. Limitations of this study include the nature of the sepsis model and the fact that the NOS-1 and sGC association was established only in smooth muscle.  This work may some day be clinically relevant for septic patients with refractory hypotension if the results can be replicated in humans.

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.

Tags: , |
Back to Top
No Cost, Online CME Activities from the 43rd Critical Care Congress

Several videos featuring the industry-supported sessions from the Society of Critical Care Medicine’s (SCCM) 2014 Critical Care Congress in San Francisco, California, USA, are available in the SCCM Store. Whether you missed the 2014 Congress or couldn’t make it to all the sessions of interest, you can still participate in the most popular events online at your convenience. Earn free continuing medical education (CME) credits by viewing any of the following webcasts and then applying for credit.

Can We Feed? Ensuring Optimal Early Enteral NutritionSupported by educational grants from Abbott Nutrition and Nestlé HealthCare Nutrition, Inc.

This offering identifies the development and initiation of early enteral nutrition therapy in the intensive care unit (ICU), compensatory enteral nutrition administration techniques, and strategies to reduce the incidence of aspiration and aspiration-related pneumonia in critically ill, tube-fed patients.

Feed Your Brain: It’s Not Just About Calories!Supported by an educational grant from Abbott Nutrition

In this session, expert faculty identify the basic concepts for optimal ICU nutritional support, examine pros and cons of pre- and probiotic use in the ICU and translate research findings into ICU management protocols.

Hemostatic Resuscitation and Acute Coagulopathy in the ICU – Supported by an educational grant from CSL Behring

This discussion focuses on the issues surrounding plasma and factor concentrates, as well as management of bleeding with the new anticoagulants.

Malnutrition: New International Etiology-Based DiagnosisSupported by an educational grant from Abbott Nutrition

The presenters discuss the integration of a cutting edge, international, etiology-based malnutrition diagnosis in the ICU, and outline characteristics of the diagnosis in the critically ill patient.

Noninvasive VentilationSupported by an educational grant from Covidien Puritan Bennett

This offering reviews the latest techniques in providing noninvasive ventilation and explores the efficacy of noninvasive ventilation in treating primary respiratory failure.

Pulmonary HypertensionSupported by an educational grant from Actelion Pharmaceuticals US, Inc.

Expert faculty describe basic management principles of patients with pulmonary hypertension, and look at developing a medication treatment plan for pulmonary hypertension.

Translation Research in Cardiopulmonary Resuscitation – Supported by an educational grant from ZOLL Medical Corporation

This offering details how outcomes of sudden death have not changed since the introduction of cardiopulmonary resuscitation, and examines how many established standards of medical care are wrong or less than perfect.

Tags: , |
Back to Top
Register Now for Webcasts on Corticosteroids and Pet and Music Therapy

In the month of June, the Society of Critical Care Medicine (SCCM) will feature two webcasts on critical care topics pertinent to quality patient care:

Use of Corticosteroids in Septic Shock
Tuesday, June 24, 2014
1:00 p.m. Central Time
Register online today

Septic shock is a serious condition often seen in the intensive care unit. Treatment is complicated and options vary. In this webcast from the Society of Critical Care Medicine’s Controversies in Critical Care series, the rationale for use or avoidance of corticosteroids in critically ill patients with septic shock will be discussed. Djilalli Annane, MD, and Greet Van den Berghe, MD, PhD, will highlight the controversies surrounding the use of low-dose corticosteroids and the association with clinical outcomes. The registration fee for this 60-minute webcast is $30 for SCCM members ($40 for nonmembers). For institutions seeking unlimited participation, a $200 group rate is available. Participants will receive 1 hour of continuing education credit.

Learning Objectives

  • List the rationales for the use of low-dose steroids in septic shock
  • Explain the controversies surrounding steroid use and clinical outcomes
  • Describe the context in which steroids should be used (e.g., dose, duration, severe sepsis versus septic shock)
  • Outline the end points for use of steroids (e.g., mortality versus shock reversal)
  • Categorize the adverse effects expected for steroid use in the critically ill
  • Review the 2012 Surviving Sepsis Campaign guidelines regarding recommendations for steroid use

The Controversies in Critical Care webcast series is a joint project of the SCCM Scientific Review 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 is available to guide practice decisions.

The Impact of Pet and Music Therapy on the Critically Ill
Wednesday, June 25, 2014
12:00 p.m. Central Time
Register online today

Anxiety among patients in the intensive care unit (ICU) is often understandably heightened. Patients are confronted with unfamiliar surroundings and intrusive procedures, including mechanical ventilation. Music and pet therapy are two integrative approaches that may alleviate such anxiety and reduce sedation frequency and intensity. In this webcast from SCCM’s Project Dispatch series, Linda Chlan, PhD, RN, FAAN, and Erika Gonzalez, MSN, RN, CCRN, will share their unique experiences with integrative therapies for patients and families in the ICU. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

Learning Objectives

  •  Understand the key obstacles and challenges to establishing such programs
  •  Apply similar strategies in your institution
  •  Evaluate your program’s success

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.

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

Tags: , , |
Back to Top
Board Review: Early Registration Deadline Approaching

The early registration deadline for the Society of Critical Care Medicine’s (SCCM) Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC) is Wednesday, June 18, 2014.

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.

As a registered participant, you will benefit from:

  • Online access to practice questions
  • A comprehensive course syllabus
  • Networking opportunities with colleagues and world-renowned experts

Also, included in your registration fee is post-course online access to MCCBRC On Demand, which allows you to access videos containing the slide presentations and synchronized speaker audio for every lecture.

The 2014 Adult and Pediatric MCCBRC will be held August 12 to 16, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register online for the Adult or Pediatric MCCBRC using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

Tags: , , |
Back to Top
Upcoming Webcasts on Corticosteroids and Pet and Music Therapy

The Society of Critical Care Medicine (SCCM) will feature two webcasts in the month of June, covering critical care topics pertinent to quality patient care.

Use of Corticosteroids in Septic Shock
Tuesday, June 24, 2014
1:00 p.m. Central Time
Register online today

The mortality rate for septic shock can climb to 50% in the sickest patients. In this webcast from SCCM’s Controversies in Critical Care series, the rationale for use or avoidance of corticosteroids in critically ill patients with septic shock will be discussed. Djillali Annane, MD, and Greet Van den Berghe, MD, PhD, will highlight the controversies surrounding the use of low-dose corticosteroids and the association with clinical outcomes. The registration fee for this 60-minute webcast is $30 for SCCM members ($40 for nonmembers). For institutions seeking unlimited participation, a $200 group rate is available. Participants will receive 1 hour of continuing education credit.

Learning Objectives

  • List the rationales for the use of low-dose steroids in septic shock
  • Explain the controversies surrounding steroid use and clinical outcomes
  • Describe the context in which steroids should be used (e.g., dose, duration, severe sepsis versus septic shock)
  • Outline the end points for use of steroids (e.g., mortality versus shock reversal)
  • Categorize the adverse effects expected for steroid use in the critically ill
  • Review the 2012 Surviving Sepsis Campaign guidelines regarding recommendations for steroid use

The Controversies in Critical Care webcast series is a joint project of the SCCM Scientific Review 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 is available to guide practice decisions.

The Impact of Pet and Music Therapy on the Critically Ill
Wednesday, June 25, 2014
12:00 p.m. Central Time
Register online today

Pet and music therapy have been in use for centuries. In this webcast from SCCM’s Project Dispatch series, these two integrative approaches and their ability to alleviate patient anxiety and reduce sedation frequency and intensity will be discussed. Linda Chlan, PhD, RN, FAAN, and Erika Gonzalez, MSN, RN, CCRN, will share their unique experiences with integrative therapies for patients and families in the intensive care unit. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

Learning Objectives

  • Understand the key obstacles and challenges to establishing such programs
  • Apply similar strategies in your institution
  • Evaluate your program’s success

This webcast was organized by SCCM’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.

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

Tags: , |
Back to Top
Early-Bird Rates for Critical Care Ultrasound Courses End Soon

Register for the Society of Critical Care Medicine’s (SCCM) Critical Care Ultrasound, Advanced Critical Care Ultrasound, and Critical Care Ultrasound – Pediatric courses by Wednesday, June 18, 2014, to take advantage of discounted registration rates.

In the evaluation and treatment of acute illness and injury, every second makes a difference. Focused ultrasound examinations in the critical care setting have become an extension of the clinical assessment because of their rapid, precise detection capabilities. Assist in the immediate management of patients by learning or enhancing point-of-care ultrasound skills.

Critical Care Ultrasound and Critical Care Ultrasound – Pediatric will be held August 17 and 18, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. The Advanced course will follow on August 19, 2014. Make your hotel reservation by July 14, 2014, to receive SCCM’s discounted rate.

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

Tags: , , |
Back to Top
New Edition of Compensation of Critical Care Professionals Available

The third edition of Compensation of Critical Care Professionals is now available. This resource is invaluable for critical care providers needing to benchmark compensation packages. Available in a free download, this edition  presents results and comparison data divided out by profession from a 2013 survey of critical care professionals conducted by the Society of Critical Care Medicine (SCCM).

Employees can use the information to compare salaries, benefits and working conditions of critical care professionals across the country. Employers can access and review valuable information to help them formulate competitive compensation packages to meet the increasing demands of critical care personnel.

Compensation of Critical Care Professionals, Third Edition, is available to download for free in the SCCM store.

Tags: , |
Back to Top
Submit Your Abstract for SCCM’s 44th Critical Care Congress

sq-CongressAbstract submission for the Society of Critical Care Medicine’s (SCCM) 44th Critical Care Congress is now open. Contribute to the advancement of critical care by submitting your original investigative research and case reports for presentation at the 2015 Congress, to be held in Phoenix, Arizona, USA. If accepted, your work will be on display from January 18 to 20, 2015, and will be published in Critical Care Medicine, the number one critical care subspecialty journal. You also will benefit from:

  • Presentation Opportunity: Authors of the top 64 abstracts are granted the opportunity to give oral presentations.
  • Peer evaluation: Select posters will be visited by critical care experts who provide indispensable feedback.
  • Awards: Multiple awards are offered, including scientific awards, educational scholarships and research awards.

Presenting authors who are SCCM members at the time of abstract submission may have an opportunity to apply for complimentary Congress registration.

Abstracts will be accepted until noon Central Time on August 1, 2014. Submission categories are: Case Reports, Clinical, Clinical Research, and Basic Science Research.

Visit www.sccm.org/abstracts for complete details on submission guidelines and categories.

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. Registration opens June 2014.

Tags: , , |
Back to Top
Help Further the Mission of Project Dispatch

The most recent issue of Critical Connections focused on the Society of Critical Care Medicine’s (SCCM) Project Dispatch initiative, which aims to put a spotlight on efforts to improve patient- and family-centered care by disseminating the latest research in this exciting field. Be sure to check out the articles from our contributors:

The Value and Future of Patient-Centered Outcomes Research

Transforming Care: Developing a Patient- and Family-Centered ICU

Team Training to Enhance Communication with Families in the ICU

Have an Interest in Patient- and Family-Centered Care?

If you have a passion for patient-centered initiatives, an interest to learn more or are looking for an opportunity to be a leader in this field, SCCM and Project Dispatch want to hear from you. Whether you have started a successful program related to family presence during procedures or rounds, have outcomes-related research or are exploring new ideas, we want to hear from you! Contact Project Dispatch staff partner Stephen Davidow and get involved.

Tags: |
Back to Top
Deborah J. Cook Receives Prestigious Grenvik Family Award for Ethics

Cook_DeborahDeborah J. Cook, MD, received this year’s Grenvik Family Award for Ethics in recognition of her many contributions to safe and humanistic patient care.

Throughout her research, Cook — a professor of medicine, clinical epidemiology and biostatistics at McMaster University in Hamilton, Ontario, Canada — has emphasized ethical issues. She led the Level of Care Study that examined how healthcare providers make decisions about directions of care for critically ill patients. This work led to numerous publications, including an important paper in The New England Journal of Medicine centered on the clinical determinants that were associated with the withdrawal of mechanical ventilation.

Cook always maintains the highest level of ethical integrity in her interactions with patients, students and colleagues. Additionally, she has been heavily involved in the ethics-related activities of national and international organizations such as the Society of Critical Care Medicine (SCCM), the Canadian Critical Care Trials Group and the American Thoracic Society.

It is time again to nominate a colleague for SCCM’s Grenvik Family Award for Ethics. If you know an SCCM member who has made significant contributions toward addressing ethical problems in critical care, 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 intensive care unit (ICU) team. Most award recipients receive a complimentary registration to the 44th Critical Care Congress. Apply for these opportunities by August 1, 2014.

Tags: , , |
Back to Top
New CDC Website Features Surviving Sepsis Campaign

SSC LogoThe U.S. Centers for Disease Control and Prevention (CDC) recently launched a new website to increase sepsis awareness and improve early recognition, diagnosis and treatment of patients.

The Surviving Sepsis Campaign, a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine, features heavily on the new website. Throughout, readers are directed to the Campaign’s website for additional information regarding sepsis. They are also specifically encouraged to examine and review Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012.

The CDC website houses the following resources:

  • Basic Information: Fact sheets and questions and answers for patients
  • Clinical Guidelines and Tools: Guidelines, bundles, education resources, and tools
  • Information on Improving Survival:  A look at quality improvement efforts undertaken by healthcare facilities to improve survival in sepsis
  • Medical Bibliography: Selected sepsis chapters from medical textbooks
  • Data Reports: Recent reports on the incidence of sepsis
  • Related Links: Links to websites that provide additional information about sepsis
Tags: , |
Back to Top
Sign-on Letter: Detect and Protect Against Antibiotic Resistance Initiative

The Society of Critical Care Medicine (SCCM) recently signed onto a letter regarding the U.S. Centers for Disease Control and Prevention (CDC) Detect and Protect Against Antibiotic Resistance Initiative.

The letter urges the U.S. Congress to appropriate $30 million included in the Fiscal Year 2015 President’s Budget Request for the Detect and Protect Against Antibiotic Resistance Initiative. The initiative is part of a CDC strategy to achieve measurable results in combating the public health crisis of rapidly rising antibiotic resistance. The time to act is now, the letter states, while there is still an opportunity to prevent a post-antibiotic era in which we are unable to successfully treat infections or carry out many other healthcare activities (e.g., transplants and other surgeries, chemotherapy, care of preterm infants) currently made safe and possible by effective antibiotics.

Other letters that SCCM signed onto in 2014 are:

AMA Protecting Access to Medicare Act of 2014

AMA SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000)

AMA SGR Repeal and Medicare Provider Payment Modernization Act of 2014

IDSA ADAPT Act Letter

ACP CSS Meaningful Use Letter

You can also view the  2013 letters receiving Society support.

The Society is asked to sign onto letters addressing upcoming rules, payment policies, regulation, performance measurement, clinical topics, and other matters in cooperation with a variety of organizations. SCCM also issues letters of comment independently as the Council and Executive Committee deem important to patients and membership.

Tags: , , |
Back to Top
New Award Recognizes Excellence in Pediatric Critical Care Medicine

The Dharmapuri Vidyasagar Award for Excellence in Pediatric Critical Care Medicine, sponsored by Dr. Vidyasagar and the Society of Critical Care Medicine (SCCM), recognizes an individual for sustained exemplary and pioneering achievement in the care of critically ill and injured infants and children.

Nominees for this award should have distinguished themselves by achieving national and international professional prominence due to personal character, leadership, eminence in clinical practice, and outstanding contributions to research, education, program development, and advocacy for pediatric critical care medicine. All SCCM members are eligible for this award.

Candidates will be selected and evaluated according to the following criteria (not all criteria need apply, though it is expected that recipients will have demonstrated excellence in several of the areas):

  • Personal attributes that distinguish the recipient as a pediatric critical care medicine pioneer and exemplar
  • Leadership in pediatric critical care medicine, as evidenced by current and past academic and organizational accomplishments
  • Contributions that further the mission, vision and values of the Society, specifically pertaining to the care of critically ill and injured infants and children
  • Scientific publications, specifically related to the care of critically ill and injured infants and children
  • Research grants and projects that have advanced the care of critically ill and injured infants and children
  • Teaching accomplishments, especially those that have impacted the training of healthcare professionals in pediatric critical care medicine
  • Contributions to pediatric critical care medicine through other medical societies and organizations
  • Contributions to the community and volunteerism, specifically related to pediatric medical and/or educational programs
  • Awards and honors

The recipient will receive a $500 cash award, a plaque and complimentary registration to SCCM’s Critical Care Congress.

Nominations for this award must be submitted by August 1, 2014. Submit nominations and questions related to this award to SCCM staff member Carol Prendergast.

Tags: |
Back to Top

Hamilton Medical – Reduced time on the ventilator with ASV

© Society of Critical Care Medicine
Headquarters: 500 Midway Drive | Mount Prospect, Illinois 60056 USA
Phone: +1 847 827-6869 | Fax: +1 847 827-6886
Manage your communication preferences or unsubscribe.