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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
Early-Bird Rates for Critical Care Ultrasound Courses End Soon
Upcoming Webcasts on Corticosteroids and Pet and Music Therapy
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
Sign-on Letter: Detect and Protect Against Antibiotic Resistance Initiative
New Award Recognizes Excellence in Pediatric Critical Care Medicine
Sandra Swoboda Wins Nursing Excellence Award
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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Hamilton Medical – Reduced time on the ventilator with ASV

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