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March 3, 2016

Concise Critical Appraisal

The Predictive Power of Mitochondrial DNA and Toll-Like Receptor-9

Education

Registration Open for 2016 Adult and Pediatric Board Review Courses

SCCM News

New Sepsis Definitions Published in JAMA and Highlighted at Congress
Severe Influenza-Associated Critical Illness Prompts CDC Health Advisory
SCCM Collaborative to Focus on Improving Patient- and Family-Centered Care
The Predictive Power of Mitochondrial DNA and Toll-Like Receptor-9

Cell injury and death leads to the release of intracellular molecules called damage-associated molecular patterns (DAMPs)—mitochondrial DNA (mtDNA) is one of these DAMPs. Krychtiuk et al set out to analyze whether levels of mtDNA are associated with 30-day survival and whether this predictive value is modified by the expression of its receptor (toll-like receptor-9).

They found that circulating levels of mtDNA at intensive care unit admission predict mortality in critically ill patients. This association was in particular present in patients with elevated toll-like receptor-9 expression.

Read the full Concise Critical Appraisal by logging in to 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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Registration Open for 2016 Adult and Pediatric Board Review Courses

Registration is now open for the Society of Critical Care Medicine’s (SCCM) 2016 Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC). Register online for the adult or pediatric course using your customer ID and password or contact SCCM Customer Service at +1 847 827-6888.

The 2016 board review courses will be held in a new location at the Loews Chicago O’Hare Hotel in Rosemont, Illinois, USA. Rosemont offers the convenience and amenities of downtown Chicago but at a lower price, and it’s just minutes from O’Hare International Airport. The courses will be held July 19-23, 2016.

MCCBRC sets the standard in board preparation with a comprehensive review that prepares fellows and attending physicians for the certification and recertification examinations in critical care. Led by internationally recognized faculty, these 4.5-day courses offer expert guidance on the core areas of critical care medicine. Whether you need to certify, recertify or simply review, MCCBRC provides an excellent update and thorough overview 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
  • Post-course online access to MCCBRC On Demand, which features slides and recorded speaker audio from all sessions of the live course

For more information and to view the complete line of available board review products, visit www.sccm.org/adultboardreview or www.sccm.org/pediatricboardreview.

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New Sepsis Definitions Published in JAMA and Highlighted at Congress

In a series of articles published last month in JAMA and released during the 45th Critical Care Congress, an international task force updated definitions of sepsis and septic shock. The group’s recommendations not only advance new definitions for sepsis and septic shock, but also offer clinical guidance to help physicians more quickly identify patients with or at risk of developing sepsis.

At present, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), has more than 560,000 views, making it one of the best viewed JAMA articles of all time.

Accompanying articles by Seymour et al and Angus et al published in Critical Care Medicine also present a conceptual framework to help patients, clinicians, researchers and hospitals apply the new definitions. The Society has also released SCCM Pod-311 New Sepsis Definitions: An In-Depth Interview with Craig Coopersmith to help give context to the new definitions.

“This is an incredibly exciting time in the field of sepsis,” said Craig M. Coopersmith, MD, FCCM, a task force member and immediate past president of the Society. “Driven by a combination of data analysis on well over one million patients as well as expert consensus, these new definitions provide a real step forward.”

The task force definitions were directly informed by research out of the Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center at the Pitt School of Medicine and were funded in part by grants from the National Institutes of Health. They were sponsored by more than 30 organizations representing a variety of professionals who manage and diagnose sepsis.

Visit www.sccm.org/sepsisredefined for a complete list of resources and articles. Also, make sure to read this informative Medscape article centered on the updated definitions of sepsis and septic shock.

Keep the discussion on Twitter going by using #SepsisRedefined. Join the #SepsisRedefined conversation group for updates on upcoming Twitter Chats on this topic.

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Severe Influenza-Associated Critical Illness Prompts CDC Health Advisory

Influenza activity is increasing across the country and the U.S. Centers for Disease Control and Prevention (CDC) has received reports of severe influenza illness.

Since October 2015, the CDC has detected co-circulation of influenza A(H3N2), A(H1N1)pdm09, and influenza B viruses. However, H1N1pdm09 viruses have predominated in recent weeks. The CDC has issued a Health Advisory urging rapid antiviral treatment of very ill and high-risk suspect influenza patients without waiting for testing.

The CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit admission. Fatalities have been reported. Some of these patients reportedly tested negative for influenza by RIDT (rapid influenza diagnostic test); their influenza diagnosis was made later with molecular assays. Most of these patients were reportedly unvaccinated. H1N1pdm09 virus infection in the past has caused severe illness in some children and young- and middle-aged adults.

In response to this cluster of cases, mostly reported in Arizona, the U.S. Critical Illness and Injury Trials Group has published a comprehensive review of the salient epidemiologic, diagnostic and therapeutic features that have been learned from the experience with influenza A (H1N1)pdm09 virus infection in adults.

Clinicians should continue efforts to vaccinate patients this season for as long as influenza viruses are circulating, and they should promptly start antiviral treatment of severely ill and high-risk patients if influenza is suspected or confirmed.

Keep up to date on influenza with the CDC’s weekly surveillance reports:

Weekly Reports
Weekly Summary

Visit www.sccm.org/disaster for additional influenza resources.

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SCCM Collaborative to Focus on Improving Patient- and Family-Centered Care

The Society of Critical Care Medicine (SCCM) is launching a new collaborative aimed at helping hospitals implement patient and family engagement programs.

The Society is seeking intensive care unit (ICU) teams interested in participating in the PCOR-ICU Collaborative: Improving Care for Critically Ill Patients and Families Through Research Dissemination and Implementation. This program is funded through a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (2626-SCCM).

Visit www.sccm.org/PCOR to learn more about the application process.

Led by SCCM Executive Committee members Ruth M. Kleinpell, PhD, RN-CS, FAAN, FCCM, and Jerry J. Zimmerman, MD, PhD, FCCM, the PCOR-ICU Collaborative will bring together ICU teams to implement patient- and family-centered initiatives.

The Society is seeking 50 ICU teams based in the United States to participate. Adult and pediatric ICUs will be considered.

Potential initiatives will include:

  • Implementing open visitation (non-restricted ICU hours)
  • Integrating families in rounds (family-centered rounds)
  • Integrating structured family care conferences to establish goals of care
  • Disseminating information and providing support to families on how they can assist with the care of their loved one
  • Family presence during invasive procedures in the ICU
  • Family presence during resuscitation
  • Forming a family/patient advisory group
  • Implementing music therapy in the ICU setting
  • Implementing pet therapy in the ICU setting
  • Facilitating the use of patient/family ICU diaries
  • Investigation and planning for implementation of a post-ICU clinic
  • Project of team’s choice related to patient- and family-centered outcomes

The Patient-Centered Outcomes Research Institute (PCORI) is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work.

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