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May 1, 2014

Concise Critical Appraisal

How Accurate Are Tracheal Aspirates at Diagnosing Nosocomial Pneumonia?
What Effect Do Corticosteroids Have on the Genomic Response of Pediatric Septic Shock?

Education

Featured Updates for the 2014 Adult and Pediatric Board Review Courses
Register Now for Webcasts on Corticosteroids and Pet and Music Therapy
Board Review: Early Registration Deadline Approaching
Early-Bird Rates for Critical Care Ultrasound Courses End Soon
New Edition of Compensation of Critical Care Professionals Available

SCCM News

Be Critical Care Aware in May
Discussion: Latest SCCM eCommunity Updates
SCCM Awards Recognize Dedication to Critical Care
Submit Your Abstract for SCCM’s 44th Critical Care Congress
Deborah J. Cook Receives Prestigious Grenvik Family Award for Ethics
Sign-on Letter: Detect and Protect Against Antibiotic Resistance Initiative
How Accurate Are Tracheal Aspirates at Diagnosing Nosocomial Pneumonia?

Pneumonia is either the first or second most common ventilator-associated event (VAE) seen in the pediatric intensive care unit. The reported incidence varies widely among studies (from 0.3 to 45.1 per 1,000 ventilator days). The lack of a consistent, gold-standard definition for what had been traditionally referred to as ventilator-associated pneumonia (VAP) plays a large part in this variance.

The U.S. Centers for Disease Control and Prevention (CDC) defines VAP as a positive bacterial culture from a tracheal aspirate (more than 104 colony-forming units [cfu] from a sample obtained via bronchoalveolar lavage) and/or purulent secretions (more than 25 neutrophils and fewer than 10 epithelial cells per low-power field) in a patient who requires mechanical ventilation and has acutely worsening oxygenation. However, other investigators have defined VAP by the presence of pathogenic bacteria in tracheal aspirate in conjunction with new chest radiographic findings and fever or leukocytosis. Studies by Srinivasan and colleagues and Carcillo et al have found that the presence of pneumonia is associated with high antimicrobial use and increased morbidity, mortality, hospital length of stay, and costs. The Society of Critical Care Medicine, in partnership with the Critical Care Societies Collaborative, also has been working closely with the CDC to develop the VAE surveillance definition algorithm, representing a purposeful departure from VAP toward more purposeful, objective measures of conditions and complications occurring in adult patients on mechanical ventilation. The findings of the VAP Surveillance Definition Working Group, which has only focused on adult patients, were published in the November 2013 issue of Critical Care Medicine. It is clear, the development and use of a standardized definition is essential.

Read more…

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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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Featured Updates for the 2014 Adult and Pediatric Board Review Courses

The Society of Critical Care Medicine’s (SCCM) Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC) continue to set the standard in board preparation as new enhancements to the 2014 programs will provide additional benefits to attendees.

This year’s Adult MCCBRC program will include new and updated practice questions and cases created by the Adult MCCBRC Question Writing Committee.  In conjunction, maintenance of certification (MOC) points have doubled for participating anesthesiologists, surgeons and internal medicine physicians.

For the 2014 Pediatric MCCBRC program, Board Review Sessions 1 and 2 each have been extended by one hour to cover additional cases pertinent to pediatric critical care and board preparation.

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.

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 program using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

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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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Be Critical Care Aware in May

During National Critical Care Awareness and Recognition Month (NCCARM), be sure to share your celebration ideas and stories with the Society of Critical Care Medicine (SCCM) and your colleagues. This month-long celebration allows critical care team members to exemplify their dedication to patient care while creating more awareness of this demanding, life-saving practice.

Some hospitals organize tours of the intensive care unit for outside staff, offer an educational symposium or simply remember to wear blue on Friday, May 16. No matter how you celebrate, be sure to post your stories and photos on the Society’s Facebook page.

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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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Discussion: Latest SCCM eCommunity Updates

sq-eCommunities-Learn-ICUThe Society of Critical Care Medicine’s (SCCM) eCommunity offers critical care professionals the opportunity to connect, share and collaborate. Communities are open to SCCM members and nonmembers to facilitate knowledge sharing and improve care. Join these latest discussions and access related resources by logging into MySCCM.org.

LearnICU eCommunity: Sepsis
Surviving Sepsis – How Have the Surviving Sepsis Campaign Guidelines Changed Your Practice?

LearnICU eCommunity: Obstetrics
Dual-balloon Catheter Use in Postpartum Hemorrhage – An Obstetrician’s Take on the Sengstaken-Blakemore Tube

LearnICU eCommunity: Epidemiology/Outcomes
Predicting Who Needs the Intensive Care Unit – Using Electronic Health Record Data to Predict Who Is at Risk for Impending Critical Illness

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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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SCCM Awards Recognize Dedication to Critical Care

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

Dr. Joseph and Rae Brown Award – Recognize an SCCM member who has advanced multiprofessional quality care at the regional or local level through exceptional leadership contributions that have furthered the vision and mission of chapters or affiliates.

Grenvik Family Award for Ethics – Acknowledge an SCCM member who has made significant contributions toward addressing ethical problems in critical care.

Norma J. Shoemaker Award for Critical Care Nursing Excellence  – Recognize an SCCM nurse member who demonstrates excellence in clinical practice, education and/or administration in the field of critical care.

Barry A. Shapiro Memorial Award for Excellence in Critical Care Management – Nominate an SCCM member who has made significant contributions to the design and/or implementation of evidence-based practices that have improved clinical, operational or fiscal outcomes.

Family-Centered Care Innovation Award  – Commend an intensive care unit team that has succeeded in instituting a novel approach to compassionate care and has a desire to share that innovation with other teams.

ICU Design Citation Applications Due August 15

Submit your application for the ICU Design Citation, which is co-sponsored by the Society of Critical Care Medicine, the American Association of Critical-Care Nurses, and the American Institute of Architects Academy of Architecture for Health. The award recognizes an operating critical care unit designed with attention to both functional and humanitarian issues.

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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.

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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.

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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.

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Hamilton Medical – Reduced time on the ventilator with ASV

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