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May 15, 2014

Concise Critical Appraisal

Report of Decreased Mortality Related to Severe Sepsis in Australia and New Zealand

Education

What’s New for the 2014 Critical Care Ultrasound Courses?
Registration Open for Webcast on Corticosteroids in Septic Shock
Registration Open for Pet and Music Therapy Webcast
Consent for Research On Demand is Now Available

SCCM News

Wear Blue Tomorrow to Support Critical Care
New: ICU Heroes Award
Apply For ICU Design Citation Award
What Critical Care and Emergency Medicine Clinicians Need to Know about MERS
Report of Decreased Mortality Related to Severe Sepsis in Australia and New Zealand

Much attention has been devoted in the literature to the details of sepsis pathophysiology and therapy over the last decade, while severe sepsis and septic shock remain the number one cause of death in critically ill patients. The failure of numerous randomized controlled trials for interventions in severe sepsis has led some to believe that little progress has been made in terms of improving survival. Kaukonen and colleagues sought to estimate trends in mortality in a large cohort of patients in Australia and New Zealand over a 13-year period. The authors hypothesized that mortality rates decreased significantly throughout this time period. Their study affirmed similar findings of decreased mortality among patients with severe sepsis over the last decade. However, the study also demonstrated a decrease in overall mortality among all admitting ICU diagnoses over the same time period. This mortality reduction remained after multiple adjustments for confounders, including illness severity. These findings likely reflect a better understanding of disease processes and therapies in the ICU, whether related to sepsis or not. One potential criticism of this work is that an element of surveillance bias or stage migration (i.e., the Will Rogers phenomenon) might be at play given improved awareness and detection of sepsis. With the decrease in short-term mortality observed in this study and others, future studies examining measures of healthcare-related quality of life and other measures of morbidity are merited.

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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What’s New for the 2014 Critical Care Ultrasound Courses?

The Society of Critical Care Medicine (SCCM) is introducing a number of improvements and innovations for the 2014 Critical Care Ultrasound programs to enhance the experience of attendees. This summer, SCCM has added a dedicated Critical Care Ultrasound – Pediatric course. The new workshop is designed specifically for ultrasound clinicians caring for critically ill or injured infants and children in the intensive care unit (ICU). This course includes expanded vascular, lung and volume hands-on training skill stations with targeted “Pediatric Rapid Response” and “Unexpected Congenital Heart Disease” case discussions.

An hour of new clinical cases has been added to the agenda to enhance Critical Care Ultrasound and Advanced Critical Care Ultrasound, which both focus on the critically ill or injured adult patient. For all three courses, this year’s skill stations will include not only demonstrations on human models, but also simulation software to show pathology.

The 2014 summer ultrasound courses will be held August 17 to 19, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register online for Critical Care Ultrasound, Critical Care Ultrasound – Pediatric, and Advanced Critical Care Ultrasound using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

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Registration Open for Webcast on Corticosteroids in Septic Shock

Registration is now open for Use of Corticosteroids in Septic Shock, the latest webcast from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series. Treating critically ill patients can be further complicated by a diagnosis of septic shock; the treatment options are varied and debatable. This webcast will discuss the rationale for use or non-use of corticosteroids in critically ill patients with septic shock. Expert faculty will highlight the controversies surrounding the use of low-dose corticosteroids and its association with clinical outcomes.

Djilalli Annane, MD, and Greet Van den Berghe, MD, PhD, will debate seminal clinical trials, meta-analyses and other studies that have been completed in this area. The rationale for testing for adrenal insufficiency, cortisol metabolism in critical illness, and the adverse effects of corticosteroids in critically ill patients will also be reviewed. A third member of the panel, R. Phillip Dellinger, MD, MCCM, will moderate the discussion and review the 2012 SCCM Surviving Sepsis Campaign recommendations on corticosteroid use. The webcast will conclude with a question and answer session.

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 SCCM septic shock guidelines regarding recommendations for steroid use

This webcast will take place on Tuesday, June 24, 2014, at 1:00 p.m. Central Time and participants will receive 1 hour of continuing education credit.

Register online today using your Customer ID and password. The registration fee for this 60-minute webcast is $30 for SCCM members and $40 for nonmembers. For institutions seeking unlimited participation, a $200 group rate is available. Please contact SCCM Customer Service at +1 847 827-6888 to inquire about the group rate.

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 there is no clear consensus or unequivocal evidence for guiding practice decisions.

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Registration Open for Pet and Music Therapy Webcast

Registration is now open for The Impact of Pet and Music Therapy on the Critically Ill, the latest webcast from the Society of Critical Care Medicine’s (SCCM) Project Dispatch series. Music and animals have a distinct ability to improve a patient’s mood and outlook. Anxiety among patients in the intensive care unit (ICU) is often understandably heightened. Patients are confronted with unfamiliar surroundings and intrusive procedures, including being on mechanical ventilation. Music and pet therapy are two integrative approaches that may alleviate such anxiety and reduce sedation frequency and intensity. In this webcast, expert faculty will share their unique experiences with integrative therapies for patients and families in the ICU.

Linda Chlan, PhD, RN, FAAN, will review the results of her randomized clinical trial published in the Journal of the American Medical Association: “Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support.” She will highlight how music can be used to reduce the common patient symptom of anxiety and the subsequent reduction of sedative exposure in mechanically ventilated patients. Erika Gonzalez, MSN, RN, CCRN, will discuss her critical care unit’s implementation of music and pet therapy.

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 will take place on Wednesday, June 25, 2014, at 12:00 p.m. Central Time.

Register online today using your Customer ID and password. Registration is complimentary for all participants. 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 the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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Consent for Research On Demand is Now Available

The recently broadcast Consent for Research in the ICU webcast is now available for purchase On Demand.

In this webcast from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series, Alex Kon, MD, FCCM, and Dan Thompson, MD, MA, FCCM, discuss the challenges associated with obtaining pediatric and adult consent for complex research in critically ill patients. Also, federal regulations, the SUPPORT study, and the potential impact of consent decisions on the well-being of patients and healthcare personnel are reviewed.

Consent for Research in the ICU On Demand gives you access to videos containing both slides and lectures from every lecture in a searchable format, making it the next best thing to attending the live event. Once you’ve purchased Consent for Research in the ICU On Demand, you can access the materials as often as you like by logging into www.MySCCM.org.

Consent for Research in the ICU On Demand is available for purchase in the SCCM store. The registration rate is just $35 for members ($45 for nonmembers).

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 there is no clear consensus or unequivocal evidence for guiding practice decisions.

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Wear Blue Tomorrow to Support Critical Care

Be sure to wear blue on Friday, May 16, to show your support for National Critical Care Awareness and Recognition Month (NCCARM). There is still time to mark this year’s NCCARM, and the Society offers several simple ideas for recognition of critical care teams.

Some teams choose to offer tours of the intensive care unit to other hospital staff, while others organize educational symposia or invite former patients and their families back to the unit. No matter how you choose to celebrate, we hope you post your NCCARM photos and stories to the Society’s Facebook page.

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New: ICU Heroes Award

The new ICU Heroes Award, presented by the Society of Critical Care Medicine (SCCM), recognizes that patients and their respective family members are an integral part of intensive care unit (ICU) care. The award is consequently offered to an ICU patient, family and the multiprofessional ICU team that delivered the care.

Applicants are asked to share the patient’s story with a focus on attention to patient- and family-centered aspects of care. The following will be considered during the application evaluation process:

  • Clinical details
  • Principal diagnosis
  • ICU course
  • Hospital course
  • Outpatient course
  • Final outcome
  • How the individual’s course demonstrates multiprofessional care

The winning patient and ICU team leader will receive a medal, and the winning ICU team and the patient’s family will receive a commemorative plaque. Complementary travel and registration to SCCM’s Critical Care Congress also will be provided to select award recipients.

The deadline to submit an application is August 1, 2014. Application submissions and questions related to this award may be directed to SCCM staff member Kathleen Ward at kward@sccm.org.

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Apply For ICU Design Citation Award

The ICU Design Citation award was conceived to identify and recognize a critical care unit already in operation whose design demonstrates attention to both functional and humanitarian issues. This prestigious award is co-sponsored by the Society of Critical Care Medicine (SCCM), the American Association of Critical-Care Nurses and the American Institute of Architects Academy of Architecture for Health.

The deadline to submit an application is August 15, 2016.

The citation is awarded to the entry that best resolves both functional and humanitarian issues in a unique and complementary manner. The focus is on planning and design characteristics rather than process or administrative features. Units are reviewed in a blinded fashion according to the following criteria:

  • Demonstrates commitment to creating a healing environment and promoting safety and security
  • Demonstrates commitment to efficiency
  • Demonstrates attention to an innovative, unique aesthetic and creative design features

ICU Design Guidelines

Most healthcare providers have little experience designing and constructing an intensive care unit (ICU). The ICU Design Guidelines can make the process easier and the finished project more efficient, effective, safe, and patient centered.

Award Winning ICU Designs

SCCM offers an interactive, web-based program that contains the top ICU design projects since 1992, with each project reviewed in short video segments. The companion PDF document contains features and floor plans of each winning unit.

Learn more about ICU design.

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What Critical Care and Emergency Medicine Clinicians Need to Know about MERS

The U.S. Centers for Disease Control and Prevention (CDC) recently released recommendations regarding Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Critical care and emergency medicine clinicians should be alert for patients who:

  • Develop severe acute lower respiratory illness within 14 days after traveling from countries in or near the Arabian Peninsula, excluding those who only transited at airports in the region; or
  • Are close contacts of a symptomatic recent traveler from this area who has fever and acute respiratory illness; or
  • Are close contacts of a confirmed case

Clusters of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) without recognized links to cases of MERS-CoV or to travelers from countries in or near the Arabian Peninsula should be evaluated for common respiratory pathogens. If the illnesses remain unexplained, providers should consider testing for MERS-CoV, in consultation with state and local health departments. Healthcare professionals should immediately report to their state or local health department any person being evaluated for MERS-CoV infection as a patient under investigation.

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