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November 6, 2014

Concise Critical Appraisal

Mitochondrial Defects in PBMCs of Children with Sepsis
Is the Sun Setting on Goal-Directed Resuscitation for Septic Shock?

Education

Sixth Edition of Coding and Billing for Critical Care: A Practice Tool Available
Register for Webcast on Comprehensive Patient-Centered Care in the ICU
New Self-Directed Adult and Pediatric Board Reviews
MCCKAP Early Registration Ends Next Week
Webcast Next Week on Patient- and Family-Centered Care in the Pediatric ICU
Critical Care Ultrasound Courses Expected to Sell Out Early

Emergency Preparedness

SCCM Continues to Provide a Variety of Ebola-Related Resources

SCCM News

Discover Clinical Breakthroughs during Congress
Congress Early Registration Ends Next Week
Elections: SCCM Council and ACCM Board of Regents
Critical Care Telemedicine: Evolution and State of the Art
Mitochondrial Defects in PBMCs of Children with Sepsis

Mitochondrial dysfunction has been implicated in the pathogenesis of organ injury related to the sepsis syndrome. This can be seen in the condition known as cytopathic hypoxia, wherein oxygen delivery is maintained, but the mitochondria are unable to efficiently convert this delivered oxygen to adenosine triphosphate (ATP) production. An energy deficit consequently arises. In adults, this diminished ability to produce adequate ATP has been demonstrated in peripheral blood mononuclear cells (PBMCs) of septic patients. Mitochondrial defects in PBMCs of septic children have not been previously described. Weiss et al sought to correlate defects in mitochondrial oxygen consumption and mitochondrial membrane potential in the PBMCs of children with septic shock of clinical severity. Twenty-eight children with septic shock were approached for consent. Ultimately, data from 13 patients were compared to those of 11 control subjects.

The authors found that mitochondrial dysfunction occurs in PBMCs from critically ill children with septic shock and multiple organ dysfunction syndrome. While this study has limitations related to the choice of cells studied, the timing of sampling and the numbers of patients, mitochondrial dysfunction in these patients is a significant finding that warrants further research.

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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Is the Sun Setting on Goal-Directed Resuscitation for Septic Shock?

Since the landmark 2001 trial by Rivers et al, early goal-directed therapy (EGDT) for septic shock has been endorsed as the standard of care. The multicenter Australasian Resuscitation in Sepsis Evaluation (ARISE) trial was designed to test the hypothesis that EGDT, as compared with usual care, would reduce all-cause mortality at 90 days among patients presenting to the emergency department with early septic shock. The study was a prospective, randomized, parallel-group trial hosted in 51 tertiary care and nontertiary care hospitals in Australia, New Zealand, Finland, Hong Kong, and Ireland.

The authors concluded that EGDT does not offer a survival advantage in patients presenting to the emergency department with early septic shock. This work represents the second published study in a triad of trials. The Protocolised Management in Sepsis (ProMISe) trial has yet to be published; the results of the Protocolized Care for Early Septic Shock (ProCESS) trial were published earlier this year. Strengths of the ARISE trial include an appropriate sample size, the multicenter nature of the study and high compliance with the intervention. However, early resuscitation and antibiotic administration likely are now regarded as “usual care,” and this may have had a significant impact before randomization. A meta-analysis of all three trials is planned when the ProMISe trial is completed. This meta-analysis — which could have greater power than any individual study — may demonstrate benefits of EGDT in certain patient populations.

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.

The Surviving Sepsis Campaign recently released an updated statement regarding hemodynamic and oximetric monitoring. This statement is in response to the ProCESS and ARISE trials. The statement highlights recently released data from the Surviving Sepsis Campaign, which confirms that “adherence to quality improvement measures in severe sepsis and septic shock is associated with mortality decline.”

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Sixth Edition of Coding and Billing for Critical Care: A Practice Tool Available

A must-have text for professional coders, hospital administrators, physicians, nurse practitioners, and physician assistants, Coding and Billing for Critical Care: A Practice Tool, Sixth Edition explains the complexities of critical care coding and billing and offers a better understanding of coding and billing procedures in a critical care setting.

This expanded edition includes new chapters on diagnosis-related group coding and documentation, coding for advanced practice providers and the establishment of appropriate auditing procedures.

Coding and Billing for Critical Care: A Practice Tool, Sixth Edition is available for purchase in the SCCM store. Please contact SCCM Customer Service at +1 847 827-6888 with any questions.

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Register for Webcast on Comprehensive Patient-Centered Care in the ICU

Registration is now open for the webcast, Comprehensive Patient-Centered Care in the ICU, the latest offering from the Society of Critical Care Medicine’s (SCCM) Project Dispatch series. This session will discuss how patient- and family-centered care considers and anticipates the needs of patients and their families, all of whom are important members of the support and care team. The multidisciplinary team in a mixed medical-surgical adult intensive care unit (ICU) at Memorial Sloan Kettering Cancer Center (MSKCC) in New York received the ICU Design Citation award in 2009 for their creation of an ICU that focuses on this approach.

In this presentation, Neil A. Halpern, MD, FCCM, Chief, Critical Care Medicine Service at MSKCC, will describe how his unit developed a calming, healthy, safe, and healing ICU environment by ensuring shared decision making and frequent communications with patients and families through the ICU stay to end of life. He will discuss innovative programs and technologies linked to direct patient care, such as advanced alarm management systems, early mobility programs for ventilated patients and integrative medicine consultation for bedside massage, music therapy and meditation.

Dr. Halpern will also review the extensive accommodations made for patients and families, as well as how the MSKCC program encompasses patients’ entire ICU experience. Some unique features include video displays to soothe patients, family members and visitors, volunteer greeters in the waiting room to help orient families and visitors to the ICU, food and coffee service, weekly multidisciplinary rounds and end-of-week conferences to discuss the full spectrum of patient and family issues, communication skills training for staff through the Department of Psychiatry and Behavioral Sciences, child visits, and the use of a survey to assess how patients, family members and visitors cope with a difficult situation.

Learning Objectives

  • Describe the comprehensive program at MSKCC
  • Formulate plans to implement elements of the MSKCC program in the participants’ own organizations
  • Evaluate the impact these types of programs have on patient and family satisfaction

This webcast will take place on Thursday, December 11, 2014, at 12:00 p.m. Central Time.

Register online today using your customer ID and password. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

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

This webcast was organized by SCCM’s Project Dispatch. Project Dispatch focuses on the patient and family experience. The initiative highlights a number of patient-centered care approaches to encourage awareness and adoption at the bedside among SCCM’s members. 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.

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MCCKAP Early Registration Ends Next Week

Early registration ends November 26, 2014, for the Society of Critical Care Medicine’s (SCCM) 2015 Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP). The exam will be administered from February 26 to March 6, 2015.

The MCCKAP online exam assesses critical care fellowship programs nationally.  Held annually, the MCCKAP exam helps program directors:

  • Prepare fellows for the subspecialty board examinations in critical care
  • Identify specific areas of strength and weakness with lists of references and key terms for missed questions
  • Assess results for each individual fellow and the overall program, as well as the institution’s national ranking

Available in both adult and pediatric formats, the exam is offered exclusively online and consists of 200 multiple-choice questions pertaining to critical care knowledge and patient management. Exam content is developed by critical care professionals experienced in exam preparation and analysis.

Immediate preliminary scores and analysis are available to the examinee and the program director upon completion of the test. Final results will be available approximately five weeks following the exam.

Register online using your customer ID and password, or contact SCCM Customer Service at +1 847 827-6888. Sign-up by November 26, 2014, to take advantage of discounted registration rates.

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New Self-Directed Adult and Pediatric Board Reviews

The Society of Critical Care Medicine’s (SCCM) new Self-Directed Adult Multiprofessional Critical Care Board Review Course (MCCBRC) and Self-Directed Pediatric Multiprofessional Critical Care Board Review Course (MCCBRC) provide a relaxed learning experience with access to the same didactic sessions found in the live courses. MCCBRC is the preferred resource for critical care professionals seeking a comprehensive review of content focused on the diagnosis, monitoring and management of critically ill patients.

Learn at your own pace from the comfort and convenience of your home or office and then assess your knowledge through the use of pre- and posttests. Physicians, nurses and pharmacists are eligible to receive 41.5 hours of continuing education credit upon completion of the adult course; 38.25 hours of continuing education credit are available to physicians, nurses and pharmacists upon completion of the pediatric course. Maintenance of Certification credits are also available for both courses. Registrants have two years from the date of enrollment to complete the course.

Enhance your learning experience by purchasing the Comprehensive Board Prep Bundle, which is available in adult and pediatric versions.

For more details, visit www.sccm.org/adultboardreview or www.sccm.org/pediatricboardreview. Please contact SCCM Customer Service at +1 847 827-6888 with any questions.

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Discover Clinical Breakthroughs during Congress

Learn about clinical breakthroughs and advances in patient care during the educational symposia at the Society of Critical Care Medicine’s (SCCM) 44th Critical Care Congress. Each stimulating session is presented by leading experts in critical care and offers a thorough analysis of the developments and issues affecting most intensive care unit (ICU) environments. These sessions are complimentary for all Congress registrants, and no additional registration is needed to attend.

Diagnosis and Application of Current and Emerging Therapeutic Interventions for Hyponatremia in the Critical Care Patient
Supported by an educational grant from Otsuka America Pharmaceutical, Inc.

This session will discuss the diagnosis, presentation and impact on patient outcomes of hyponatremia and will review the safety and efficacy of current and emerging therapies for its management. It will also outline individualized treatment approaches for patients with hyponatremia based on their clinical presentation, underlying etiology and severity of symptoms.

Best Practices for the Management of Invasive Fungal Infections in the ICU
Supported by an educational grant from Astellas Scientific and Medical Affairs, Inc.

This session will help participants identify patients at risk for invasive fungal infections. In addition, it will present current and emerging treatment options for the management of these infections and review strategies for the early diagnosis and initiation of appropriate antifungal therapy in patients at risk.

These symposia will be held on Monday, January 19, 2015, at the Phoenix Convention Center. Seating is on a first-come, first-serve basis. A continental breakfast will be available prior to each symposium beginning at 6:00 a.m. The sessions will start promptly at 6:30 a.m.

Register for Congress online today using your customer ID and password. Take advantage of the advance registration rate through December 10, 2014, and save up to $80.

To secure hotel accommodations at the best rates, registrants should reserve their rooms online by Friday, December 12, 2014.

Please contact SCCM Customer Service at +1 847 827-6888 with any questions.

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Webcast Next Week on Patient- and Family-Centered Care in the Pediatric ICU

Review the implementation of patient- and family-centered care practices in the pediatric intensive care unit (ICU) with the webcast, Comprehensive Patient-Centered Care in the Pediatric ICU, the latest offering from the Society of Critical Care Medicine’s (SCCM) Project Dispatch series. In this presentation, Jason L. Adler, MD, MBA, from the Joe DiMaggio Children’s Hospital (JDCH) in Hollywood, Florida, USA, will discuss his unit’s implementation and the impact these practices have had on staff and the institution.

Daily bedside multidisciplinary rounds were introduced in 2006 at JDCH. During these rounds, active participation in care is sought from all who are present. This includes parents, patients, physicians, nurses, respiratory therapists, pharmacists, social workers, and family advocates/educators. The program at JDCH has grown dramatically over the years and continues to anticipate many needs of patients and their families. It is integral to how care is provided, and the impact it has had is significant and far reaching.

Learning Objectives

  • Outline the patient- and family-centered care program at Joe DiMaggio Children’s Hospital
  • Formulate plans to implement patient- and family-centered care programs in the participants’ own pediatric ICUs
  • Evaluate patient- and family-centered care efforts using patient satisfaction data

This webcast will take place on Wednesday, November 12, 2014, at 12:00 p.m. Central Time.

Register online using your customer ID and password. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

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

This webcast was organized by SCCM’s Project Dispatch. Project Dispatch focuses on the patient and family experience. The initiative highlights a number of patient-centered care approaches to encourage awareness and adoption at the bedside among SCCM’s members. 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.

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Critical Care Ultrasound Courses Expected to Sell Out Early

Registration is open for the Society of Critical Care Medicine’s (SCCM) popular Critical Care Ultrasound and Critical Care Ultrasound – Pediatric courses. Register early to guarantee your spot for a limited number of remaining seats. 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 at SCCM’s ultrasound courses.

Critical Care Ultrasound

Gain the realistic training needed to perform and interpret ultrasound imaging during this two-day, comprehensive course. Participants benefit from guided, focused skill stations featuring live models and interactive presentations to reinforce key learning points. Extensive faculty coverage ensures a significant hands-on experience for each participant.

Critical Care Ultrasound – Pediatric

SCCM’s Critical Care Ultrasound course is also offered in a pediatric format. This two-day course focuses exclusively on how to perform and interpret pediatric ultrasound imaging. Participants receive a comprehensive, high-quality learning experience that combines hands-on technique through guided, focused skill stations and interactive presentations to reinforce key learning points.

The ultrasound courses will be held January 21 and 22, 2015, at the Sheraton Phoenix Downtown in Phoenix, Arizona, USA. Be sure to register early as space for these courses is limited and expected to sell out early. Visit the ultrasound courses Web page and register today to guarantee your seat!

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SCCM Continues to Provide a Variety of Ebola-Related Resources

During the recent annual meeting of the American College of Chest Physicians, late-breaking sessions were held in collaboration with the Society of Critical Care Medicine (SCCM) and featured personal protective equipment (PPE) demonstrations. Content was drawn from SCCM’s Fundamental Disaster Management program. This joint effort was intended to better prepare health professionals who may soon manage the treatment of patients exposed to the Ebola virus.

SCCM continues to actively monitor the Ebola outbreak and will continue to provide pertinent information to the critical care community. A variety of resources are available at www.sccm.org/disaster, including new Ebola guidelines for emergency departments, which were recently published by the U.S. Centers for Disease Control and Prevention. The guidelines establish consistency for emergency care workers and reflect lessons learned thus far in the fight against Ebola.

SCCM also recently released an iCritical Care podcast in which Margaret Parker, MD, MCCM, speaks with SCCM President-Elect Craig M. Coopersmith, MD, FCCM, and Jay Varkey, MD, about the Ebola epidemic and how clinicians should be preparing for emerging infections. Dr. Varkey was on a team of clinicians at Emory University Hospital who successfully treated an American missionary and doctor infected with the Ebola virus.

SCCM Pod-242 Preparing for Emerging Infections

Finally, SCCM also recently made available the following Ebola protocols from Baylor Scott & White Health:

Ebola Mandatory Protocol – Screening PPE

Ebola Mandatory Protocol – Observer Role

Ebola Mandatory Protocol – Treatment PPE for Healthcare Worker and Coach

To share valuable Ebola-related resources akin to those enumerated above, visit the Society’s Disaster eCommunity. This forum is an excellent venue offering insight and any recent developments.

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Congress Early Registration Ends Next Week

The Society of Critical Care Medicine (SCCM) is hosting its 44th Critical Care Congress January 17 to 21, 2015, in Phoenix, Arizona, USA.  Register early for this exciting event and take advantage of lower registration fees. Early registration, which lasts until Wednesday, November 12, 2014, can save participants over 15% on Congress registration. Register online using your customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

To secure hotel accommodations at the best rates, registrants should reserve their rooms online by Friday, December 12, 2014.

The 2015 Congress will provide unique opportunities to network with leadership in critical care and experience enlightened and innovative learning experiences that highlight the most up-to-date, evidence-based developments in critical care medicine.

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Elections: SCCM Council and ACCM Board of Regents

Society of Critical Care Medicine (SCCM) members will have the opportunity to cast their votes for SCCM Council and American College of Critical Care Medicine (ACCM) Board of Regents as elections are open November 6 through December 4. There is also a proposed amendment to the SCCM bylaws as the Neuroscience and Emergency Medicine Sections have requested designated seats on SCCM Council. Notices with voting instructions will be sent via email as well as through the U.S. Postal Service. Candidates and open seats are as follows:

SCCM Council

President Elect
Todd Dorman, MD, FCCM

Treasurer
Jerry Zimmerman, MD, FCCM

Anesthesia Designated Seat
Daniel R. Brown, MD, PhD, FCCM
Andrew J. Patterson, MD, PhD, FCCM

Collective Designated Seat
Heatherlee Bailey, MD, FCCM
Cherylee W. J. Chang, MD, FCCM

Pediatric Designated Seat
Vinay Nadkarni, MD, MS, FCCM
Ken Tegtmeyer, MD, FCCM

Surgery Designated Seat
Lewis J. Kaplan, MD, FCCM
H. Mathilda Horst, MD, MCCM

At Large Seat (2 seats)
Lauren Sorce, RN, PhD(c), CPNP-AC/PC, FCCM
Antoinette (Toni) Spevetz, MD, FCCM
Sandralee Blosser, RN, MD, FCCM
Mohan Mysore, MD, FCCM

 

ACCM Board of Regents

Secretary General
Bruce Greenwald, MD, FCCM
Abstain

Regent (3 years; choose 1)
Edward Conway Jr., MD, FCCM
Elizabeth Farrington, PharmD, BCPS, FCCM
Abstain

Regent (2 years; choose 1)
Aryeh Shander, MD, FCCP, FCCM
Julie Mayglothling, MD, FCCM

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Critical Care Telemedicine: Evolution and State of the Art

An intensive care unit (ICU) telemedicine program is a practical way to increase access as well as to reduce mortality rates and length of stay, according to a review in the November issue of Critical Care Medicine.

Critical Care Telemedicine: Evolution and State of the Art” summarizes the results of numerous telemedicine studies, reviewing the growth and current penetration of ICU telemedicine programs, their associated outcomes and their impact on medical education. The review also identifies program revenue sources and costs and regulatory aspects.

Proposals for further advancing the field are provided in an editorial by Jeremy Khan, MD, MS.

Developed with input from the Society of Critical Care Medicine’s (SCCM) Tele-ICU Committee, led by Craig M. Lilly, MD, FCCM, the review calls urgently for comparative effectiveness studies. Dr. Lilly has tied telemedicine to current events, noting how such tools have been used to help manage high-risk Ebola patients by limiting room entries, by allowing for consultation without infectious exposure and by facilitating patient communication with family and friends.

SCCM resources related to telemedicine are available in the Administration Knowledge Line of LearnICU.org. In past issues, Critical Connections has featured two articles on the topic: “Should Critical Care Training Programs Start Offering Formal Training in Tele-ICU?” and “All Eyes on the ICU – Telemedicine.”

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