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September 18, 2014

Concise Critical Appraisal

Continuous vs. Intermittent Renal Replacement Therapy for Acute Renal Failure

Education

Construct a Service Model for Advanced Practice Providers
No Cost, Online CME Activities from the 43rd Critical Care Congress
Webcasts: “Tree of Life” Event and Transition After Catastrophic Injury

SCCM News

Explore Arizona’s Main Attractions at Congress with SCCM’s Organized Tours
Drug Shortage Alert: Alternative Medications for Procedural Sedation
WAAAR Issues Declaration Against Antibiotic Resistance
Participate in an International Study on Mechanical Ventilation
Hospitals Report Results of SSC Implementation
Continuous vs. Intermittent Renal Replacement Therapy for Acute Renal Failure

Acute renal failure (ARF) requiring dialysis is a common and frequently lethal problem encountered in the intensive care unit (ICU). Despite two multicenter trials and a meta-analysis, a survival benefit for continuous venovenous hemofiltration (CVVH) versus intermittent hemodialysis (IHD) renal replacement therapy has not been convincingly demonstrated. Schefold and colleagues conducted the CONVINT trial (continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure) to study the impact of the initial choice of renal replacement therapy on patient outcomes in a medical ICU.

The authors concluded that IHD and CVVH might be considered equivalent approaches for a population of critically ill patients with dialysis-dependent ARF treated in a medical ICU. The study has several major limitations. For example, CVVH dosing practices used may differ from those employed at other institutions, potentially limiting the external generalizability. Nevertheless, data from this trial add to the accumulating evidence that CVVH may be equivalent to IHD in selected ICU 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.

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Construct a Service Model for Advanced Practice Providers

Learn the components to building a successful advanced practice provider (APP) service model during the Society of Critical Care Medicine’s (SCCM) Advanced Practice Providers: Administration, Leadership and Outcomes series. This four-part educational series features three webcasts and a live half-day course.

Developed by SCCM’s eLearning Nurse Practitioner (NP)/Physician Assistant (PA) Task Force, each component of the series includes speakers who bring their local and national expertise to a variety of subject areas, providing participants with the comprehensive view needed to establish a multiprofessional intensive care unit (ICU) provider team.

Webcasts
The webcasts cover a spectrum of topics on designing, initiating and maintaining a skilled APP program.

Developing Formal Orientation and Onboarding for Advanced Practice Providers
Tuesday, September 30, 2014
11:00 a.m. – 12:00 p.m. Central Time

Ensuring Initial and Ongoing Competency of Advanced Practice Providers in the ICU
Wednesday, October 8, 2014
12:00 p.m. – 1:30 p.m. Central Time

Financial and Administrative Considerations for the Development of an ICU NP/PA Practice
Originally broadcasted on Thursday, August 21, 2014
Once registered, you can access the webcast On Demand by logging into www.MySCCM.org

Live Event
The half-day course will be held at SCCM’s 2015 Critical Care Congress and will focus on identifying care models that integrate APPs in the ICU, national trends in clinical nurse specialist, NP and PA practice, fiscal approaches, and benchmarking to assess program value.

Advanced Practice Providers: Administration, Leadership and Outcomes
Saturday, January 17, 2015
8:00 a.m. – 12:00 p.m. Mountain Standard Time
Phoenix Convention Center
Phoenix, Arizona, USA

Register online today using your customer ID and password. The registration fee is $295 ($348 for nonmembers) and includes all three webcasts, On Demand access to content after the webcasts and the live event. Attendees of the live event are eligible to receive continuing education credit. Components of the series are not available to purchase separately.

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

If you plan to attend this course in conjunction with Congress, register at www.sccm.org/Congress.

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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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Webcasts: “Tree of Life” Event and Transition After Catastrophic Injury

The Society of Critical Care Medicine’s (SCCM) Project Dispatch series will present two non-continuing medical education webcasts in the upcoming weeks.  Complimentary registration for both 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.

The “Tree of Life” Memorial Event: Meaningful for Families
Wednesday, September 24, 2014
12:00 p.m. Central Time
Register Online

To honor the unselfish acts of organ donation in the face of overwhelming grief, University Hospital in San Antonio, Texas, USA, created the “Tree of Life” Memorial Event following the deaths of two young men in 2005. Both families independently decided to donate their loved ones’ organs so that something good might come from such a devastating loss. These actions started a special journey for these men’s families and the hospital staff that cared for them.

In this webcast, Charles Reed, PhD, RN, CNRN, will discuss the development of the “Tree of Life” Memorial Event, including how the program has grown and become an integral part of the hospital’s commitment to patients, their families and the community.

Learning Objectives

  • Describe the “Tree of Life” Memorial Event and its impact on families and the healthcare institution
  • Examine how this program can be a model for others
  • Evaluate the impact the program has on families, staff and the community

Patient-Centered Approach to Community Transition After Catastrophic Injury
Wednesday, October 15, 2014
12:30 p.m. Central Time
Register Online

One of the greatest challenges for patients and their families after a catastrophic injury is the transition home and back into the community. These patients have profound care needs and face a lifetime of risk for developing life-threatening medical problems. Can a patient- and family-centered approach to education, mentoring and support be effective in minimizing hospital readmissions for patients?

Michael Jones, PhD, FACRM, and Julie Gassaway, MS, RN, of the Shepherd Center in Atlanta, Georgia, USA, have received a Patient-Centered Outcomes Research Institute (PCORI) grant to examine just that question. They also investigated the sense of self-sufficiency and intensity of community participation for patients with spinal cord injury. The Shepherd Center is one of only two specialty hospitals that provide rehabilitation for patients with acute brain and spinal cord injuries. In this webcast, Dr. Jones and Ms. Gassaway will share patient feedback on how the rehabilitation experience could be improved, discuss the patient- and family-centered approach to education, peer counseling, discharge planning, and support, and present preliminary results from their research.

Learning Objectives

  • Outline the challenges for patients and their families in the wake of catastrophic injury
  • Apply a patient- and family-centered approach to support the patient’s transition to home and community
  • Develop programs that benefit patients and families in the participants’ own communities

These webcasts were 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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Explore Arizona’s Main Attractions at Congress with SCCM’s Organized Tours

Arizona is known for its vast desert landscape, magnificent rock canyons and formations and rich Native American history. See the sights and explore all that Arizona has to offer during the Society of Critical Care Medicine’s (SCCM) 44th Critical Care Congress by participating in one of the following tours:

Half-Day Tours

Heard Museum
Built in the early 1900s, the internationally acclaimed Heard Museum provides a unique glimpse into the fascinating cultures and art of Native Americans of the Southwest.

Horseback Riding
Relax as professional guides take you on the most scenic horseback riding trails in Arizona.

Hot Air Balloon Ride
Enjoy an awe-inspiring flight over the scenic desert floor.

Desert Four-Wheel Drive
Head into the heart of cactus country for a memory-making four-wheel drive tour.

Full-Day Tours

Grand Canyon – South Rim by Land
Explore the spectacular panorama of the mystical red-rock monuments of Sedona, Flagstaff and, finally, the Grand Canyon.

Sedona/Jerome
Join us for a day in northern Arizona discovering the enchanting city of Sedona and Arizona’s best kept secret, Jerome.

For additional details, or to register for tours, visit www.sccm.org/Congress.

The Society’s annual Congress is the largest multiprofessional critical care event of the year, bringing together more than 6,000 critical care clinicians from around the world. This five-day event will offer opportunities to explore breakthroughs in research, share creative and stimulating ideas, make valuable connections, and obtain inspired perspectives from all members of the multidisciplinary, multiprofessional critical care team.

Register online for Congress by using your customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

For information on hotel and travel reservations, visit www.sccm.org/Congress.

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Drug Shortage Alert: Alternative Medications for Procedural Sedation

The Society of Critical Care Medicine’s Drug Shortages Task Force has developed a guideline that can be referred to for options if a drug shortage arises that affects commonly used medications for procedural sedation.

The alert, Alternative Medications for Procedural Sedation, includes pertinent information that can help guide critical care practitioners. The characteristics of an ideal drug for procedural sedation are listed. Risks associated with administering alternative medications are also provided.

Visit www.sccm.org/currentissues to access all Drug Shortage Alerts, including those addressing:

  • Electrolyte Medication Shortages
  • Intravenous Sodium Bicarbonate
  • Web Resources
  • Intravenous Loop Diuretics
  • General Considerations
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WAAAR Issues Declaration Against Antibiotic Resistance

The World Alliance Against Antibiotic Resistance (WAAAR) recently issued a declaration against antibiotic resistance (ABR). The declaration is intended to encourage dialogue centered on the public health threat posed by ABR. Concerted action by medical organizations, policymakers, patient advocacy groups, pharmaceutical companies, and the general population is needed to mitigate this threat, the declaration states.

By any measure, ABR exacts a tremendous cost. According to the declaration, thousands in Europe and the United States alone die each year from infections caused by resistant bacteria. The declaration further notes that a direct correlation exists between ABR and the volume of antibiotics dispensed. Widespread use ultimately promotes the development and dissemination of antimicrobial resistance. Wise antibiotic use and corresponding preservation policies are needed to counter this, especially given the relative dearth of new antibiotics in the pipeline.

WAAAR is a group of 700 individuals from 55 countries that represents physicians, veterinarians, microbiologists, surgeons, pharmacists, nurses, evolutionary biologists, ecologists, environmentalists, and patient advocacy groups.

Discuss antibiotic resistance and the WAAAR declaration at the SCCM eCommunity.

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Participate in an International Study on Mechanical Ventilation

The International Observational Study Investigators are looking at mechanical ventilation (MV) discontinuation practices internationally in intensive care units. The goal of the study is to characterize practice variation in weaning critically ill adults from invasive MV, as well as the influence of selected discontinuation strategies on important outcomes. Each unit  will be asked to collect data on at least 10 consecutive discontinuation events — one event (e.g., tracheostomy, direct extubation, initial successful spontaneous breathing trial) per patient receiving invasive ventilation for at least 24 hours and all patients who die before any attempt at MV discontinuation. Those interested in participating should email ioswean@smh.ca.

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Hospitals Report Results of SSC Implementation

Four hospitals in Detroit reported their success in implementing the Surviving Sepsis Campaign (SSC), demonstrating improved frequency of blood culture testing before antibiotic administration and significant improvement in the time to antibiotic treatment — from a mean of approximately 182 minutes to 92 minutes. The four hospitals participated in a study published in the Journal for Healthcare Quality.

“While guidelines provide a roadmap for patient care, successful implementation relies on consistent patterns of clinician practice to achieve optimal outcomes,” said lead author of the study and Society of Critical Care Medicine (SCCM) member Maria Teresa Palleschi, CCRN, DNP, ACNP, of Detroit Medical Center. “Educating staff is essential to the process of improving patient outcomes, and the results of our study showed the relationship between education and sampling of lactate and blood cultures, as well as timeliness of antibiotic administration.”

Learn more about the tools needed to implement the SSC at www.survivingsepsis.org and get involved in the community at www.facebook.com/survivingsepsis.

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