Driving Pressure and Survival in the Acute Respiratory Distress Syndrome

Protective lung strategies—low tidal volumes (Vt), increased positive end-expiratory pressures (PEEP) and lower plateau pressures (Pplat)—have been the mainstay of acute respiratory distress syndrome (ARDS) treatment, thought to confer survival benefit by reducing mechanical damage to the lungs. However, strategies can conflict, and the net negative effect of sacrificing one parameter for another is unclear. Because respiratory-system compliance (Crs) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), Amato et al hypothesized that driving pressure (ΔP = Vt/Crs), in which Vt is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than Vt or PEEP in patients with ARDS who are not actively breathing.

They found that driving pressure was the ventilation variable that best stratified risk. Decreases in driving pressure owing to changes in ventilator settings were strongly associated with increased survival.

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.

Video: ICU Survivor Discusses His Struggle with Delirium

In this illuminating video, intensive care unit (ICU) survivor Anthony Russo provides an emotional and frank account of his ICU experience following his infection with the H1N1 virus. Anthony paints a vivid and heart-wrenching picture of his struggle with delirium and its long-term impact on his life. He also discusses the heroic efforts of the medical team at Sutter Health who oversaw his care.

After watching the video, you are encouraged to visit www.ICULiberation.org to learn about the upcoming grant-funded ICU learning collaborative and the fall simulation-based conference being offered by the Society of Critical Care Medicine at Vanderbilt University Medical Center. The ICU Liberation Initiative aims to engage clinicians in improving practice and patient outcomes related to pain, agitation and delirium. Consider how your ICU can become a part of this growing campaign.

Upcoming Webcast Will Explore Understanding of Brain Death

Registration is now open for Understanding Brain Death: From Experts to Laypersons, a collaborative webcast from the Society of Critical Care Medicine’s (SCCM) Emergency Medicine Section and Project Dispatch. During this session, Isaac Tawil, MD, FCCM, Chair of the Emergency Medicine Section and Associate Professor of Emergency Medicine and Intensive Care at the University of New Mexico Health Sciences Center, and David Seder, MD, FCCM, Director of Neurocritical Care at Maine Medical Center, will explore the understanding of brain death by experts and the lay community and provide insight on how interactions with patients and families can contribute to patient-centered outcomes.

Learning Objectives

  • Review medical literature on understandings of brain death among clinicians and laypersons
  • Discuss interventions to improve the understanding and clinical evaluation of brain death
  • Review the guidelines and challenges of brain death determination
  • Discuss patient-centered outcomes

This 60-minute webcast will take place on Wednesday, April 8, 2015, at 2:00 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 in collaboration with the Emergency Medicine Section. 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.

Registration Open for the Summer Critical Care Ultrasound Courses

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 skills during the Society of Critical Care Medicine’s (SCCM) Critical Care Ultrasound courses.

Obtain the realistic training needed to perform and interpret ultrasound imaging with SCCM’s comprehensive, two-day Critical Care Ultrasound or Critical Care Ultrasound – Pediatric course. In each, participants benefit from guided, focused skill stations and interactive presentations to reinforce key learning points. Extensive faculty coverage ensures a significant hands-on experience for each participant.

New this year, SCCM’s Advanced Critical Care Ultrasound course is also offered in a pediatric format.

In both the adult and pediatric one-day advanced courses, fundamental skills and knowledge are expanded and focus on the specialty-specific use of echocardiography in the management of the critically ill patient. Participants explore the noninvasive management of the hemodynamically unstable patient.

The summer ultrasound courses will be held August 16 to 18, 2015, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register today by visiting the ultrasound courses webpage.

Webcast Aims to Increase Knowledge in Determining DNC

Review the most up-to-date research and processes in determining death by neurological criteria (DNC) in the webcast, Death by Neurological Criteria: Diagnosis and Management, the latest offering from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series. This webcast aims to improve your confidence and knowledge in determining DNC.

Expert faculty, David Greer, MD, FAHA, FNCS, FAAN, FCCM, and Jose Javier Provencio, MD, FAAN, FNCS, FCCM, will examine the appropriate use of ancillary testing and discuss skills to successfully engage families and surrogates in conversation and decision making after DNC.

Learning Objectives

  • List the objective clinical tools needed to arrive at a DNC diagnosis and describe the management and organ support (hemodynamics, electrolytes, endocrine imbalances) for DNC patients
  • Articulate the indications and pros/cons for ancillary testing to support a DNC diagnosis
  • Explain techniques and authoritative and unambiguous terms used by experts to appropriately engage families and surrogates in the discussion of DNC, and recognize the related common cross-cultural, ethnic and religious sensitivities

This webcast will take place on Wednesday, March 25, 2015, at 1:00 p.m. Central Time. 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 members ($40 for nonmembers). For institutions seeking unlimited participation at a single location, a $200 group rate is available. Please contact SCCM Customer Service at +1 847 827-6888 for details.

The Controversies in Critical Care webcast 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.

2015 Editions of Current Concepts in Adult and Pediatric Critical Care Available

Each year, the Society of Critical Care Medicine’s (SCCM) popular Congress pre-courses, Current Concepts in Adult Critical Care and Current Concepts in Pediatric Critical Care, deliver the latest clinical information applicable to patients in the intensive care unit. These courses are now available On Demand and the companion textbooks are available in print and as eBooks.

Save over 10% by purchasing the Adult or Pediatric bundle, each containing the 2015 textbook and unlimited access to the On Demand course.

pi-lg-CCACC15BUNDThe 2015 version of Current Concepts in Adult Critical Care includes the topics:

  • Management of the “Almost Never Events”
  • Early Mobility
  • Antithrombolytics and Antiplatelet Therapy in the Intensive Care Unit
  • How to Start an Extracorporeal Membrane Oxygenation Program

Among the topics in the 2015 version of Current Concepts in Pediatric Critical Care pi-lg-CCPCC15BUNDare:

  • Diabetic Ketoacidosis and Cerebral Edema
  • Extracorporeal Membrane Oxygenation in High-Risk Populations
  • Managing Comfort in the Critically Ill Pediatric Patient
  • Donation After Cardiac Death

All of the Current Concepts resources are available for purchase in the SCCM store. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

Is Fluid Overload Associated with Mortality in Children?

Early fluid resuscitation remains an integral therapy in most critically ill children with sepsis.  However, as of late, an increasing body of literature (i.e., studies by Modem et al and Sutherland et al) has reported that fluid overload in critical illness may be associated with increasing mortality. Sinitsky and colleagues investigated the association of early fluid overload with respiratory parameters and mortality in a general pediatric intensive care unit (PICU) population.

The authors found that, in this general PICU population, fluid overload percent (%FO) at 48 hours was associated with oxygenation index at 48 hours and need for invasive ventilation in survivors. However, no association was detected between %FO and mortality.

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.

Start Adding to Your SCCM “ePortfolio”

The Society of Critical Care Medicine (SCCM) now offers a list of all of your SCCM teaching, continuing medical education (CME)/continuing education (CE) and volunteer activities in one convenient location on your personalized electronic portfolio webpage. The “ePortfolio” page also allows you to enter your CME/CE activities outside of SCCM so that you can track all of your CME/CE activities in one location.

Log into www.MySCCM.org, choose the MY INVOLVEMENT tab and click on the “ePortfolio” link to see your recent SCCM activities and begin entering your other CME/CE activities.

ICU Liberation Launches ABCDEF Improvement Collaborative

The Society of Critical Care Medicine’s (SCCM) ICU Liberation Campaign is launching a quality improvement initiative related to implementing the ABCDEF bundle.

The ICU Liberation ABCDEF Improvement Collaborative is seeking U.S. hospitals interested in improving outcomes for patients and families by reliably implementing the newly modified bundle. Participating hospitals would work with a team of leading national and regional experts to:

  • Reduce time on mechanical ventilation
  • Engage families to participate in the care and healing of their loved ones
  • Validate compliance and improvement through use of an online data collection tool
  • Enhance teamwork through implementation of evidence-based care
  • Engage with leading experts who have demonstrated improved patient outcomes through the ABCDEF bundle
  • Create partnerships with other institutions doing the same improvement work across the United States

Applications are due May 19, 2015, and must be accompanied by all four commitment letters, which are available on the website.

The Collaborative will be operating in three regions: Atlanta, San Francisco and Chicago, but it is not required that applying hospitals be located in these regions. Hospitals of any type or size may apply, and no experience in implementing the bundle is required. Learn more about the Collaborative and application requirements.

If you have any additional questions, please contact SCCM staff partner Diane Byrum at dbyrum@sccm.org.

Register Now for Sepsis Without Walls Conference

JHM_2C_P_HEarly detection of sepsis, with the timely administration of appropriate antibiotics, appears to be the single most important factor in reducing morbidity and mortality from sepsis. The Society of Critical Care Medicine is partnering with The Johns Hopkins University School of Medicine to offer Sepsis Without Walls: Ensuring All Patients Receive Optimal, Time-Sensitive Care. This one-day interactive conference will focus on strategies to identify, diagnose and manage patients who present with signs and symptoms of sepsis, irrespective of their care unit.

It has become increasingly apparent that there is a long delay in both the recognition of sepsis and the initiation of appropriate therapy in many patients. This translates into an increased SCCM-Logo-Color-RGB-600pxincidence of progressive organ failure and a higher mortality. Healthcare providers, therefore, need a high index of suspicion for the presence of sepsis and must begin appropriate antimicrobials quickly. Join the multiprofessional panel of leading experts who will focus on problem solving through case studies in developing effective strategies in specific patient populations.

Register today for the Sepsis Without Walls conference, which will be held September 25, 2015, at The Johns Hopkins University School of Medicine in Baltimore, Maryland, USA.

Registration Is Now Open for ICU Liberation and Animation Conference

VanderbiltThe Society of Critical Care Medicine is partnering with Vanderbilt University Medical Center to offer ICU Liberation and Animation: Implementing the Pain, Agitation and Delirium Guidelines. This two-day didactic and simulation conference will review implementation strategies and discuss approaches to enable a more effective and lasting application of the pain, agitation and delirium (PAD) guidelines by utilizing the multiprofessional team.

Internationally recognized faculty will present lectures on patient management strategies and engage participants in clinical scenarios through small-group simulation labs. Hospitals are SCCM-Logo-Color-RGB-600pxencouraged to send a team of two or more participants who will then be able to implement these strategies within their hospital’s intensive care unit after the conference.

Register today for the ICU Liberation and Animation conference, which will be held September 9 and 10, 2015, at Vanderbilt University Medical Center in Nashville, Tennessee, USA.

Register for Webcast on Death by Neurological Criteria

Improve your confidence and knowledge in determining death by neurological criteria (DNC). In the webcast, Death by Neurological Criteria: Diagnosis and Management, the latest offering from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series, expert faculty will review the most up-to-date research and processes in determining DNC.

David Greer, MD, FAHA, FNCS, FAAN, FCCM, and Jose Javier Provencio, MD, FAAN, FNCS, FCCM, will examine the appropriate use of ancillary testing and discuss skills to successfully engage families and surrogates in conversation and decision making after DNC.

Learning Objectives

  • List the objective clinical tools needed to arrive at a DNC diagnosis and describe the management and organ support (hemodynamics, electrolytes, endocrine imbalances) for DNC patients
  • Articulate the indications and pros/cons for ancillary testing to support a DNC diagnosis
  • Explain techniques and authoritative and unambiguous terms used by experts to appropriately engage families and surrogates in the discussion of DNC, and recognize the related common cross-cultural, ethnic and religious sensitivities

This webcast will take place on Wednesday, March 25, 2015, at 1:00 p.m. Central Time. 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 members ($40 for nonmembers). For institutions seeking unlimited participation at a single location, a $200 group rate is available. Please contact SCCM Customer Service at +1 847 827-6888 for details.

The Controversies in Critical Care webcast 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.

Practice and Prepare with the Adult Board Review Course

The Society of Critical Care Medicine’s (SCCM) 2015 Adult Multiprofessional Critical Care Board Review Course (MCCBRC) sets the standard in board preparation. Register online today. Whether you need to certify, recertify or simply review, MCCBRC provides an excellent update and thorough overview of the field.

Comprehensive Learning Experience
Receive 4.5 days of extensive coverage of core concepts in critical care, including cardiology, endocrinology, gastrointestinal disorders, infectious diseases, monitoring, neurology, nutrition, respiratory care, sepsis, and more. Each comprehensive session is presented by world-class faculty.

Accurate Skills Assessment
Daily interactive board preparation sessions will consist of practice board questions, answers and rationales. Monitor your progress through audience response system technology and receive accurate feedback regarding areas that may need further refinement.

Valuable Study Resources
As a registered participant, you will receive the course syllabus, online access to practice questions and networking opportunities with colleagues and world-renowned experts in critical care. After the event, you will enjoy online access to MCCBRC On Demand videos containing the slide presentations and synchronized speaker audio for every lecture.

The 2015 Adult MCCBRC will be held August 11 to 15, 2015, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register online using your Customer ID and password or contact SCCM Customer Service at +1 847 827-6888.

On Demand: Should We Prone All ARDS Patients?

The recent webcast, Should We Prone All ARDS Patients?, is now available for On Demand purchase. In this pro/con webcast from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series, the most up-to-date evidence on the benefits, limitations and alternatives of prone positioning of patients with acute respiratory distress syndrome is presented by an esteemed panel of physicians.

Should We Prone All ARDS Patients? On Demand allows you to access a video containing the slide presentations and synchronized speaker audio from the event. Enjoy this access from the comfort and convenience of your home or office and review the content on your own time and at your own pace. This is the next best thing to attending the live event. Following your purchase, you can access the materials as often as you like by logging into www.MySCCM.org.

Should We Prone All ARDS Patients? On Demand is available for purchase in the SCCM store. The registration rate is just $35 for members ($45 for nonmembers).

If you participated in the live event, your subscription to the On Demand service was included in your registration fee. The materials can be accessed by logging into www.MySCCM.org with your customer ID and password.

The Controversies in Critical Care webcast 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.

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