Examining Utility of Specific First-Line Vasoactive Drugs in Pediatric Septic Shock

Observational and qualitative studies have suggested positive benefits associated with family presence during cardiopulmonary resuscitation (CPR). Family presence may help alleviate the emotional burden and improve the bereavement process. Concerns about interference with resuscitative efforts and medicolegal ramifications have yet to be answered in rigorously designed studies. Patricia Jabre and colleagues in France conducted a multicenter, randomized controlled trial to determine if family presence during CPR was associated with a reduction in the likelihood of posttraumatic stress disorder (PTSD)-related symptoms. Results were published in the March 14 issue of The New England Journal of Medicine.

The primary end point was the proportion of relatives with PTSD-related symptoms, while secondary end points included the effect of family presence on medical efforts at resuscitation, the well-being of the healthcare team, and the filing of medicolegal claims. Of the 570 family members enrolled in an intention-to-treat analysis, 79% of the experimental group witnessed resuscitation versus 43% in the control group. Seventeen percent (n=95) of family members did not complete the 90-day post-event psychological assessment. There were no significant differences between the two groups in the characteristics of the resuscitation procedure, survival or characteristics of patients or enrolled family members. One significant limitation to this work was the prehospital environment; the results from this trial deserve replication in an intensive care unit. Read the full Concise Critical Appraisal.

New Pediatric Board Prep and Review Tool Available

Assess your critical care knowledge and prepare for the subspecialty board examination in critical care with the Society of Critical Care Medicine’s (SCCM) Advanced Knowledge Assessment in Pediatric Critical Care. This self-study tool is designed for physicians working on board preparation and maintenance of certification (MOC).

Comprising 100 questions and rationales with accompanying study materials, the Advanced Knowledge Assessment in Pediatric Critical Care provides a review of cardiovascular and pulmonary critical care topics. Participants will gain an online board examination experience, consisting of:

  • One hundred multiple choice questions, similar to those covered on the actual exam, as well as evidence-based rationales
  • A list of keywords and references from missed questions for further study
  • Online access to accompanying study materials, stored in one convenient location
  • Twenty points towards MOC part 2 in pediatrics and six hours of continuing medical education/continuing education credit

For more information or to purchase the Advanced Knowledge Assessment in Pediatric Critical Care, contact SCCM Customer Service at +1 847 827-6888.

Access Webcasts from the 41st Critical Care Congress

Webcasts featuring the sponsored sessions from the Society’s Critical Care Congress in Houston, Texas, USA, still are available at LearnICU.org. Access these complimentary presentations before they expire and earn continuing education credits:

Nominate Prestigious Fellows for MCCM

The deadline to nominate colleagues for the American College of Critical Care Medicine’s (ACCM) Master of Critical Care Medicine (MCCM) designation is approaching. Those with the MCCM designation have distinguished themselves through outstanding contributions in research and education, as well as through service to the Society and the field. They have achieved national and international professional recognition due to personal character, leadership and eminence in clinical practice. To be eligible, candidates must have been Fellows of the ACCM for at least five years. Nominations for the MCCM designation are due April 15, 2013.

SCCM Highlights 2013 Vision Grant Winner

Interested in applying for the 2013 Vision Grant? The 2013 recipient, Azra Bihorac, MD, MS, FCCM, FASN, summarizes her research project and offers insight into the grant application process. Her work also is featured in the February/March issue of Critical Connections.

The Vision Grant offers up to $50,000 in funding to an SCCM member whose work supports education, teamwork, outcomes measures, and reporting and continuous improvement. The deadline to submit an application is August 31, 2013. For more information, please contact SCCM staff partner Sharon Plenner at splenner@sccm.org.

What Are the Risks in Pediatric RBC Transfusion?

Although anemia may cause an increase in morbidity and mortality rates in critically ill pediatric patients, transfusion of packed red blood cells (pRBCs) carries significant risks, which have also been demonstrated in pediatric cardiac surgery patients. However, studies related to these risks have had problems with confounding and the use of pRBCs that were not leukoreduced. Kneyber et al address these concerns in their study testing whether transfusion of leukocyte-depleted pRBCs within the first 48 hours after cardiac surgery would be independently associated with prolonged duration of mechanical ventilation. Results were published in the March 2013 issue of Pediatric Critical Care Medicine.

Kneyber and colleagues retrospectively analyzed data from 335 children between the ages of 0 months to 18 years who underwent cardiac surgery between 2007 and 2010. Of these subjects, 111 were transfused, 86 of them within the first 48 hours of admission to the pediatric intensive care unit. The author then compared the outcomes of these 86 patients to those of the 249 who were not transfused within 48 hours. Patients who received pRBCs within the first 48 hours had a longer duration of ventilation and inotropic support, longer ICU stay, and a higher rate of ventilator-associated pneumonia. However, after adjusting for the severity of illness, the transfusion of pRBCs within the first 48 hours remained independently associated with only the prolonged duration of mechanical ventilation. This study provides more evidence against arbitrary decisions to transfuse blood products. Prospective studies are necessary to determine which transfusion triggers will provide more benefit than cost. Read the full Concise Critical Appraisal.

Hong Kong Warns of New Coronavirus

new coronavirus is on the loose, and Hong Kong and world health authorities are taking notice. The virus has killed 11 of the 17 people known to have contracted it, a death rate much higher than that of severe acute respiratory syndrome (SARS). Unlike SARS, which affected the respiratory system, this new virus, dubbed “novel coronavirus,” attacks multiple organs. The most likely source of this new disease is bats, though monkeys, pigs, civet cats and even rabbits can also harbor it. To be prepared, Hong Kong officials have started conducting simulations in the event of an outbreak, including quarantines and treatment protocols. The new potential outbreak seems to be centered in the Middle East, with several cases linked to travelers who visited Qatar, Jordan and Saudi Arabia. The Society will continue to monitor this situation and will keep members abreast of any new information.

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