Is Thoracic Ultrasound an Alternative to Conventional Imaging?

Ultrasound has particular usefulness in the critical care setting, with well-established applications for line placement and echocardiography. Questions remain regarding the validity of replacing traditional adjuncts with ultrasound. A previous Concise Critical Appraisal noted that thoracic ultrasound has been shown to be comparable to chest radiographs. In this review by Ashton-Cleary from Royal Cornwall Hospital in the United Kingdom, evidence is reviewed to evaluate the usefulness of thoracic ultrasound in the ICU.

MEDLINE, EMBASE, and Cochrane’s CENTRAL databases were searched as well as the International Standard Randomized Controlled Trial Number Register for relevant articles between 1995 and 2012. Eighty-eight articles of relevance were identified. The review specifically focused on ultrasound and comparative ability to detect or quantitate four common thoracic conditions in critical care: pleural effusion, consolidation, pulmonary edema, and pneumothorax. In each of the included studies, ultrasound was performed by physicians who were described explicitly or implicitly as having training and experience in the skill. Diagnostic measures for the four conditions were tabulated and included sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and area under the curve (AUC).

Read more…

Webcasts on Sepsis Data Tool, Systems Engineering, Pediatric Transfusion, and Patient Distress

The Society of Critical Care Medicine (SCCM) will offer four non-CME webcasts in the months of October and November. These webcasts are complimentary for all participants. If you have questions regarding these webcasts, please contact SCCM Customer Service at +1 847 827-6888.

Using the New Surviving Sepsis Campaign Collection Tool

SSC LogoCollection and analysis of data from bundle compliance is crucial to the success of improvement efforts in the care of patients with severe sepsis and septic shock. Learn to use the new data collection tool efficiently and effectively in your institution with instruction from the primary designer and member of the SSC leadership, Christa Schorr, RN, MSN. Using screen shots of the new resource, Ms. Schorr will explain how it differs from the previous database, illustrate how users can download and install it locally, and demonstrate how participating facilities can generate reports. A question and answer session will follow her presentation. This webcast will be held October 21, 2013, at 12:00 p.m. Central Time (view additional time zones). This webcast is supported by the Gordon and Betty Moore Foundation.
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Septic Shock Case Study: Acute Management of the Morbidly Obese Patient

SSC LogoMorbidly obese patients have unique needs in the emergency department and ICU. In this latest offering from the SSC webcast series, Tiffany Osborn, MD, MPH, will present a case study in which she offers insight into best practices for treating the morbidly obese patient with septic shock. This webcast will be held on Wednesday, November 6, 2013, at 2:00 p.m. Central Time (view additional time zones). This webcast is supported by the Gordon and Betty Moore Foundation.

Moore

ICU Systems Engineering

sq-CongressA systems approach, as well as systems engineering principles and best practices, can foster continuous improvement in the safety and quality of care delivered to ICU patients while lowering the total costs. During the ICU Systems Engineering webcast, Peter J. Pronovost, MD, PhD, Adam Sapirstein, MD, Alan Ravitz, and Doug Solomon, PhD, MPH, will discuss improving ICU care through a systems approach and systems engineering principles. This webcast will take place on Friday, November 8, 2013, at 12:00 p.m. Central Time (view additional time zones). An intermediate session on the same topic will be held at the 2014 Critical Care Congress.

Reducing Distress Among Critical Illness Survivors

sq-Quality-Project-Dispatch v1_0Nearly 800,000 Americans receive mechanical ventilation for acute respiratory failure in the ICU each year. In this webcast from the Project Dispatch series, Christopher Ethan Cox, MD, MPH, and his team explore a Patient-Centered Outcomes Research Institute-funded study and explain which of two treatments is more effective in reducing psychological distress and improving quality of life. This webcast will take place on Tuesday, November 12, 2013, at 12:00 p.m. Central Time (view additional time zones).

Made possible through a grant from the Agency for Healthcare Research and Quality (AHRQ), SCCM’s Project Dispatch aims to improve the quality, effectiveness, accessibility, and cost-effectiveness of healthcare in the United States by developing and distributing resources for critical care clinicians focused on patient-centered research.

Transfusing the Critically Ill Child: It’s Not Like Giving Them Kool-Aid 

sq-CongressMore than 22 million units of blood are transfused in the United States annually, and understanding the risk/benefit ratio is essential. In this webcast, part of an ongoing educational effort to provide the latest information on transfusion to the critical care community, Philip Spinella, MD, FCCM, Howard Corwin, MD, FCCM, Joshua Salvin, MD, MPH, and Paul Checchia, MD, FCCM, will address transfusing the critically ill child. This webcast will take place on Thursday, November 14, 2013, at 1:00 p.m. Central Time (view additional time zones). A follow-up intermediate session on the same topic will be held at the 2014 Critical Care Congress.

Surviving Sepsis Campaign Update: Start Collecting Data, Join a Local Collaborative

SSC LogoThe Surviving Sepsis Campaign (SSC) is launching a quality improvement initiative to increase early recognition and treatment of sepsis in patients on hospital medical, surgical and telemetry units. It is seeking hospitals to participate in collaboratives in San Francisco, Chicago and the East Coast (meeting in Providence, RI).

The aim of this new initiative is to study, test and disseminate tools related to the early identification and treatment of sepsis on hospital floors. Participating hospitals will select one unit to enroll in this pilot project. During the course of the collaborative hospitals that experience significant improvements may choose to implement changes in other units outside the collaborative. At the end of the collaborative, a consensus statement will be produced along with change/tool packages free to hospitals across the world interested in improving their own care.

The SSC Collaborative initiative is made possible through a generous grant from the Gordon and Betty Moore Foundation to continue the work of the SSC in the United States. There is no fee to join the collaborative. The Foundation’s support covers the costs of the faculty, collaborative project management, database support and benchmarking, virtual meeting support and other related expenses.

Apply to be part of the SSC collaboratives and learn more about the participation criteria and leading faculty. Applications are due by November 15, 2013.

The SSC Data Collection Tool is Now Available
Hospitals worldwide are encouraged to download the free data collection tool to improve the care of sepsis patient worldwide. Collecting data helps improve outcomes and inform benchmarking data. Hospital seeking to download the Data Collection Tool should seek the help of their Information Technology Department. A webcast detailing the data collection tool will be held October 21, 2013, at 12:00 p.m. Central Time.

New Resources Highlight Post-Intensive Care Syndrome

The Society of Critical Care Medicine has developed several resources for clinicians and patients related to post-intensive care syndrome.

Post-intensive care syndrome, or PICS, is made up of health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient’s body, thoughts, feelings, or mind and may affect the family. PICS may show up as an easily noticed drawn-out muscle weakness, known as ICU-acquired weakness; as problems with thinking and judgment, called cognitive (brain) dysfunction; and as other mental health problems.

Learn more by exploring these resources:

Registration Open for 2014 MCCKAP Exam

Registration is now open for the Society of Critical Care Medicine’s (SCCM) 2014 Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP), to be administered exclusively online February 27 to March 7, 2014.

Register by November 27, 2013, to take advantage of discounted registration rates.

The MCCKAP online exam assesses critical care fellowship programs nationally. Held every spring, 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
  • Review preliminary scores and analysis immediately upon completion of the test

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.

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

Webcast to Discuss the Surviving Sepsis Campaign as a Model for Mentoring

SSC LogoThe latest offering from the Surviving Sepsis Campaign (SSC) webcast series, The SSC as a Model for Mentoring, will be held on Tuesday, October 15, 2013. The Physician Assistant (PA) Section of the Society of Critical Care Medicine (SCCM) will share examples of prime mentoring activities from the SSC. Presentations from the viewpoints of the mentee, mentor, and an objective educator will set the stage for participants to implement a mentoring program that can provide significant professional growth for all involved while furthering the reach of the SSC. Presenters include Ryan O’Gowan, MBA, PA-C, FCCM, from St. Vincent’s Hospital, Mari Mullen, MD, from the University of Massachusetts, and Emanuel P. Rivers, BS, MD, MPH, IOM, from Henry Ford Hospital.

During this webcast, faculty will:

  • Describe the role of mentor and mentee in a healthcare setting
  • Explain the benefits of serving as a mentor
  • Outline goals for a mentoring relationship using the SSC as a model

The SSC as a Model for Mentoring webcast will be held at 1:00 p.m. Central Time (view additional time zones).

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

Previous webcasts and related educational slide presentations are also available on a variety of topics.

Moore

This webcast series is supported by the Gordon and Betty Moore Foundation.

 

More than 700 sites have enrolled for the SCC’s International Multicentre PREvalence Study on Sepsis (IMPRESS). Help us reach our goal of 1000 sites and enroll today! De-identified patient-level data will be collected on patients with severe sepsis or septic shock presenting to a participating intensive care unit (ICU) or emergency department within a 24-hour period, midnight to midnight on November 7, 2013. Data collected as part of routine clinical care, including hospital and ICU characteristics, patient characteristics, severity of illness, adherence to SSC bundle elements, and mortality, will be used for this study.

The SSC listserv has topped 2,100 members. Join and be part of the discussion!

Meet at the Intersection of Technology and Medicine

Experience the City by the Bay at the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress, to be held January 9 to 13, 2014, in San Francisco, California, USA. This five-day event will offer opportunities to connect with colleagues from around the globe and participate in valuable programming, including:

  • Cutting-edge educational sessions
  • Hands-on workshops
  • Compelling plenary sessions
  • Captivating symposia
  • One-of-a-kind multiprofessional networking

When the right people come together in one place, ideas become reality. Join nearly 5,000 critical care clinicians at the 2014 Congress, where creative and inspirational ideas for the critical care field will be developed and shared. Regardless of your profession or role in the critical care team, you will find opportunities to enhance your practice. Register today.

Additional Incentives Tied to Maintenance of Certification Activities

The American Board of Surgery (ABS) has been approved by the Centers for Medicare and Medicaid (CMS) for the 2013 Physician Quality Reporting System (PQRS) MOC Incentive. This incentive allows physicians participating in PQRS reporting to earn an additional 0.5% on Medicare Part B charges by also participating in an approved Maintenance of Certification (MOC) program “more frequently” than what is required to maintain board certification. Surgeons must also participate in a patient experience of care survey to earn the incentive.

Surgeons not yet enrolled in the ABS MOC Program must pass a recertification exam in 2013 to be eligible. Even if certified by more than one board of the American Board of Medical Specialties , participants cannot receive more than one MOC incentive payment.

For more information about PQRS reporting, visit www.cms.gov/pqrs.

Is Remote Ischemic Postconditioning Cardioprotective in Children Undergoing Cardiac Surgery?

Children who undergo cardiac surgery may suffer predictable systemic inflammatory responses, myocardial depression, and pulmonary endothelial dysfunction, all related to ischemia-reperfusion (IR) injury and cardiopulmonary bypass (CPB). One therapeutic strategy to prevent these injuries involves remote ischemic preconditioning (RIC), whereby a remote organ (usually a limb) is made repeatedly ischemic and then reperfused over a short period before the more significant IR insult (like cardiac surgery). This practice has been shown to modify the expression of key proteins in cytokine synthesis and leukocyte trafficking. Cheung et al demonstrated that RIC, applied prior to the initiation of CPB, provided some myocardial protection in children who underwent cardiac surgery.

In the August issue of Pediatric Anesthesia Zhong et al applied the same principles, though the timing of ischemia was different. The authors recruited 69 subjects (35 in the control group and 34 in the ischemic group) between the ages of 3 and 12 years who underwent repair of their congenital heart diseases. Remote ischemia was achieved by inflating a blood pressure cuff located on a lower limb to a pressure of 200 mm Hg for 5 minutes, followed by deflation for 5 minutes; this was repeated for a total of 3 cycles. These maneuvers were performed after the aorta was unclamped. The primary endpoint the maneuver’s effect on cardiac troponin I levels over 24 hours. Secondary endpoints included clinical outcomes, adverse cardiac events and changes in other metabolic markers such as neuron-specific enolase. Read more…

AMA Releases Simplified Toolkit in Light of New HIPAA Rules

A new toolkit released by the American Medical Association can help physicians navigate sweeping new revisions to the privacy and security rules of the Health Insurance Portability and Accountability Act (HIPAA). Physicians must comply with these new rules by September 23, 2013.

Among the key changes physicians must make for the September 23 deadline are new agreements with business associates who handle patient information, privacy notices to share with patients and increased security measures for patient data. Download the toolkit and visit the AMA website for additional resources, including a list of frequently asked questions. Read more…

Join the Sepsis Point Prevalence Study

The Surviving Sepsis Campaign (SSC) will conduct a point prevalence study, the International Multicentre PREvalence Study on Sepsis (IMPRESS), on November 7, 2013. Conducted by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, under the framework of the SSC, IMPRESS aims to help clinicians and researchers better understand the global burden of sepsis.

At least 1,000 institutions are sought to participate in the study. If your team has not yet joined, now is the time to be a part of this important effort.

More than 500 sites from 64 nations have registered to participate in IMPRESS, each recognizing their role in helping researchers better understand the global burden of severe sepsis and septic shock in adult patients.

De-identified patient-level data will be collected on patients with severe sepsis or septic shock presenting to a participating intensive care unit (ICU) or emergency department within a 24-hour period, midnight to midnight on November 7, 2013. Data collected as part of routine clinical care, including hospital and ICU characteristics, patient characteristics, severity of illness, adherence to SSC bundle elements, and mortality, will be used for this study.

The Sepsis Alliance recognized the Surviving Sepsis Campaign with its Sepsis Heroes Award, commending the group for its contributions to advancing sepsis care and awareness. Presented in New York during the Sepsis Alliance’s event, An Evening with Sepsis Heroes: Celebrating Champions of Sepsis Awareness, the award was accepted by European Society of Critical Intensive Care Medicine President Jean-Daniel Chiche , MD, and SSC co-founders, Mitchell M. Levy, MD, FCCM, and R. Phillip Dellinger, MD, MCCM, on behalf of the Society of Critical Care Medicine. James Obrien, MD, MSC, Chairman of the Board of Directors for the Sepsis Alliance, presented the award.

Surviving-Sepsis-Heroes

“The Surviving Sepsis Campaign has achieved incredible globalization and buy-in from both scientific organizations and practicing clinicians,” said Dellinger. “This is a tribute to the volunteers on the guidelines committee, the volunteer leadership and the volunteers in the trenches at hospitals participating in the Campaign’s performance improvement program.” Congratulations to the SSC on this achievement as it enters its tenth year.

Webcast to Discuss the Surviving Sepsis Campaign as Model for Mentoring

The Physician Assistant (PA) Section of the Society of Critical Medicine (SCCM) has identified the Surviving Sepsis Campaign (SSC) as a prime model for mentoring that improves patient care while affording PAs unique growth opportunities. This type of relationship can be applied to all professionals on the sepsis care team.

In this latest offering from the SSC webcast series, the PA Section will share examples of prime mentoring activities from the SSC. Presentations from the viewpoint of the mentee, mentor, and an objective educator will set the stage for participants to implement a mentoring program that can provide significant professional growth for all involved while furthering the reach of the SSC. Presenters include Ryan O’Gowan, MBA, PA-C, FCCM, from St. Vincent’s Hospital, Mari Mullen, MD, from the University of Massachusetts, and Emanuel P. Rivers, BS, MD, MPH, IOM, from Henry Ford Hospital. During this webcast, faculty will:

  • Describe the role of mentor and mentee in a healthcare setting
  • Explain the benefits of serving as a mentor
  • Outline goals for a mentoring relationship using the SSC as a model

The SSC as a Model for Mentoring webcast will be held on Tuesday, October 15, 2013, at 1:00 p.m. Central Time (view additional time zones).

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

Previous SSC webcasts and related educational slide presentations are also available on a variety of topics.

This webcast series is supported by the Gordon and Betty Moore Foundation

Gordon and Betty Moore Foundation

Surviving Sepsis Campaign Implementation Kits
The Surviving Sepsis Campaign has developed pre-packaged kits to help clinicians improve sepsis identification, management and treatment within their institutions. Each kit contains two posters featuring the graded recommendations from the latest guidelines, 25 pocket guides, 25 bundle cards and a package of 15 Surviving Sepsis Campaign logo pins. Visit www.survivingsepsis.org/improvement for more resources.

Help Shape the Future of Critical Care Medicine

Learn about new developments and tools to help expand your knowledge and advance your practice of critical care at the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress, to be held January 9 to 13, 2014, in San Francisco, California, USA.

This five-day event will offer opportunities to make valuable connections and draw diverse perspectives from all members of the multiprofessional critical care team. Participate in cutting-edge educational sessions, hands-on workshops, captivating symposia, and popular plenary sessions promoting innovative developments in critical care.

Plenary sessions are given by distinguished, world-renowned leaders in the critical care field. Speakers will include:

Rosemary Gibson, MSc
Senior Advisor
The Hastings Center
Section Co-Editor, Less is More
JAMA Internal Medicine
Arlington, Virginia, USA
C. William Hanson III , MD, FCCM
Professor of Anesthesiology and Critical Care
Chief Medical Information Officer
University of Pennsylvania Health Systems
Philadelphia, Pennsylvania, USA
Patrick M. Kochanek, MD, MCCM
Professor and Vice Chair, Department of Critical Care Medicine
Professor of Anesthesiology,
Pediatrics and Clinical and Translational Science
Director, Safar Center for Resuscitation Research
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, USA
Geoffrey Ling, MD, PhD, FAAN
Deputy Director, Defense Sciences Office,
Defense Advanced Research Projects Agency
Attending Physician and Director, Neurosciences Critical Care,
Department of Critical Care Medicine,
Walter Reed National Military Medical Center
Washington, DC, USA
Peter J. Pronovost, MD, PhD, FCCM
Professor, Departments of Anesthesiology/
Critical Care Medicine and Surgery
The Johns Hopkins University School of Medicine
Baltimore, Maryland, USA
Basil A. Pruitt, Jr., MD, FACS, MCCM
Clinical Professor of Surgery
Betty and Bob Kelso Distinguished Chair in Burn and Trauma Surgery
University of Texas Health Science Center
San Antonio, Texas, USA
Jean-Louis M. Vincent, MD, PhD, FCCM
Professor of Intensive Care Medicine
Université Libre de Bruxelles
Head, Department of Intensive Care
Erasme University Hospital
Brussels, Belgium

Regardless of your profession or role on the critical care team, you will find opportunities to enhance your practice. Act by November 6, 2013, to take advantage of early bird discounts. Register online using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

Physiotherapy in Intensive Care

Historically, respiratory physiotherapy has been considered as an integral part of the daily rehabilitation of the intensive care unit (ICU) patient. However, not since 2000 has there been a specific evaluation of the various physiotherapy modalities available. Kathy Stiller, PhD, conducted a systematic review to evaluate evidence appearing over the last 13 years either supporting or refuting the role of physiotherapy in the care of the adult, intubated ICU patient.

The review is deliberately broad, encompassing clinical studies as well as expert opinion pieces and surveys. A literature review focused on papers published between 1999 and 2012 and accessible through PubMed, MEDLINE, CINAHL, Embase, the Physiotherapy Evidence Database and the Cochrane Library databases. The broad criteria naturally resulted in culling studies with variable study designs and outcomes, hence precluding a meta-analysis. Eighty-five new studies were identified including 12 focused systematic literature reviews. The identified trials evaluated several physiotherapy interventions including multimodality respiratory physiotherapy (an umbrella term encompassing diverse interventions such as manual or ventilator hyperinflation, positioning, chest wall vibrations, and rib-cage compression), mobilization, inspiratory muscle training and neuromuscular electrical stimulation. Read more…

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