Do You Know Your SCCM Engagement Score?

SCCMGaugeThe SCCM Engagement Index dashboard quantifies how engaged you are with SCCM. It represents your activity level with the Society, including years of continuous membership, products ordered, conferences attended and volunteer services on various committees.

The dashboard is located at mysccm.org. Log in using your username and password, and find your engagement score below your profile. The more engaged you are with your  Society, the higher your score. Start increasing your score today!

Webcasts to Discuss Patient Distress and Pediatric Transfusion

The Society of Critical Care Medicine (SCCM) will offer two non-CME webcasts in the month of 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.

Reducing Distress Among Critical Illness Survivors sq-Quality-Project-Dispatch v1_0
Tuesday, November 12, 2013
12:00 p.m. Central Time (view additional time zones)
Register online today.

Nearly 800,000 Americans receive mechanical ventilation for acute respiratory failure in the intensive care unit  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.

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&#39s Not Like Giving Them Kool-Aid  sq-Congress
Thursday, November 14, 2013
1:00 p.m. Central Time (view additional time zones)
Register online today.

More 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 practices  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. A follow-up intermediate session on the same topic will be held at the 2014 Critical Care Congress.

Can You See Retinal Hemorrhages with Increased Intracranial Pressure?

Child abuse is a significant problem in the United States with approximately four children dying of abuse every day, most of whom are younger than 4 years. Additionally, 1300 children are presumed to die each year following abusive head trauma. Rapid identification of non-accidental head trauma helps child-protection workers and the police protect children and apprehend and prosecute abusers.

For many years, the presence of retinal hemorrhages in an infant with a neurologic injury was thought to be diagnostic for shaken baby syndrome (SBS), and frequently these hemorrhages were the only physical finding suggestive of abuse. However, the literature supporting this assumption was lacking, and many have suggested that cardiopulmonary resuscitation and increased intracranial pressure could also cause retinal hemorrhages. In 1997, Odom et al helped dispel the notion that cardiopulmonary resuscitation could cause the types of retinal bleeding seen with SBS. The recent article by Binenbaum et al, which appeared in the August issue of Pediatrics, continues this process of validation by examining the presence of retinal hemorrhages in children with non-traumatic causes of increased intracranial pressure (ICP).

In this work, the authors recruited subjects between the ages of 1 and 17 years who were undergoing lumbar punctures. Children with a history of head trauma, indwelling ventricular catheters, lumbar drains, or brain tumors were excluded. Opening pressure (OP) measurements were obtained. OP was defined as the highest pressure sustained for 10 seconds. All subjects also underwent a dilated funduscopic examination performed by a pediatric ophthalmologist no later than 96 hours after the lumbar puncture; 93% were completed within 48 hours.

Of the 100 subjects who met inclusion criteria, 32 had an OP between 20 and 28 cm H2O, and 68 had an OP >28 cm H2O. The most common diagnosis was idiopathic intracranial hypertension, but other diagnoses included infectious disease, rheumatologic or demyelinating disease, and venous thrombosis. Optic disc swelling was noted in 74 children. Sixteen subjects had splinter optic disc hemorrhages or superficial intraretinal hemorrhages, as well as moderate to severe optic disc swelling. Retinal hemorrhages were not seen in other areas (e.g., retinal periphery), not even in one case of papilledema causing severe vision loss.

The authors claim that these findings are consistent with anecdotal experiences of other pediatric ophthalmologists who routinely perform funduscopic exams on children with increased ICP. However, they also claim that the hemorrhages seen in this study are fundamentally different from the severe hemorrhagic retinopathy typically described with SBS, which are often multilayered and deeper, &#34dot-and-blot&#34 intraretinal hemorrhages. The authors also comment on the relative infrequency of disc swelling (<9% of cases) seen with head trauma compared to the study subjects.

This study&#39s strengths lie in the number of subjects enrolled and in the fact that pediatric ophthalmologists performed the funduscopic exams. The authors acknowledged the weaknesses, which are not insignificant. First, the ICPs in these subjects were presumably chronic in nature as opposed to the circumstances seen with an acute head injury. The pattern of hemorrhage seen in acute injuries is primarily preretinal and vitreous and is, again, different from the patterns seen with SBS (or Terson syndrome). Secondly, the subjects in this study were older than those seen with SBS, but, as the authors comment, because of their open sutures and fontanelles, infants are less likely to have papilledema and associated retinal hemorrhage.

Critical care physicians, child abuse specialists, and other medical professionals are often asked to testify in court about the nature of injuries, particularly in cases of non-accidental head trauma, and must be able to support their conclusions with good medical evidence. While there is not an exhaustive supply of literature supporting the notion that significant retinal hemorrhages are diagnostic of SBS, this work provides more affirming evidence.

This Concise Critical Appraisal is authored by SCCM member Daniel E. Sloniewsky, MD. Each installment highlights journal articles most relevant to the critical care practitionerDaniel Sloniewsky is an associate professor in the Department of Pediatrics at the Stony Brook Long Island Children&#39s Hospital in Stony Brook, NY, where he is board certified in pediatrics and pediatric critical care. He completed his fellowship training at Children&#39s Memorial Hospital and Northwestern University in Chicago. His major interests are in acute pediatric pulmonary disease, transfusion medicine and ethics. He is also actively involved in resident education, Pediatric Advanced Life Support and Pediatric Fundamental Critical Care Support instruction.

Lung Ultrasound: Better Than a Chest Radiograph?

Ultrasound use in the intensive care unit (ICU) has become increasingly prevalent, especially as more intensivists gain valuable training and experience in this cost-effective imaging modality. In this month’s issue of Intensive Care Medicine, Xirouchaki et al compared the diagnostic performance of lung ultrasound and bedside chest radiography (CXR) for the detection of four pathologic entities: consolidation, interstitial edema, pneumothorax, and pleural effusion.

Forty-two mechanically ventilated patients in a mixed medical-surgical ICU were prospectively enrolled in this blinded, non-randomized trial. Enrollment in the trial was triggered by the need for thoracic computed tomography (CT), which was used as the gold standard for all patients. All patients had a CXR, CT, and ultrasound examination. The primary author performed all ultrasound exams and was blinded to the CT findings; the exams were not reviewed by a blinded radiologist.

Ultrasound had superior sensitivity and specificity for the detection of consolidation, pleural effusion, and interstitial edema when compared to CXR. A positive likelihood ratio of 14.29 was reported for detecting consolidation with ultrasound (100% sensitivity, 78% specificity); a likelihood ratio of 13.4 was reported for diagnosing interstitial edema (94% sensitivity, 93% specificity). Alternatively, CXR had a sensitivity of only 38% for consolidation and a sensitivity of 46% for interstitial edema. Ultrasound identified six of eight pneumothoraces with a sensitivity of 75%. None of the pneumothoraces were clinically significant. The authors concluded that lung ultrasound demonstrated superior diagnostic performance compared to CXR, and may be considered as an alternative to computed tomography (CT) in some instances.

Since patient selection was based on a predefined need for a CT, the study was subject to considerable verification bias. Moreover, all exams were performed by one investigator, and none of the exams were confirmed by a blinded radiologist or second ultrasonographer. All patients were positioned laterally for the exam, and this positioning might have changed the localization for some abnormalities, and may not always be feasible or safe for many ICU patients in other settings. The case mix, plagued by the limitation of a small sample size, was heavily skewed towards trauma patients (n=11) and patients with sepsis (n=18), further limiting the generalizability across diverse ICU patient populations.

Notwithstanding the significant limitations, this work stands as yet another example of how ultrasound might be used in the ICU as a safer and cheaper alternative to other diagnostic modalities. Training, equipment acquisition and quality control remain significant concerns that must be addressed before ultrasound can be reliably used in place of an established “gold standard” such as chest CT.

Concise Critical Appraisal is a regular feature authored by SCCM member Samuel M. Galvagno Jr., DO. Each installment highlights journal articles most relevant to the critical care practitioner.

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.
Moore

 

 

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.

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