Permissive hypercapnia is a well-accepted ventilator strategy for the management of acute respiratory distress syndrome as well as other causes of respiratory failure, such as the respiratory distress syndrome seen in premature infants. Multiple studies have demonstrated that both myocardial contractility and systemic vascular resistance (SVR) decrease with hypercapnic acidosis, the ultimate effect being that cardiac function is maintained or even augmented. The effects of hypercapnic acidosis on cardiac function in the preterm infant have not been elucidated. In a prospective observational study, published in the May issue of The Journal of Pediatrics, the authors analyzed paired blood gasses and echocardiograms from 29 hemodynamically stable preterm infants at 30 weeks gestation
Samples were taken within the first two weeks of life, either during the transitional period (days 1-3) or post-transitional period (days 4-14). In all, there were 103 paired blood gasses and echocardiograms from 21 subjects in the transitional period and 44 paired studies from 15 subjects in the post-transitional period. During the transitional period, pH and PaCO2 had no effect on any of the hemodynamic measures, including shortening fraction, stress-velocity index, or SVR. However, during the post-transitional period, the infants’ hemodynamics resembled those seen in adult patients. The results of the study demonstrated differences in the way the older infants responded to acidosis and hypercapnia. Read the full Concise Critical Appraisal.
The recently revised Surviving Sepsis Campaign (SSC) guidelines identify triage in the emergency room as “time zero,” starting the clock on measuring compliance with the bundle elements. This measurement is central to the Campaign’s goals of performance improvement and mortality reduction. When determining patient eligibility for the three- and six-hour bundles, clinicians must understand the rationale for establishing triage as time zero and recognize how to implement the bundles in various scenarios.
During the Society of Critical Care Medicine’s (SCCM) April 23 webcast, The New Surviving Sepsis Campaign Bundles: From Time Zero to Tomorrow, senior leaders of the Surviving Sepsis Campaign will focus on the revised SSC bundles and the rationale for the changes. Additionally, they will highlight ongoing research efforts that are dependent upon the data from bundle implementation.
This event, part of SCCM’s newest webcast series, provides strategies for successful application of the SSC guidelines. An initiative of the European Society of Intensive Care Medicine (ESICM) and SCCM, the SSC aims to improve the management, diagnosis and treatment of sepsis in order to reduce its high mortality rate.
Register online today. Registration is complimentary for all participants. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.
As May approaches, it is time for intensive care unit (ICU) teams to consider how they will celebrate National Critical Care Awareness and Recognition Month (NCCARM). ICUs mark this special month in various ways, from sharing blue treats with staff or providing educational symposia, staff recognition ceremonies, or ICU tours. Other units invite former patients and their families to meet staff and share their progress.
Regardless of how you celebrate NCCARM this year, be sure you wear blue on Friday, May 17, 2013, and share your stories and photos with the Society of Critical Care Medicine. Your stories will inspire other ICUs as we all celebrate the extraordinary contributions of our critical care colleagues in May.
The Society of Critical Care Medicine’s (SCCM) Nominating Committee is seeking candidates for the 2014 election. Council terms are for three years, and both at-large and designated seats are open. Elections for designated seats are staggered to allow for a sustained experience and memory of Council deliberations, as well as to promote fresh perspectives in the governance of the Society.
The following 2014 seats are open for nomination:
- Designated Seat – Nursing
- Designated Seat – Pediatrics
- At-Large Seat #1
- At-Large Seat #2
The Nominations Policy suggests that each section should nominate at least two and (usually) no more than three willing candidates to fill a designated seat. Nominations for the designated seats will also be entertained from the general membership. Nominations for the at-large seats can be submitted by the specialty sections or general membership.
Complete the online nominations form as soon as possible, but no later than May 1, 2013.
Questions can be directed to Diana Hughes, CAE, at email@example.com.
There is still time to join the Society of Critical Care Medicine’s Creative Community. Participation is one of the most important contributions a member can make in helping the Society achieve its mission and vision. Applications to join are due May 1, 2013. Please note that reappointment to a committee is not automatic. If you are already a committee or task force member and your term is about to expire, you will need to reapply.
Members of the Creative Community not only play an active role in Society activities and initiatives, they also gain leadership skills and networking opportunities. Visit the Creative Community Resource Center for more information.
A new bird flu virus, influenza A (H7N9), has killed or critically stricken patients in China. Genetic evaluation of the virus shows it has the ability to mutate readily.
The World Health Organization notes, “analysis of the genes of these viruses suggests that although they have evolved from avian (bird) viruses, they show signs of adaptation to growth in mammalian species.” So far, H7N9 has not been found to be transmissible from human to human; those who’ve contracted it have had contact with poultry.
The Centers for Disease Control and Prevention has developed a diagnostic test, advising clinicians to be on the lookout for H7N9 in “patients with respiratory illness and an appropriate travel or exposure history.” Most of the people identified with the new bird flu have had symptoms of severe pneumonia such as chest congestion, difficulty breathing, fever, and severe cough. The Society will continue to monitor this situation and will keep members abreast of any new information.
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.
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.
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:
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.
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 firstname.lastname@example.org.
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.
A 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.