England Sees Improvement After Investing in ICU Changes

Survival rates of patients in intensive care have jumped in England since the government boosted spending and reformed critical care services, according to a study published in the British Medical Journal. The Department of Health invested £300 million in 2000 to help fund a 35% increase in beds as well as to implement outreach services and adopt clinical guidelines. The move cut the risk of mortality in critical care units by 11.3% and reduced hospital mortality rates by 13.4%. The cost effectiveness of critical care also increased after 2000, partly as a result of outcomes improvements and smaller increases in the average length of stay. Read more from Reuters.

Looking for guidelines to improve care in your intensive care unit? All of the American College of Critical Care Medicine guidelines are available at LearnICU.org.

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Study Investigates New Pulmonary Embolism Thrombolysis

Researchers at Stanford have shown catheter-directed thrombolysis to be an effective procedure in first-line treatment for pulmonary embolism (PE). A meta-analysis published in the Journal of Vascular and Interventional Radiology found that, between 1990 and 2008, the procedure was successful in 86.5% of 594 patients who were at risk of dying of PE. Catheter-directed thrombolysis appeared effective and safer than injecting the high-dose thrombolytic drug into the bloodstream, which can cause bleeding in up to 20% of patients. By targeting blood clots directly, the catheter-based procedure was associated with only a 2.4% chance of major complications.

Lead author William Kuo, MD, recalled the catalyst for the study, a patient whose life was saved with this experimental treatment. "The patient was by far the sickest I had ever seen on my angiography table," he said. "She couldn't breathe on her own. She was barely alive. There was no time to waste." He made a small incision in the patient's neck, inserted a catheter and used fluoroscopy to navigate through the heart and reach the blood clots within the lungs. He injected clot-busting medicine directly into the clots, then using the catheter to break up and suction them out. "That one case changed my views on the existing treatment algorithm for this deadly disease, and I suddenly realized the limited options available for life-threatening pulmonary embolism,” Kuo noted. The results were immediate. The patient's oxygenation improved, her blood pressure started to rise.

Medpage Today also reported on a study published in Annals of Internal Medicine, which showed hand-held computers and decision-support software can improve PE diagnosis in the emergency department.

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Get the First Articles from CCM's H1N1 Supplement

A supplement to Critical Care Medicine focused on H1N1 influenza will be released next year, but open-access article proofs are being posted online as they become available, ensuring clinicians receive this information as soon as possible. Read the first supplement article available, "Infection control in mass respiratory failure: Preparing to respond to H1N1."

In addition to the many resources available at www.sccm.org/H1N1 look for the Society of Critical Care Medicine to unveil a comprehensive online course aimed at educating multiprofessional, multidisciplinary non-critical care professionals on preparing for and responding to the anticipated surge in critically ill patients with influenza. The course, Critical Care Cross-Training of Hospital-Based, Non-ICU Healthcare Professionals, will cover core elements of critical care support, include pediatric-specific critical care considerations, and provide guidance on how to operate mechanical ventilators from the U.S. Strategic National Stockpile.

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ISCCM Preparing a New Critical Care Workforce

The Nagpur chapter of the Indian Society of Critical Care Medicine (ISCCM) recently was featured in the The Times of India for the group’s efforts to launch a new, hands-on critical care training program for resident and junior physicians, nurses and other members of the multiprofessional team. For many, this will be their first exposure to such training, as critical care management courses usually are not included in the Indian curriculum at the undergraduate or postgraduate levels.

The Society of Critical Care Medicine (SCCM) has been working with ISCCM for several years to improve critical care in India, most notably through the Fundamental Critical Care Support (FCCS) program. ISCCM has trained thousands of healthcare professionals throughout India with the course. The Mumbai chapter of ISCCM also held the country’s first Fundamental Disaster Management (FDM) course in September, and FDM and FCCS courses will be held in conjunction with the ISCCM annual meeting in February.

ISCCM leaders Jigeeshu V. Divatia, MD, and Rajesh Chawla, MD, FCCM, both serve on SCCM's Congress Program Planning Committee and will meet with SCCM leadership during Congress to discuss future endeavors.

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AMA House of Delegates Address EOL, Healthcare Reform

The American Medical Association’s House of Delegates last week met for its interim meeting to discuss the ongoing healthcare system debate. Representatives from the Society of Critical Care Medicine attended the meeting, where AMA President J. James Rohack, MD, reiterated the group’s support for the latest bills making their way through Congress, the Affordable Health Care for America Act and the Medicare Physician Payment Reform Act of 2009. Rohack noted the perceived shortcomings of the Affordable Health Care for America Act, namely its lack of coverage for everyone and concerns about access. He stressed that the AMA would continue to advocate for changes as the legislative process moves forward.

Of particular interest to the critical care community were proposed resolutions around decisions involving futile care and end-of-life discussions. The House of Delegates voted not to adopt these measures. Delegates stressed the need for protection when dealing with futile care decisions and conversations, but argued that legislation was not an effective or appropriate mechanism for resolving such issues. Ethical concerns about patient autonomy as well as the ambiguity of “futility” and its definition prevented the resolution’s passage. Delegates also noted that the value of end-of-life care discussions, such as advance directives and medical orders for life-sustaining treatment, lie in making patients' wishes known and accessible to family members and to all care providers. Keeping discussions private could undercut the fundamental goal of advance care planning. Several highlights from the House of Delegates meeting are available online.

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Experience the Complete Congress Package

Pre-register for the Society of Critical Care Medicine’s (SCCM) 39th Critical Care Congress by December 10, 2009. The five continuous days of educational sessions, hands-on workshops, interactive debates, and networking opportunities will provide you with effective solutions to the everyday challenges facing you and your team. Explore opportunities to make powerful advances in critical care while learning alongside other members of the multiprofessional team during these popular Congress sessions:

Pre-Congress Educational Sessions
Arrive at Congress early and participate in pre-Congress educational sessions. Each course is packed with essential clinical information to keep you well informed on various critical care topics. Three new postgraduate courses will debut this year:

• Intensivists as Educators: Developing an Accreditation Program and Surviving the Accreditation Process
• Managing Pharmacotherapeutic Challenges: Learning Through Simulation


• Commit - Transform - Improve: Critical Care Quality Tools and Techniques

Sponsored Symposia
Learn about clinical breakthroughs and advances that lead to better patient care during the stimulating discussions of sponsored symposia. Sessions are presented by leading experts in critical care and are complimentary for all Congress registrants.

Exhibit Hall
One of the world’s largest critical care exhibitions, the exhibit hall features more than 150 companies showcasing the latest technologies, products, services, and career opportunities available to critical care practitioners.

Access the complete Congress program to learn about all activities and events available during this year's Congress, to be held January 9 to 13, 2010, in Miami Beach, Florida, USA.

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Make a Sweet Escape: Attend the Post-Congress Conference

Enjoy an extended Congress by attending the Post-Congress Conference, Hyperglycemia and Critical Illness: Adaptive Response or Therapeutic Opportunity?, to be held in Key West, Florida, USA. A faculty of international experts will present a pro/con debate on the Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) Study. The meeting also will feature case studies on insulin protocols and nutritional guidelines as well as interactive debates on glucose variability and achieving glycemic control. Audience participation will be encouraged to enhance the overall learning experience.

Pre-register by December 10, 2009, and make housing reservations at the luxurious Casa Marina Resort and Beach Club by December 4, to take advantage of the best rates.

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