SCCM - Society of Critical Care Medicine

Message from the President

Making a Difference Locally Requires Thinking Globally

Mitchell M. Levy, MD, FCCM
Professor of Medicine
Director, Medical ICU
Brown University School of Medicine
Rhode Island Hospital
Providence, Rhode Island, USA

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Having recently returned from the World Federation of Societies of Intensive and Critical Care Medicine’s quadrennial meeting, I remain impressed with the caliber of research and practice that was reported from all parts of the globe. Clearly, standards of practice have risen to new heights internationally and the messages I’ve presented all year about being a good caregiver are not confined to a given location. Participating in the World Federation meeting in Florence and communicating with the Society of Critical Care Medicine’s (SCCM) sister societies in China, Korea and India, I have become increasingly aware of the importance and potential impact of the global critical care community.

Accountability has no borders. As I said in my previous president’s messages, we owe it to our patients and ourselves to take responsibility and be accountable for the quality of care we offer our vulnerable, critically ill and injured patients. Through our global partnerships and the depth of communication and insight that is established as a result, cultural differences that present themselves during the care of intensive care unit (ICU) patients around the world can be identified and addressed.

Knowledge translation is not one-dimensional. While the individual physiologic variability of patients must be understood and appreciated when applying therapies in the ICU, cultural, regional and national influences also play an important role in the way patients get sick and how they react to illness and the therapies we offer. For example, cultural differences play a huge role in our ability to facilitate appropriate end-of-life decision making in the ICU. The understanding of these cultural and global differences is crucial to our ability to provide the highest level of critical care, which all our patients deserve.

We often describe wide differences in clinical practice as potentially detrimental to patient care, but it is extremely important to take into account how much of that practice variation may be accounted for by regional and cultural differences. We may still find best practice models that transcend cultural and national barriers. And perhaps we may find that, just like language, best practice models require translation.

Our job as ICU caregivers is to examine closely the ability of best practice models to transfer across cultures and to appreciate the inevitable variability that will arise based on individual cultural differences. Our ability to do this properly will be based on the dialog that arises through fostering discussion in the global community of critical care practitioners. If we have any question about the global nature of our critical care world, consider just these few examples of how SCCM provides its members a plethora of opportunities to take part in the global conversation.

Members of SCCM come from 85 countries throughout the world, allowing a global dialog through SCCM’s Critical Care Forums, Facebook and other networking tools.

The ability to gain knowledge from around the world is presented in SCCM’s prestigious journals, Critical Care Medicin (CCM) and Pediatric Critical Care Medicine (PCCM). In 2008, two-thirds of the 1,798 manuscripts submitted to CCM were from authors outside North America. Authors from 53 countries – including 84 from China, 52 from Brazil and 138 from France – sent in papers for consideration for publication in CCM. And of the 167 original articles received by PCCM, authors represented 27 countries from six continents. Further, PCCM provides translated abstracts of articles in each issue in six languages.

Evidence-based guidelines developed by the American College of Critical Care Medicine provide evaluation and recommendations based on global literature reviews.

The Surviving Sepsis Campaign, of which SCCM was one of three organizing societies, is a performance improvement effort that, as of the end of 2008, included representatives from more than 250 sites in 18 countries. Its listserv, newly revised Web site, and published results offer global insight into patient care.

SCCM’s Fundamental Critical Care Support program and its related courses – Pediatric Critical Care Medicine and Fundamental Disaster Management – are offered throughout the world with course consultants currently active in 18 countries. FCCS is translated into four languages.

These are only some of the opportunities SCCM provides members to participate in the international critical care community. Perhaps SCCM’s upcoming 39th Critical Care Congress provides the best venue – a multiprofessional, multicultural forum in which global practitioners of intensive care medicine can network, compare notes, examine cultural differences and debate face-to-face regarding where differences are valuable and where standardization of care across cultures will lead to improved outcomes for critically ill patients across the globe. What better setting to have this multicultural conversation than Miami? Miami is truly an international city, and to say that it is multicultural would be an extreme understatement. The language, the food and the flavors of Miami are a testament to this fact. Come celebrate our similarities and differences at the meeting beginning on January 9.

When we come together in Miami in January, critical care practitioners from across the globe will hone their skills together in the ongoing search to identify the best practice for our critically ill and injured patients. As I have said, it is important to recognize the potential impact of culture and national differences on best practice models. At the same time, the pursuit of high-quality patient care is not solely a question of language and culture; it is also a question of physiology. We all must remember that physiology is the ultimate equalizer. Disease and death don’t recognize geographic boundaries; it is important for us to demonstrate our deep respect for individual cultural differences simultaneously with an appreciation for the ultimate commonality of physiology.