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Concern over the 2019 novel coronavirus (2019-nCoV) is growing. It is vital that those on the frontlines be prepared. This article highlights several strategic goals and special considerations related to caring for a critically ill patient who can transmit a deadly disease to you, your staff, or others in your hospital.
Procalcitonin testing on admission seems to be a valuable piece of information for early risk assessment and ruling out bacterial co-infection in COVID-19 patients. Host Pamela M. Peeke, MD, MPH, is joined by Michael Broyles, PharmD, and Eric H. Gluck, MD, to explore this topic. Dr. Broyles is director of pharmacy and laboratory services at Five Rivers Medical Center in Pocahontas, Arkansas, USA, and Dr. Gluck is director of critical care services at Swedish Covenant Chicago in Chicago, Illinois, USA. This podcast is sponsored by Thermo Fisher Scientific.
Kyle B. Enfield, MD, and Paula Ferrada, MD, discuss Dr. Ferrada's talk from the 48th Critical Care Congress titled "Clostridium difficile: Sparring With Spores." Current treatment recommendations and surgical options are discussed. Dr. Ferrada is professor of surgery, surgical and trauma ICU medical director, and surgical critical care fellowship director at Virginia Commonwealth University in Richmond, Virginia, USA. This podcast is supported by an unrestricted educational grant provided by Merck & Co., Inc.
Ludwig Lin, MD, speaks with Colin R. Cooke, MD, about the article, “The Burden of Influenza-Associated Critical Illness Hospitalizations,” published in the November 2014 issue of Critical Care Medicine. Dr. Cooke is an Assistant Professor of Pulmonary Critical Care Medicine in the Department of Medicine at the University of Michigan in Ann Arbor, Michigan. In this article, Dr. Cooke and coauthors use mathematical modeling and data to examine seasonal influenza and its relationship to critical illness hospitalizations.
Adam Keene, MD, MS, discusses his paper published in the January 2010 issue of Critical Care Medicine, titled “The Use of a Critical Care Consult Team to Identify Risk for Methicillin-Resistant Staphylococcus aureus Infection and the Potential for Early Intervention: A Pilot Study.” Keene is an assistant professor of medicine at the Albert Einstein College of Medicine and a medical intensivist working primarily in the medical ICU at Montefiore Medical Center in the Bronx, New York.
Naomi O'Grady, MD clarifies the strain of the current virus, discusses the difference between a pandemic and an epidemic, and outlines the prescription therapies available specific to H1N1 Influenza. O'Grady is a senior staff physician in the Clinical Center's Critical Care Medicine Department and the medical director of the department's Vascular Access and Conscious Sedation Services at the National Institutes of Health. She also is an attending physician with the Pediatric Critical Care Medicine Department of the Children's National Medical Center and an assistant professor in the Department of Internal Medicine's Division of Infectious Diseases at Johns Hopkins University School of Medicine. This podcast is the third in a series focused on the H1N1 Influenza outbreak.
John H. Beigel, MD, clarifies the definition of influenza and discusses the evolution of viruses, speculation on the mode of transmission and the role of vaccines and therapies as they relate to H1N1 Influenza. The conversation references his recent publication in Critical Care Medicine (Beigel JH. Influenza. Crit Care Med. 2008; 36:2660-2666). Beigel is Director of Clinical Research at MacroGenics, Inc. in Rockville, Maryland, and a volunteer consultant at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. This podcast is the second in a series focused on the H1N1 Influenza outbreak.
Randy S. Wax, MD, discusses the current outbreak of H1N1 Influenza, the triage protocol for critical care during an influenza epidemic, the public's role in taking necessary precautions, and educational resources that are available. The background materials cited in this podcast can be found online at Christian MD, Hawryluck L, Wax RS et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175;1377-1381 and the International Society for Infectious Diseases. Wax is an intensivist at Mount Sinai Hospital in Toronto, Ontario, Canada, and Assistant Professor of Medicine at the Faculty of Medicine, University of Toronto. He has multiple areas of expertise, including disaster management. This podcast is the first in a series focused on the H1N1 Influenza outbreak.
Peter Pronovost, MD, PhD, FCCM, discusses his article published in the December 28 issue of the New England Journal of Medicine, titled "An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU." Dr. Pronovost and researchers showed through this study that simple measures, such as hand washing, can have a dramatic effect in reducing bloodstream infections. They focused on improved teamwork between doctors, nurses and other intensive care unit professionals, collecting data from 103 Michigan hospitals for up to 18 months.
Vera De Palo, MD, outlines several common questions healthcare professionals should consider to help prevent catheter-related bloodstream infections in the ICU. Her article "Catheter-Related Bloodstream Infections: Can We Make it Safer For Our Patients?" appears in the April 2006 issue of Critical Connections. Dr. DePalo is associate chief of medicine and director of critical care at Memorial Hospital of Rhode Island. She also is an associate professor of medicine at Brown Medical School.
The Society of Critical Care Medicine (SCCM) has compiled and developed resources on what clinicians need to know about mpox (formerly monkeypox). While mpox is usually a self-limited disease with symptoms lasting two to four weeks, severe cases and death have occurred during the current outbreak, so it is important for critical care clinicians to recognize potential mpox infections. Visit SCCM’s mpox web page for additional details.
Does delaying antibiotic treatment in patients with bloodstream infections have an effect on mortality? This Concise Critical Appraisal reviews a study on the impact that time-to-appropriate antimicrobial treatment has on 30-day mortality in adult patients with bloodstream infections.
This Concise Critical Appraisal explores a Lancet Respiratory Medicine article by Ramanathan et al, which outlines how to plan for extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress syndrome (ARDS) related to COVID-19. ECMO is a complex therapy usually restricted to specialized centers. World Health Organization guidelines suggest that carefully selected patients with ARDS may benefit. The authors explore how good planning can help during outbreaks of emerging infectious diseases.
Critical care teams should consider using remdesivir to treat patients with severe acute SARS-CoV-2 infection, but supply of the drug is limited and best practices for maximizing its effectiveness are not completely understood.
Severe COVID-19 infection can be a form of viral sepsis with occasionally concomitant bacterial infection. Pamela M. Peeke MD, MPH, FACP, FACSM, is joined by Russell Miller, MD, MPH, FCCM, to discuss the definition of sepsis and overlap with case descriptions of patients with severe COVID-19, how experience with viral sepsis can be leveraged to diagnose and treat COVID-19 patients being admitted to ICU, and the need to be able to differentiate viral from bacterial sepsis to avoid over or under treatment. Dr. Miller is medical director of critical care at FirstHealth of the Carolinas in Pinehurst, North Carolina, USA. This podcast is sponsored by Immunexpress.
COVID-19 is associated with a high prevalence of coagulopathy and venous thromboembolism. Host Kyle B. Enfield, MD, FCCM, talks with Jerrold H. Levy, MD, FAHA, FCCM, about what clinicians need to know about this serious problem and how it impacts care delivery (Iba et al. Crit Care Med. 2020;48:1358-1364). Dr. Levy is professor of anesthesiology, critical care professor of surgery (cardiothoracic), and codirector of the cardiothoracic ICU at Duke University Hospital in Durham, North Carolina, USA. This podcast is sponsored by BioFire.
The increase in acute kidney injury in COVID-19 patients is resulting in more utilization of renal replacement therapy (RRT) and continuous renal replacement therapy (CRRT). Host Pamela M. Peeke, MD, MPH, FACP, FACSM , is joined by Michael J. Connor Jr, MD, to review RRT utilization and best practices in COVID-19, what hospitals are doing to prepare for a surge in RRT, and how to mitigate anticoaguability in CRRT. Dr. Connor is associate professor of medicine in critical care medicine and nephrology at Emory University in Atlanta, Georgia, USA. This podcast is sponsored by Baxter Healthcare.
Alternative strategies are needed to combat and prevent antibiotic-resistant bacterial infections. Host Ashish K. Khanna, MD, FCCP, FCCM, talks with David R. Cameron, PhD, about the potential for bacteriophage prophylaxis in the context of experimental ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus in rats (Prazak J, et al. Crit Care Med. 2020;48:1042-1046). Dr. Cameron is research group leader in the department of intensive care medicine at Inselspital, Bern University Hospital in Bern, Switzerland.
Clinicians are working to understand and formulate an effective treatment for COVID-19-associated acute respiratory distress syndrome (Marini J. Crit Care Med. 2020 May 13; Epub ahead of print). Host Kyle B. Enfield, MD, FCCM, discusses specifics with John J. Marini, MD. They also discuss the need to continue sharing clinical data, experience, and ideas. Dr. Marini is director of physiological and translational research at Regions Hospital in Saint Paul, Minnesota, USA.
The National Institutes of Health has released Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. SCCM members Craig M. Coopersmith, MD, FACS, MCCM; Amy L. Dzierba, PharmD, FCCP, BCCCP; and Greg S. Martin, MD, MS, FCCM, served on the guidelines development panel after being invited by Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases. They talk with host Margaret M. Parker, MD, MCCM, about the major critical care recommendations, how these guidelines differ from the Surviving Sepsis COVID-19 guidelines, future updates, and more.