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Critical Care Medicine: October 4, 2021
Since the publication of the Surviving Sepsis Campaign guidelines, the focus has been on sepsis management, early identification, and treatment. (Evans L, et al. Crit Care Med. 2021;49:e1063-e1143). As more patients are surviving sepsis, they may be left with short- and long-term problems that need to be addressed. Host Ludwig H. Lin, MD, is joined by Christa A. Schorr, DNP, MSN, RN, FCCM, to discuss the implementation of initiatives for preventing impairments due to sepsis. They will also discuss the challenges faced by survivors of sepsis and the difficulties of matching care to the patient’s and family’s goals of care. In addition to the challenges of physical rehabilitation, patients often are uncertain about how care is coordinated to promote recovery and avoid complications and recurrence. Christa Schorr is a clinical nurse scientist at Cooper Hospital University Medical Center in Camden, New Jersey, USA.
Because COVID-19 can create a status of systemic inflammation, which can affect multiple organs, including the kidneys, the adjuvant therapy of blood purification has gained some recognition. Host Pamela Peeke is joined by Javier Neyra to discuss clinical cases and the use of extracorporeal blood purification in COVID-19 patients (Rosalia R, et al. Blood Purif 2021. doi: 10.1159/000515627). Dr. Javier Neyra is an Acute Care Nephrology and CRRT Program and Assistant Professor at the University of Kentucky Medical Center in Lexington, Kentucky. This podcast is sponsored by Baxter.
Learn about the importance of utilizing dynamic assessments of fluid responsiveness to guide treatment in patients with viral sepsis, including COVID-19, and understand how they can be used to help improve patient outcomes in sepsis patients. Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Patrick Troy, MD, to discuss how only 50% of hemodynamically unstable patients are fluid responsive and that the same treatment paradigm in fluid management applies to both viral sepsis and COVID-19 patients (Douglas IS, et al. Chest. 2020;158:1431-1445; Latham H, et al. J Crit Care. 2017;42:42-46). This podcast is sponsored by Baxter. Patrick Troy M.D., is the Division Director Pulmonary Critical Care and Sleep Medicine Physician at Hartford Hospital, Assistant Professor of Clinical Medicine at the University of Connecticut School of Medicine.
Ludwig Lin, MD, speaks with Daniel E. Leisman, BS, about the article, “Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort,” published in Critical Care Medicine. Mr. Leisman addresses the controversy of the role of fluids in management of sepsis. Study findings showed that earlier crystalloid initiation was associated with better patient outcomes, including decreased mortality, mechanical ventilation, ICU utilization, and length of stay. Comorbidities and severity did not modify this effect. Mr. Leisman is a clinical researcher in the Department of Emergency Medicine at Hofstra-Northwell School of Medicine, and MD/MSCR candidate at Mount Sinai School of Medicine in New York, New York. Crit Care Med. 2017; 45(10):1596-1606. Released: 1/11/18
Margaret Parker, MD, MCCM, speaks with Clifford S. Deutschman, MD, FCCM, about his talk, “Sepsis Redefined: Why Do We Need a New Definition?” presented at the 2016 Critical Care Congress in Orlando, Florida. Dr. Deutschman is Vice Chair of Research in the Department of Pediatrics, and Professor of Pediatrics and Molecular Medicine at Steven and Alexandra Cohen Children’s Medical Center in New Hyde Park, New York. He also serves as Director of the Center for Pediatric Research at Feinstein Institute for Medical Research in Manhasset, New York.
The Society of Critical Care Medicine’s Immediate Past-President, Craig Coopersmith, MD, FACS, FCCM, discusses the new sepsis definitions published in JAMA and unveiled during the 45th Critical Care Congress. Dr. Coopersmith is considered a leading expert in the field of sepsis and offers an in-depth analysis of newly published sepsis definitions, which were endorsed by more than 30 organizations representing a wide spectrum of professionals who identify and manage sepsis. Dr. Coopersmith is a Professor of Surgery, as well as Director of the Surgical/Transplant ICU and Associate Director at Emory Center for Critical Care. He also serves as Vice Chair of the Department of Surgery at Emory University School of Medicine in Atlanta, Georgia. “The Third International Consensus Definitions for Sepsis and Septic Shock” by Mervyn Singer et al was released by JAMA on February 22 in conjunction with the Joint SCCM/ESCIM Session: Sepsis Redefined. It was accompanied by several other JAMA and Critical Care Medicine articles meant to provide a conceptual framework to help patients, clinicians, researchers and hospitals apply the new definitions.
Use of Procalcitonin (PCT) for the diagnosis of infection has been studied extensively with conflicting results, in part because of the many different populations and clinical syndromes studied. This variability prompted Steven Reynolds, MD, FRCPC, and colleagues to report PCT values relative to baseline patient characteristics, ICU length of stay, infectious status and infecting organism. Jeffrey Guy, MD, delves into the conclusions of this article, “Longitudinal changes in procalcitonin in a heterogeneous group of critically ill patients,” with specific focus on why PCT is important when managing patients with suspected sepsis. Reynolds is a clinical assistant professor in the Department of Medicine at the University of British Columbia in Vancouver, British Columbia, Canada. Published: Crit Care Med. 2012 Oct;40(10):2781-7
Marin H. Kollef, MD, is lead author of an article published in the March 2011 Critical Care Medicine titled, “Implementation of a Real-Time Computerized Sepsis Alerts In Nonintensive Care Unit Patients.” Dr. Kollef is a professor of medicine at the Washington University School of Medicine in St. Louis. He is also the director of both the medical intensive care unit and respiratory care services at Barnes-Jewish Hospital.
Leticia Castillo, MD, FCCM, assistant professor at Baylor College of Medicine in Houston, Texas, discusses an article published in Pediatric Critical Care Medicine, “Secondary HLH and Severe Sepsis/Systemic Inflammatory Response Syndrome/Multiorgan Dysfunction Syndrome/Macrophage Activation Syndrome Share Common Intermediate Phenotypes on a Spectrum of Inflammation.”
Margaret Parker, MD, FCCM, discusses her article published in the January 2009 issue of Critical Care Medicine, titled “An International Survey: Public Awareness and Perception of Sepsis.” Parker is a professor of pediatrics, medicine and anesthesia at Stony Brook University in Stony Brook, New York. She is also the director of the pediatric intensive care unit at Stony Brook University Medical Center. Parker serves as the SCCM guest editor for pediatric podcasts and is an associate editor for Critical Care Medicine.
In 2001 a sepsis definitions conference was held to determine whether new data existed to inform updates to the sepsis criteria established in 1991. Afterward, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) announced plans to launch the Surviving Sepsis Campaign (SSC) with the goal of reducing mortality from sepsis by 25%. Given the prominence of sepsis and septic shock as emergency conditions, it is worthwhile to review how care has evolved to its current format and the future directions it may take.
The Assessment of Implementation of Methods in Sepsis and Respiratory Failure (AIMS) study seeks to determine the safest, most effective approach to sepsis intervention.
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.
Margaret M. Parker, MD, MCCM, and Jerry J. Zimmerman, MD, PhD, FCCM, talk about the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. This discussion is based on two articles Dr. Zimmerman recently published in Critical Care Medicine, Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock (Zimmerman J, et al. Crit Care Med. 2020;48(3):319-328) and Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock (Zimmerman J, et al. Crit Care Med. 2020;48(3):329-337). Dr. Zimmerman is professor of pediatrics and anesthesiology and a faculty member and emeritus division chief of pediatric critical care medicine at Seattle Children's Hospital, Harborview Medical Center, and University of Washington School of Medicine in Seattle, Washington, USA. He has received research funding from National Institutes of Health, Immunexpress, and Seattle Children’s Research Institute, royalties from Elsevier Publishing as co-editor for Pediatric Critical Care, and travel reimbursement from SCCM.
Margaret M. Parker, MD, MCCM, and Scott L. Weiss, MD, FCCM, discuss the release of "Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children," published in the February 2020 issue of Pediatric Critical Care Medicine (Weiss S, et al. Pediatr Crit Care Med. 2020;21(2);e52-e106). Dr. Weiss outlines the differences between the new pediatric Surviving Sepsis Campaign (SSC) guidelines and the 2017 “American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock” (Davis AL, et al. Crit Care Med. 2017;45:1061-1093), as well as key differences from the “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016” (Rhodes A, et al. Crit Care Med. 2017;45:486-552). The challenges in implementing the pediatric guidelines in resource-limited areas and key recommendations for resuscitation of children with sepsis and septic shock are also covered. Dr. Weiss has served as the SCCM-appointed co-vice-chair of the SSC Guidelines Task Force. He is an attending physician at the Children’s Hospital of Philadelphia.
Margaret M. Parker, MD, MCCM, and Mitchell M. Levy, MD, MCCM discuss the Hour-1 Bundle, the controversies of the Surviving Sepsis Campaign, and the future of sepsis. Drs. Parker and Levy go beyond the bundle to talk about the challenges of the Campaign from data entry to resistance from physicians, sepsis in resource limited countries, and spreading quality improvement worldwide. Dr. Levy is professor of medicine and chief of pulmonary and critical care at Brown University in Providence, Rhode Island, USA. This podcast is part 5 of a series sponsored by Baxter Healthcare Corporation.
Ludwig H. Lin, MD, and Philipp Schuetz, MD, discuss procalcitonin and how it impacts treatment of sepsis. This podcast originated from the article "Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis" (Iankova I, et al. Crit Care Med. 2018;46:691-698). Dr. Schuetz is a professor of internal medicine, endocrinology, diabetes, and metabolism at the University of Basel in Basel, Switzerland. This podcast is sponsored by Thermo Fisher Scientific.
Margaret Parker, MD, MCCM, speaks with Joseph A. Carcillo, MD, about the article, "American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock," published in the June 2017 issue of Critical Care Medicine. Dr. Carcillo the revisions made to the 2014 guidelines and recommendations regarding use of 1) a “recognition bundle” containing a trigger tool for rapid identification of patients with septic shock, 2) a “resuscitation and stabilization bundle” to help adherence to best practice principles, and 3) a “performance bundle” to identify and overcome perceived barriers to the pursuit of best practice principles. Dr. Carcillo is a professor of Anesthesia, Critical Care Medicine, and Pediatrics at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. Crit Care Med. 2017; 45(6):1061-1093. Published: 6/7/2018
Ranjit Deshpande, MD, speaks with James A. Russell, MD, about the article, “The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial Experience,” published in the June 2017 issue of Critical Care Medicine. Dr. Russell discusses findings from his retrospective analysis of the Vasopressin and Septic Shock Trial (VASST) using the Septic Shock 3.0 definition, and implications for trial design in septic shock. Dr. Russell is a professor of medicine at the University of British Columbia, and principal investigator at the Centre for Heart Lung Innovation at St. Paul’s Hospital in Vancouver, BC, Canada. Crit Care Med. 2017; 45(6):940-948. Released: 11/16/17