April 2012 - Society of Critical Care Medicine

Society of Critical Care Medicine - Texas Chapter
Critical Care Corner
Society of Critical Care Medicine Texas
President’s Message
Brad Domonoske, Pharm. D., BCPS
Upcoming Educational
Houston - April 18
Dallas/Fort Worth - April 24
San Antonio - TBD
For complete program details,
go to the Chapter Events page
Communications Update,
Requests for Volunteers,
GOALS for 2012
2012 & 2013 Critical
Care Congress Updates
TSCCM Election Winners
Alan Fields Award Winners & Abstracts
I would like to welcome everyone to a new year in our chapter,
a year in which we continue to grow. Before I share the goals
for the year, I would like to recognize some of the accomplishments made last year under Past-President, Clarence Finch’s
leadership. Last year saw the continued growth in the Dallas
area to where they will now have monthly educational meetings
instead of bi-monthly meeting. The Chapter expanded into the
San Antonio area. It was exciting to be among the initial attendees in that area and see the interest in the chapter. The Chapter, after receiving a record number of applications, awarded
prestigious Alan Fields Award Scholarship Grants to two very
deserving groups of professionals who continued improvements in the care of critically ill patients. For the first time in SCCM history, SCCM
Central collaborated with a state chapter to assist with the hosting of the National
Congress. Because of the relationship, new ideas were implemented during the past
Congress in Houston, such as tours of the local medical facilities in the Texas Medical Center and the use of local healthcare trainee volunteers to increase interest in
critical care. Both endeavors were very successful and SCCM Central had nothing but
praise for the efforts of the Texas Chapter. The first chapter reception at the National
Congress was a success as well. The Chapter has a strong commitment to its members and to critical care. The annual goals set forth for the Chapter reflects the Chapter’s mission of providing its members with educational opportunities, professional
resources and a chance for networking with other critical care professionals from
across the region in order to improve the quality of critical care.
Host the 1st annual Critical Care Symposium this fall.
Continue growth in the San Antonio and Dallas areas
Continue growth in the greater Houston area by expanding the locations of
the monthly educational programs
Want to get involved?
Check out page 2 for what we have to offer ad who to contact!
SCCM Texas Chapter
Communications Committee
Chair: Michelle Galvan, RN BSN, CCRN
Have you checked out the Members Only page online? From the homepage, click on
MEMBER LOGIN. You will then be prompted to enter a username and password:
Username: texaschapter
Password: sccm
From there you will be able to see when your Texas chapter membership expires* and join
our Forum. Start a thread today!
I also want to thank Don Foronda for managing the Facebook account. He regularly posts
interesting articles and information regarding our meetings. He and Janinie Mazabob have
also been very dedicated about posting pictures from chapter events on our page. Be sure
to look us up on Facebook to see what you are missing!
*Please note that the Membership Committee updates the membership list once every quarter.
Oh my, how we have grown!
Seeking VOLUNTEERS to help on committees and special projects
We have definitely proven that once again, Texas does everything big. And because of our
fondness for the big stuff, we need your help.
If you are interested in joining a committee, please send us your name and contact
Programs: Brian Dee, programs@sccmtexaschapter.org
Membership: Rina Patel, membership@sccmtexaschapter.org
Communication: Michelle Galvan, webmaster@sccmtexaschapter.og
Research: Raj Gandhi, research@sccmtexaschapter.org
If you are interesting in helping with our 2012 Special Project: 1st Annual Critical Care
Symposium, please contact:
Brad Domonoske, president@sccmtexaschapter.org
Get your Official TSCCM polo!
(To order: sccmtexaschapter.org)
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Wrap Up: 2012 Critical Care Congress
Thousands of critical care professionals from across the United States and around the world came to Houston to
attend the 2012 Critical Care Congress this past February. While there was much sharing of knowledge, there
were many of the Texas Chapter leadership who received awards for their service to the Society of Critical Care
Dr. Joseph and Rae Brown Award
Dr. Joseph Nates was awarded the Dr. Joseph and Rae Brown Award, which recognizes an SCCM member who has
significantly advanced multiprofessional quality care for critically ill and injured patients at the regional or local
The Dr. Joseph and Rae Brown Award recognizes a Society of Critical Care Medicine member who has significantly
advanded multiprofessional quality care for critically ill and injured patients at the regional or local level. The
award was established to honor Dr. Joseph and Rae Brown for their work in organizing and sustaining the Pennsylvania Society of Critical Care Medicine, which later became the Pennsylvania Chapter of SCCM.
Dr. Joseph Nates is currently Professor and Deputy Chair of the Department of Critical Care, Division of Anesthesiology and Critical Care, at The University of Texas MD Anderson Cancer Center, in Houston, TX. He received his Doctor of Medicine from the Universidad del Norte, in Barranquilla, Colombia and completed his
critical care fellowship at Alfred Healthcare Group of Hospitals, Victoria, Australia. He also received his Master’s of Business Administration at California Pacific University in Escondido, CA.
Dr. Nates has extensive clinical, administrative, and research experience. His research experience includes
national and international multicenter and collaborative studies. He has also received numerous honors and
awards, including the Presidential Citation for outstanding contributions to the Society of Critical Care Medicine and the Bill Aston Award for Quality, Texas Hospital Association. He is currently the principal investigator
and recipient of the Dr. Richard Krakauer's Award to fund the Critical Care Outcomes Research Project.
Dr. Pamela Lipsett, Professor of Surgery at John Hopkins and exiting President of the Society of Critical Care
Medicine, present the prestigious “Dr. Joseph and Rae Brown Award” to Dr. Joseph L. Nates for his contributions
to Critical Care Medicine. Dr. Nates is the Deputy Chair of Critical Care and Medical Director of MD Anderson
Cancer Center intensive care units. The award ceremony took place during the Convocation at the 41 st International Congress of the Society on February 6, 2012.
Wrap Up: 2012 Critical Care Congress
Presidential Citations
This award recognizes SCCM members who have made extraordinary contributions of
time, energy, and resources to SCCM during the previous year.
Jeffrey L Bruno, Pharm.D., BCPS
Brian M Dee, Pharm.D., BCPS, BCNSP
Bradley D Domonoske, Pharm.D., BCPS
Clarence G Finch, RRT, FCCM
Michelle Galvan, BSN CCRN
Ken D Hargett, RRT, MHA, FCCM
Janine Mazabob, RN, MSN
Joseph L Nates, MD, MBA-HCA, FCCM
Texas Chapter—SCCM Distinguished Person Award
Awarded to Brian Dee, Pharm.D., for his dedication to the Texas Chapter.
Texas Chapter Timeline and Benefits
Wrap Up: 2012 Critical Care Congress
New Fellows of the American College of Critical Care Medicine
David A Brickey, DO, FCCM
Ken D Hargett, RRT, MHA, FCCM
When the American College of Critical Care Medicine was created in 1988, the Society of Critical Care
Medicine (SCCM) began a tradition dedicated to the recognition of excellence.
The College is committed to fostering the highest goals of multiprofessional critical care medicine, honoring individuals whose achievements and contributions demonstrate personal commitment to these goals,
promoting a forum for the development of collaborative practice among the specialties and professions
providing critical care, developing guidelines and practice parameters, and providing the Society with a
consultative body possessing recognized expertise in the practice of critical care.
The prestigious designation of Fellow of the American College of Critical Care Medicine (FCCM) honors
practitioners, researchers, administrators and educators who have made outstanding contributions to the
collaborative field of critical care. The College is comprised of nurses, respiratory therapists, physicians
and other healthcare professionals who are all experts in their fields.
2013 Critical Care Congress
An ancient fortress, tropical rainforest, exotic caves, and breathtaking beaches are all top attractions in
Puerto Rico. The island’s most unique feature is its bioluminescent bays.
These rare and fragile ecosystems formed by microscopic organisms create a glow when agitated, bathing anything that comes in contact with them – whether fish, oars, or people – in an eerie light. Just like
people, these creatures thrive and glow the brightest when the environment surrounding them is healthiest.
In 2013, we invite you to go for the glow at the Society of Critical Care Medicine’s 42nd Critical Care
Congress. Surrender to the charm of island life. Enjoy paradise in its purest form and catch up on life’s
most perfect pleasures so you can return from Congress refreshed and energized.
Registration and Housing open June 2012.
Congratulations New Board Members
Executive Board
Treasurer: Wendi Jones, MSN, ACNP-BC
For 25 years, I have worked in the field of critical care. Initially I worked in various ICU’s as a bedside nurse at Jackson Memorial Hospital in Miami. Prior to leaving Miami I also worked in the Jackson Memorial/Ryder Memorial Trauma Center as a Life Flight nurse. Hurricane Andrew came
through Miami and changed many lives, including mine. I then began travel nursing in ICU’s
around the US and as a fixed-wing flight nurse in New Mexico. Travel nursing brought me to Houston. After attending graduate school at University of Texas-Houston, I began working at MD
Anderson Cancer Center as an Acute Care Nurse Practitioner in the Blood and Marrow Transplant
Department and then in the Medical/Surgical ICU. I have been lucky enough to have a wide variety
of experiences in medicine.
The Texas chapter of SCCM has undergone exemplary growth these past three years, and I would like to assist the
chapter in continuing its growth and expansion as a member of the executive board.
Board of Directors
Physician: Iqbal Ratnani, MD
I work as an Intensivist at The Methodist Hospital, Houston, Texas. I am part of the faculty as
an assistant professor of Medicine in Clinical Anesthesiology with Weill Cornell. I did my Critical Care fellowship (Internal Medicine) from the University of Medicine and Dentistry, Camden, NJ. I graduated in 2001, and since then, I have worked in various ICUs settings with experience in, electronic ICU.
I have been an active member of SCCM since the year 2000. I served in the Membership
Committee from 2004-2007. I was an active writer for the MCCKAP Questions Committee
from 2007-2010, and now I serve in the Adult Online Practice Exam Committee. I was
awarded Presidential Citation from SCCM in 2007. I have a strong commitment to the teaching of Critical Care Medicine which is evident from the six year endeavor to a purely educational website named
www.icuroom.net. Keeping my commitment to teaching, I have been a part of various FCCS courses in Houston, as
well as overseas. I was invited in 2007 in Pakistan to lead 15 days of Critical Care boot camp for physicians, medical students and allied health personnel. I am proud to be a part of the FCCS team to train 138 physicians and
nurses in Tanzania in the year 2008.
Nurse: Melissa McLenon, ACNP
I have been an Acute Care Nurse Practitioner for 8 years. I have worked in critical care throughout
my nursing career. I am currently working in the intensive care unit at MD Anderson Cancer Center. I will be completing my Doctorate in Nursing Practice (DNP) in May 2012. My focus of study
has been on enhancing multidisciplinary collaboration and teamwork among members of the
healthcare team. I am also involved in multiple quality improvement projects in the ICU.
I am interested in becoming a board member in an effort to disseminate the mission of the society
to critical care clinicians across the state of Texas. As the largest multidisciplinary critical care organization, it is imperative that the Texas chapter work diligently to recruit members that will contribute to the education of other critical care professionals. I would also like to develop innovative ways of acknowledging the accomplishments and successes of current members as a means to increase awareness of the society,
both at the state and national level.
Congratulations New Board Members
At-Large: Christiane Perme, PT CCS (re-elected)
Christiane Perme, PT CCS received a Bachelor of Science degree in Physical
Therapy in 1981. In 2005 she became a Board Certified Cardiovascular and
Pulmonary Clinical Specialist by the American Physical Therapy Association.
Mrs. Perme is currently a Senior Physical Therapist at the Methodist Hospital
in Houston, where she has practiced for the past 25 years with a variety of
complex acute care patients. She is also staff lecturer for Motivations, Inc.
and Education Resources, Inc. Mrs. Perme has published 4 articles:” Early
Mobilization of LVAD Recipients Who Require Prolonged Mechanical Ventilation” (Texas Heart Institute Journal-2006), “Managing the Patient on Mechanical Ventilation in ICU: Early Mobility and Walking Program” ( Acute Care
Perspectives-2008), “ Early Mobility and Walking Program for Patients in the Intensive Care
Unit: Creating a Standard of Care” ( American Journal of Critical Care-2009), and “Early Mobility and Walking for Patients with Femoral Arterial Catheters in Intensive Care Unit: a Case Series” ( Acute Care Perspectives-2011). She is also co-author in nine book chapters with topics
related to physical therapy in ICU.
Mrs. Perme has extensive experience in treating adult patients in Intensive Care Unit with
special interest in patients requiring mechanical ventilation. She is an experienced speaker
nationally and internationally, including Brazil and at the World Physical Therapy Congresses
in Spain (2003), Canada (2007), and in Netherlands (2011).
“I have been a member of the Texas Chapter of the SCCM Board of directors for the past 3
years and it is very exciting to be able to closely follow the growth of the Chapter. As a physical
therapist with extensive experience in the rehabilitation of patients in ICU I want to be able to
collaborate with all critical care disciplines. I strongly believe in the need for collaborative
practice and a continuum of care so patients surviving a critical illness can be adequately reintegrated in the society.”
At-Large: Hany Samir, MD
Hany Samir, MD received his medical training at Kasr El-Aini Medical School,
Cairo University in Egypt, obtaining his MD degree in 1986. During his training he specialized in cardiovascular and critical care medicine. After residency specializing in cardiac intensive care, he completed a combined Fellowship in Cardiovascular Anesthesia and Critical Care Medicine at the NYU
Medical Center and the Manhattan Veterans’ Affairs Hospital in New York,
NY. In 2003, Dr. Samir joined Baylor College of Medicine in Houston, Texas
as Assistant Professor of Critical Care Medicine and delivered critical care
services at the Michael DeBakey Heart and Vascular Center at The Methodist
Hospital. He was one of the first members recruited for the highly successful Critical Care Intensive Care team at Methodist.
Dr. Samir is board certified by the American Board of Anesthesiologists in both Anesthesiology
and Critical Care Medicine. He is a member of the National and Texas Chapter of the Society
of Critical Care Medicine, Society of Cardiovascular Anesthesiologists, and the American and
Texas Societies of Anesthesiology. He is a member of the DeBakey Heart and Lung Transplant
Team, focusing on medical assist devices, i.e. ECMO artificial heart devices and use of nitric
oxide therapy in the Intensive Care Unit. He is active staff at The Methodist Hospital facilities
in the Texas Medical Center, at Sugar Land, at Willowbrook and at the West Houston locations.
2011 Alan Fields Award Winner
Less than 2 years experience
Outcomes Associated with a Screening and Treatment Pathway for
Occult Hypoperfusion following Cardiac Surgery
Ran Xu, Pharm. D.; Gregory Laine, MS, Rph; Bee Bee Hu, Pharm.D.; Robert Solis, MD; Arthur Bracey, MD; James
Wilson, MD; Amy Miclat, MS, RN; Susan Baimbridge, MS, RN; George Reul, MD
Institution: St. Luke’s Episcopal Hospital, Houston, Texas
Routinely monitored parameters such as blood pressure (BP) and heart rate may not reliably detect perfusion abnormalities. However, central venous oxygen saturation (ScvO2) and lactate (LA) levels can detect occult
hypoperfusion (OH) and identify patients who may be at risk for complications. The purpose of this study was to
assess the impact of an OH treatment pathway (OHTP) on morbidity and length of stay (LOS) post on-pump coronary bypass and valve surgery.
An OHTP guided by ScvO2 and LA can reduce morbidity and LOS.
Prospective cohort observational study following the implementation
of an OHTP, defined by ScvO2 < 70% and LA ≥ 18mg/dL with systolic BP ≥ 90mmHg upon ICU admission. Initial treatment included
volume resuscitation
and/or blood transfusion, followed by additional interventions when
ScvO2 remained < 70%. Repeat LA was obtained 18hr postoperatively. Primary outcomes were ICU/hospital (H) LOS and complications.
Among 390 cases evaluated, 53 OH cases were identified and
treated according to the OHTP. The 53 cases were compared with
21 OH cases prior to implementation of the pathway. Furthermore,
33 cases achieving the
repeat LA goal (< 18mg/dL) were compared with 18 cases not achieving the LA goal. Comparing preimplementation (n=21) vs post-implementation (n=53): ICU LOS was 117hr vs 64hr (p=0.27); HLOS was 16 days
vs 11 days (p=0.049); ICU readmission rate was 28.6% vs 7.7% (p=0.03); length of mechanical
ventilation (LMV) was 64hr vs 44hr (p=0.67); complication rate was 47.6% vs 26.4% (p=0.10). Comparing achieving LA goal (n=33) vs not achieving LA goal 18hr postoperatively (n=14): ICU LOS was 50hr vs 105hr (p=0.06);
HLOS was 10 days vs 14 days (p=0.17); ICU readmission rate was 9.1% vs 7.1% (p=1.0); LMV was 18hr vs 117hr
(p=0.17); Complication rate was 15.2% vs 50.0% (p=0.02).
Implementation of an OHTP was associated with significantly shorter HLOS and lower ICU readmission rates, as
well as a trend toward shorter ICU LOS and lower complication rate. Among patients managed by the OHTP,
achieving the LA goal 18hr postoperatively was associated with a significantly lower complication rate, and a trend
toward shorter ICU LOS/HLOS and LMV.
2011 Alan Fields Award Winner
More than 2 years experience
The Implementation and Evaluation of an Early Mobilization Program for Critically Ill Adult Oncology Patients
Mary Lou Warren, RN, CNS-CC; Egbert Pravinkumar, MD, FRCP; Shari Frankel, PT, MBA, ATC; Stacy Ryan, PT, DPT,
APC; Vi Nguyen, MOT, OTR, RRT; Becky Garcia, RN, BSN; Mini Thomas, RN, CCN; Laura Withers, MBA, RRT; Quan
Nguyen, RRT; Ninotchka Brydges, MSN, ACNP-BC
Institution: University of Texas MD Anderson Cancer Center, Houston, Texas
To successfully implement a multidisciplinary early mobilization program in a large oncological ICU and assess the
average number of mobilization activities per patient day, before and after the implementation of an early mobilization program (EMP).
The implementation of a multidisciplinary EMP will result in an increase in the average number of mobilization activities per patient
A quality improvement methodology employing the Plan, Do, Study,
Act (PDSA) cycle was utilized to pilot the EMP. The program was implemented in 16 of the 54 ICU beds in a large oncological ICU. Baseline information was obtained prior to the implementation of EMP,
and during the pilot period. The type and rate of mobilization activities were collected at two, four, and eight weeks after implementation of the EMP.
Results: Following eight weeks of the EMP, the average number of mobilization activities per patient day increased
by 41%. Mobilization activities carried out by bed-side nursing staff increased by 31%. Mobilization activities carried out by physical therapists and occupational therapists increased by 78% and 86%, respectively.
The implementation of a multidisciplinary EMP in critically ill oncology patients led to an increase in the number of
mobilization activities per patient day. The use of an interdisciplinary team approach and the PDSA cycle ensured
success and sustainability of the program.