Update on therapeutic temperature management

Optimal Recovery from Cardiac Arrest: Implementation of a Therapeutic Hypothermia Program

Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project's aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents' schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects' research. Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.

Therapeutic Hypothermia and Temperature ManagementVol. 5, No. 3 The Arctic ChallengeClinical Q & A: Translating Therapeutic Temperature Management from Theory to PracticeEdited by Mary Kay Bader, Authors: Teresa Wavra, Chris Laux, Mary McKenna Guanci, Stephen A. Figueroa, Gretchen M. Brophy, Lisa Kurczewski, and Sarah L. LivesayEdited by Mary Kay BaderMission Hospital, Mission Viejo, California.Search for more papers by this author, Authors: Teresa WavraMission Hospital, Mission Viejo, California.Search for more papers by this author, Chris LauxHarborview Medical Center, Seattle, Washington.Search for more papers by this author, Mary McKenna GuanciMassachusetts General Hospital, Boston, Massachusetts.Search for more papers by this author, Stephen A. FigueroaDivision of Neurocritical Care, The University of Texas Southwestern Medical Center, Dallas, Texas.Search for more papers by this author, Gretchen M. BrophyVirginia Commonwealth University, Richmond, Virginia.Search for more papers by this author, Lisa KurczewskiDepartment of Pharmacy Services, Virginia Commonwealth University Health System, Richmond, Virginia.Search for more papers by this author, and Sarah L. LivesayCollege of Nursing, Rush University, Chicago, Illinois.Search for more papers by this authorPublished Online:11 Sep 2015https://doi.org/10.1089/ther.2015.29002.mkbAboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byApplication of the Care Bundle in Perioperative Nursing Care of the Type A Aortic Dissection1 September 2021 | International Journal of General Medicine, Vol. Volume 14Targeted Temperature Management in Nursing Care Gretchen M. Brophy, David A. Hildebrandt, Elizabeth A. Moore, and Todd J. Van de Bussche10 September 2019 | Therapeutic Hypothermia and Temperature Management, Vol. 9, No. 3Temperature Management in Neurological and Neurosurgical Intensive Care Unit Patrick Lyden, Gretchen M. Brophy, Nicolas Deye, and Christopher M. Horn1 December 2016 | Therapeutic Hypothermia and Temperature Management, Vol. 6, No. 4 Volume 5Issue 3Sep 2015 InformationCopyright 2015, Mary Ann Liebert, Inc.To cite this article:Edited by, Mary Kay Bader, Authors:, Teresa Wavra, Chris Laux, Mary McKenna Guanci, Stephen A. Figueroa, Gretchen M. Brophy, Lisa Kurczewski, and Sarah L. Livesay.Clinical Q & A: Translating Therapeutic Temperature Management from Theory to Practice.Therapeutic Hypothermia and Temperature Management.Sep 2015.177-181.http://doi.org/10.1089/ther.2015.29002.mkbPublished in Volume: 5 Issue 3: September 11, 2015Online Ahead of Print:August 18, 2015PDF download

Current Opinion in Critical Care was launched in 1995. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of critical care is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the journal's Editor and Section Editor for this issue. EDITOR-IN-CHIEF Jean-Louis VincentJean-Louis VincentDr Vincent is Professor of intensive care at the University of Brussels, Belgium, and Head of the Department of Intensive Care at the Erasme University Hospital in Brussels, Belgium. He earned his medical degree from the Universite Libre de Bruxelles, Belgium, with magna cum laude, with a specialty in Internal Medicine and Intensive Care Medicine. His training included two years of fellowship in critical care medicine at the University of Southern California, USA with Prof. Max Harry Weil. Dr Vincent has signed more than 700 original articles, more than 280 book chapters and review articles, and around 800 original abstracts. He has edited 86 books including 63 in his own series Update in Intensive Care and Emergency Medicine and Yearbook in Intensive Care and Emergency Medicine published by Springer-Verlag (Heidelberg, Berlin, New York). He is co-editor of the Textbook of Critical Care (Elsevier Saunders, 5th Edition). He has also written a French Manual of Intensive Care and Emergency Medicine (Springer, France), and is the co-editor of the series Le point sur… (Springer, France). Dr Vincent is the editor-in-chief of Critical Care, Current Opinion in Critical Care, and ICU Management. He is member of the Editorial Boards of about 30 journals including Critical Care Medicine (senior editor), PLoS Medicine, Lancet Infectious Diseases, Intensive Care Medicine, Chest, Shock, and Journal of Critical Care. Dr Vincent is presently Secretary General of the World Federation of Societies of Intensive and Critical Care Medicine. He is a Past-President of the European Society of Intensive Care Medicine and the European Shock Society, and the Past-Chairman of the International Sepsis Forum. For 31 years he has organized an International Symposium on Intensive Care and Emergency Medicine which is held every March in Brussels. This symposium, which gathers 5,000 participants, has become one of the largest meetings in the field. He received the Foundation André Loicq award in 1986, the Foundation De Kerckheer award in 2000, the Distinguished Investigator award of the Society of Critical Care Medicine in 2001 and the College Medalist Award of the American College of Chest Physicians in 2003. He was the Recipient of the "Society Medal” (lifetime award) of the European Society of Intensive Care Medicine in 2009 and he received “ Prix Scientifique Joseph Maison-Sciences biomédicales cliniques” (scientific award of the FRS-FNRS) in 2010. SECTION EDITOR Arthur P. WheelerArthur P. WheelerArthur Wheeler is a Professor in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University, USA, and serves as the Director of the Vanderbilt ICU. He is a graduate of the University Of Maryland School Of Medicine, USA, then completed training programs in Internal Medicine, Pulmonary Disease and Critical Care at Vanderbilt University. Dr Wheeler's research interest in severe sepsis, acute lung injury and thromboembolic disease has resulted in more than 100 publications. He is also the co-author of a successful textbook of Critical Care Medicine now in its fourth edition. He has delivered hundreds of national and international lectures and is the recipient of numerous teaching awards. Most recently Dr Wheeler has been developing and testing the effectiveness of alternative care delivery models in critical care including the use of nurse practitioners.

Patient Dumping: The Physician's Dilemma

Therapeutic Hypothermia and Temperature ManagementVol. 6, No. 2 RetractionFree AccessRetraction of: Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic Hypothermia, by Urquieta E, et al. Ther Hypothermia Temp Manag. DOI: 10.1089/ther.2015.0025This article retracts the following:Retracted: Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic HypothermiaPublished Online:10 Jun 2016https://doi.org/10.1089/ther.2015.0025.retractAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The senior author, Emmanuel Urquieta, of the article entitled, “Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic Hypothermia,” has requested that the article, published online ahead of print (DOI: 10.1089/ther.2015.0025), be retracted because he discovered one of his coauthors mistakenly submitted the same article to the Journal of Vascular Surgery due to a miscommunication between them.The editorial leadership of Therapeutic Hypothermia and Temperature Management agree that the article must be retracted as a matter of proper scientific publishing protocol whereby an article may not be simultaneously submitted to two journals. The Editors commend Dr. Urquieta for willingly bringing this situation to their attention.Dr. Urquieta and his coauthors sincerely apologize to the Editors and the readership of Therapeutic Hypothermia and Temperature Management.FiguresReferencesRelatedDetailsRelated articlesRetracted: Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic Hypothermia14 Dec 2015Therapeutic Hypothermia and Temperature Management Volume 6Issue 2Jun 2016 InformationCopyright 2016, Mary Ann Liebert, Inc.To cite this article:Retraction of: Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic Hypothermia, by Urquieta E, et al. Ther Hypothermia Temp Manag. DOI: 10.1089/ther.2015.0025.Therapeutic Hypothermia and Temperature Management.Jun 2016.110-110.http://doi.org/10.1089/ther.2015.0025.retractPublished in Volume: 6 Issue 2: June 10, 2016PDF download

ACEP Ambassadors Globalize Emergency Care

Implementing a strict fever control protocol for resuscitated cardiac arrest patients

FOR A QUARTER CENTURY, JAMA HAS SERVED AS A VENUE for articles relating to care of critically ill patients, beginning with the Concepts in Emergency and Critical Care section, in which these fields were initially described as “spanking new medical disciplines.” At the time, knowledge of the biology of critical illness was rudimentary, the focus was on initial patient care, such as airway management and resuscitation, and the few physicians trained in emergency or critical care medicine worked mainly in large teaching hospitals. During the following years, critical care and emergency medicine grew rapidly, training and accreditation became more standardized, and the focus changed to the definition, management, and outcome of postresuscitation syndromes, such as sepsis, shock, and organ dysfunction. Approximately 10 years ago, the section name was changed to Caring for the Critically Ill Patient, ushering in increased focus on high-quality multicenter randomized trials, organization and delivery of care, and attention to patient-centered outcomes. Today, the Caring for the Critically Ill Patient section of JAMA is devoted to publication of important articles in critical and emergency care at a time when the clinical and research landscape has shifted again. Advances in molecular biology now provide a wealth of information on the humoral and cellular responses to acute trauma, infection, and ischemia. This understanding has helped delineate the mechanisms of shock, sepsis, and organ dysfunction syndromes, such as acute respiratory distress syndrome (ARDS), acute renal failure, and traumatic brain injury, generating a plethora of therapeutic targets. The scale of critical care and emergency medicine services has also changed. Every acute care hospital in the United States boasts an intensive care unit (ICU), half of the nation’s ICU beds are located in small hospitals, and many teaching hospitals have built huge ICU services, often with 60 or more beds. Six million Americans, or 2% of the population, are admitted to the ICU each year, severe sepsis and ARDS affect hundreds of thousands of individuals annually, and 1 in 5 Americans receive ICU care at the end of life. All this care is provided by a workforce of hundreds of thousands of highly trained physicians, nurses, and allied health care personnel who function in integrated team systems, not just in the ICU and emergency department, but increasingly on hospital general units and in the community. With substantial investment of resources and advancement in knowledge, care of critically ill patients has no doubt improved. Mortality appears to have decreased for sepsis and ARDS, and headway has been made toward safer, quicker, more effective care. However, considerable challenges lie ahead on the path from basic science to improved public health, including a translational block between basic science and clinical trials; challenges in conducting clinical trials in critically ill patients; failure of clinical research to fully frame health issues facing critically ill patients; an inadequate evidence base for many aspects of care; and public health policy that is either lacking or uninformed by evidence. The first challenge, overcoming translation from basic science to clinical trials, is exemplified by the sepsis syndromes. Among the more than 30 large trials involving agents designed to modify the host response to infection, only 2 were positive (and neither of these are considered definitive). While trial design may be partly to blame, the problems run deeper. Severe sepsis, the subset of sepsis with acute organ dysfunction, is often difficult to define and encompasses a highly heterogeneous group of patients. Outcome and probably response to therapy are linked to multiple host, pathogen, and health care–related factors that neither in vitro nor in vivo models adequately address. Therapies enter clinical trials with little information on appropriate dosing or methods to monitor their biologic activity. A particular challenge for sepsis and other critical illnesses is that the pathways targeted for modification are as often helpful as harmful, and current clinical trial entry criteria provide no guarantee that the host response pathway of interest is either active in a particular patient or behaving in an injurious manner. Thus, clinical research needs better tools to select and monitor patients and their therapies, and basic science needs

Emergency Care Crisis in the United Kingdom and Ireland: Emergency Physician Exodus Looms in Wake of Pay Cuts, Staffing Shortages

Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.

In the fields of emergency and critical care, targeted temperature management has become a critical issue and particularly popular in clinical practices throughout Asia. As more research is carried out, evidence and concepts about targeted temperature management continue to evolve. Areas of interest include new 2015 resuscitation guidelines, temperature management in pediatrics, and integrated care and neurological monitoring for cardiac arrest patients. The Asian Targeted Temperature Management task panel includes colleagues from various Asian countries and allows them to exchange experiences in a professional environment. Some of the key issues include optimal therapeutic hypothermia temperature for postcardiac arrest syndrome pursuant to 2015 guidelines, an integral approach to postcardiac arrest syndrome with hemodynamic monitoring and stabilization, roles of percutaneous coronary intervention and extracorporeal membrane oxygenation, and temperature management for neonatal hypoxic-ischemic encephalopathy. Panel experts reviewed all of the aforementioned issues and discussed the feasibility and effectiveness of targeted temperature management based on the Asian population. These discussions can expand the perspectives with regard to applying targeted temperature management all over the world.

Emergency Physicians Seek Their Place in a Pay-for-Value World

Much has been written about the development of emergency medicine (EM) and its impact on the medical system as a whole. It is still described as ‘new’ and very much seen as a specialty that is evolving, rather than a static domain of knowledge and skills with rigid boundaries. In reality, the fundamentals of emergency treatment in mitigating the effects of acute illness and injury go back to ancient times. This is evidenced by descriptions of the urgent management of acute pain with analgesics, splinting of injured limbs, and more sophisticated procedures, such as the removal of kidney stones and craniotomies. The treatments at that time were limited, but the application of these skills brought relief to many people (and a little pain). The practitioners were generalists and did not limit themselves to emergency treatment alone. Over the past half-century, there has been an acceleration of development in emergency medical treatments and a massive explosion in emergency medical system enhancement. This has resulted in a unique body of knowledge and skills, with the evolution of a new medical specialty specific to the delivery of emergency medical care. It is worth reflecting on the drivers for EM specialisation, where the specialty has come from, and what we can expect as the complexity of medical care increases with technological innovation and social changes associated with increasing connectivity.

A POST-ARREST CARE BUNDLE IMPROVES QUALITY OF CARE AND CLINICAL OUTCOMES DURING THE NORMOTHERMIA ERA