SCCM Podcast – Details, episodes & analysis

Host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, welcomes Matthew Kirschen, MD, PhD, FAAN, FNCS, to discuss what critical care professionals need to know about determining brain death/death by neurologic criteria (BD/DNC).

In October 2023, a revised consensus practice guideline for the determination of brain death in both children and adults was published in Neurology (Greer DM, et al. Neurology. 2023;101;1112-1132). The guideline integrated guidance for adults and children to provide a comprehensive, practical way to evaluate patients with catastrophic brain injuries to determine whether they meet the criteria for brain death.

The Society of Critical Care Medicine (SCCM) offers several additional resources to support critical care clinicians’ understanding of the updated guidelines, including an article published in the March 2024 issue of Critical Care Medicine addressing what the critical care team needs to know about the guidelines (Kirschen MP, et al. Crit Care Med. 2024;52:376-386). Dr. Kirchen was the lead author of that article and shares key points in this podcast episode.

Other resources include:

• Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guidelines 2024 Critical Care Congress presentation
• Free AAN evaluation tool that walks clinicians through the process of brain death evaluation.
• Special article in Neurology: Clinical Practice that provides a detailed narrative about what has changed in the 2023 guidelines compared to prior guidelines. The article also includes tables outlining comparisons, bolding new recommendations, and italicizing age-specific guidance to easily identify the differences between determining brain death in children versus adults.

Host Elizabeth H. Mack, MD, MS, FCCM, welcomes Elizabeth Y. Killien, MD, MPH, to discuss pediatric acute respiratory distress syndrome (PARDS). Dr. Killien explains the findings from her retrospective study on PARDS severity, emphasizing how factors such as severe hypoxemia can impact health-related quality of life (HRQL) after discharge. (Killien EY, et al. Pediatr Crit Care Med. 2024;25:816-827). Dr. Killien is an attending physician in the pediatric ICU and an assistant professor at Seattle Children’s Hospital, University of Washington School of Medicine, in Seattle, Washington.

Host Elizabeth H. Mack, MD, MS, FCCM, is joined by Samuel Snider, MD, and Michael Fong, MD, to discuss a retrospective cohort study that examined factors such as cardiac arrest, brain neoplasms, and EEG patterns to determine their association with status epilepticus and isolated seizures in critically ill patients, aiming to improve monitoring and treatment strategies for high-risk patients (Snider SB, et al. Crit Care Med. 2023 Aug;51:1001-1011). Samuel Snider, MD, is a board-certified neurologist at Brigham and Women's Hospital and an instructor of neurology at Harvard Medical School in Boston, Massachusetts. Michael Fong, MD, is an assistant professor adjunct at the Yale School of Medicine in New Haven, Connecticut.

Extubation is a high-risk endeavor in some COVID-19 patients. Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Joshua H. Atkins, MD, PhD; Christopher Rassekh, MD; and Ara Chalian, MD, to discuss recognizing risks surrounding extubation in ventilated COVID-19 patients.

Targets for treatment of raised intracranial pressure or decreased cerebral perfusion pressure in pediatric neurocritical care are not well defined.

COVID-19 complicated critical care clinicians' decision-making with regard to tracheostomy.

Five new recommendations to reduce waste and enhance value in the practice of critical care address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care.

With widespread utilization of continuous renal replacement therapy, its critical to know about how citrate may have a role.

Mannitol is a commonly used osmotherapy agent in raised intracranial pressure (ICP) but the side effects are significant.

Sudden cardiac arrest remains a leading cause of premature death worldwide.