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InterchangePresident's Message It is an exhilarating time for SOCCA! I hope to see as many of you as possible at the 2024 annual meeting presented by IARS and SOCCA in Seattle on May 17-19. This is an excellent opportunity for SOCCA because we have more critical care educational content in this new format than we have ever had in any of our annual meetings. Membership Committee Update The SOCCA membership committee had quite a busy year in 2023, and we are now working diligently with our new management team to continue to provide valuable programming for our members. The Early Career Intensivists group and the Physicians in Private Practice group are organizing their events for 2024. Education Committee Update We are incredibly excited and look forward to welcoming you to the revamped IARS/SOCCA Annual Meeting in Seattle from May 17th- 19th, 2024. The meeting strives to deliver high-quality critical care education content, highlight critical care research, and provide networking opportunities to SOCCA members. As mentioned in the last newsletter, the annual meeting in 2024 will include a dedicated "Critical Care track," with educational sessions running throughout the meeting. Transplant Anesthesiology – Then and Now The field of transplant surgery, with its roots traced back to the pioneering work of Sushruta in 600 BC, has undergone a remarkable evolution. On behalf of the SOCCA-SATA Work Group, this review focuses on transplant anesthesiology, a field of medicine that has played a pivotal role in transforming transplantation into a life-extending therapy for patients with end-organ failure. Advances in multidisciplinary collaboration and research have improved surgical success and patient outcomes. SOCCA Early Career Intensivists – Dr. Maccioli's 12 Rules of Negotiation The SOCCA Early Career Intensivists group welcomed Dr. Gerald Maccioli this past November to learn about contract negotiations. Dr. Maccioli is an accomplished anesthesiologist with multiple leadership roles throughout his career, including being the former President of SOCCA and Chair of the ASA section on education and research. He is currently the Vice President of Medical Affairs for the Accreditation Commission for Health Care, CMO and Board Advisor of Quick'rCare, CMO of Care Angel, and CMO of Moterum. Fireside Consultancy by Women in Critical Care Need answers to pressing questions in clinical practice, career advancement, research, work-life balance, or academic journey? Explore the WICC's peer mentorship model – the consultancy – which may help in answering these queries. Starting on March 28, WICC will present a quarterly one-hour Fireside Consultancy style hour. Unveiling Tachycardia-Induced Cardiomyopathy: An Overlooked Medical Phenomenon We present a 36-year-old woman, BMI 19, with a history of deep vein thrombosis (on Apixaban), rheumatoid arthritis and Crohn's disease status post previous left hemicolectomy,11 years ago and completion proctocolectomy with end ileostomy ,10 years ago Furthermore, the patient was dependent on total parenteral nutrition given chronic entero-vaginal and enterocutaneous fistulas. The patient was admitted with evidence of a pelvis abscess, surgical intervention was deemed necessary. An exploratory laparotomy with small bowel resection, fistula takedown with an entero-entero anastomosis was performed. The post-operative course was complicated by a pelvic enteric leak, resulting in another exploratory laparotomy, small bowel resection with double barrel jejunostomy. Intra-abdominal wound cultures revealed Vancomycin-Resistant Enterococci and Enterobacter cloacae, hence Meropenem and Daptomycin were initiated. President's Message Volume 35 Issue 3 August was Charlie Parker Month, the month of the great musician's birth. I am, of course, a jazz fan, but Mr. Parker is also on my mind for his outstanding talent. He was among the foremost innovators in the most improvisational of music genres. This capability made him flexible, inspiring, and able to direct groups in productive and creative ways. Capabilities are the necessary support for achievement. Today, SOCCA is a nimble organization that is enhancing its capabilities. SOCCA Research Committee Update: Driving Innovation and Collaboration Forward As Chair of the SOCCA Research Committee, I am thrilled to share our latest progress and upcoming initiatives. Over the past months, our committee has been energized by the dedication and enthusiasm of our members, whose collaborative efforts have resulted in significant advancements in the field of critical care anesthesiology. Nominations Committee Update Volume 35 Issue 3 The strength of SOCCA lies in its members' incredible talent and energy. Volunteering is one of the best ways to contribute to the Society. Each year, the SOCCA Nominations Committee reviews nominees and prepares an election ballot for available Officer and Director positions. During this election cycle, we will elect four members for the Board of Directors (for a 3-year term). Further details about SOCCA's governance structure are outlined in our Society Bylaws.
Education Committee Update Volume 35 Issue 4 As the New Year dawns upon us, the Education Committee would like to announce some exciting changes to the committee structure, as well as highlight some of the new offerings for the New Year. After the immensely successful integration of the SOCCA and IARS annual meetings in 2024, where we were able to incorporate three days’ worth of critical care content along with a POCUS workshop, we are happy to share that the same model will be in place for the 2025 Annual Meeting in Hawaii.
Updates from the Physiologically Difficult Airway Task Force: Delphi Consensus Summary In October of 2020, SOCCA formed a task force to champion the cause of physiologically difficult airway (PDA) management. As is familiar to critical care anesthesiologists, in the contemporary era of airway management the physiologic challenges posed by patients requiring tracheal intubation outside of the operating room with, for example, right ventricular failure, cardiovascular instability, or severe hypoxemia, often surpass the technical challenges associated with intubation itself.
Does the 2024 Anesthesiology Critical Care Fellowship Match Reflect a Sustained Decline in Interest in Our Subspecialty? A Closer Examination of Historical Trends As the 2024 fellowship match cycle draws to a close, critical care leaders and stakeholders face a concerning reality. Data from this year’s match once again highlight trends that mirror the previous cycle, with 36% of anesthesiology critical care fellowship positions going unfilled. This persistent gap raises an urgent question: does this pattern signal a sustained decline in interest in our subspecialty?
Women in Critical Care Update Volume 35 Issue 4 We’re excited to introduce the new leadership team for the Women in Critical Care (WICC) group! First, we extend our heartfelt thanks to Drs. Siddiqui and Hua for their dedication in establishing and leading WICC. As we take up the mantle, we are eager to continue building on their efforts.
Program Director Q&A Issue 35 Volume 4 Sarah M. Alber, MD is a cardiothoracic anesthesiologist and intensivist in our cardiothoracic intensive care unit at the University of Colorado.
Continuous Glucose Monitoring in the Perioperative Period Substantial research has confirmed a critical link between perioperative glucose levels and perioperative complications including death. Hyperglycemia has been found to be the main culprit and affects 20-40% of postoperative patients and up to 80% of patients having cardiac surgery, though hypoglycemia is equally dangerous. Regardless of a preexisting diagnosis of diabetes mellitus (DM), higher glucose is an independent predictor of mortality for patients having cardiac surgery.
All the Red Herrings My greatest fear is having a case I was involved in presented at M&M. Like the inevitability of a wet tap, I could not avoid the experience, but I still find myself wondering what exactly happened to this patient.
Seraph® 100 Microbind® Affinity Blood Filter and Use in Group A Streptococcus Sepsis: A Case Report The Seraph® 100 Microbind® Affinity Blood Filter (Seraph 100) is a single-use extracorporeal broad-spectrum sorbent hemoperfusion device authorized by FDA under Emergency Use Authorization (EUA) for multi-organ failure in COVID-19. According to recent studies, the filter has been shown to decrease morbidity, mortality, and intensive care unit (ICU) length of stay (LOS) in both adult and pediatric populations and has mainly been assessed for its efficacy in the management of COVID-19.
2024 ASA House of Delegates Recap Volume 35 Issue 4 Thank you for the opportunity to serve SOCCA as the alternate delegate to the ASA. This year’s meeting returned to Philadelphia for the first time since the 1960s and the City of Brotherly Love proved to be a great host city. The meeting was vibrant and energetic with over 12,700 people attending in person (including 1,200 international attendees) and an additional 500 virtual participants.
President’s Message Volume 35 Issue 3 August was Charlie Parker Month, the month of the great musician’s birth. I am, of course, a jazz fan, but Mr. Parker is also on my mind for his outstanding talent. He was among the foremost innovators in the most improvisational of music genres. This capability made him flexible, inspiring, and able to direct groups in productive and creative ways. Capabilities are the necessary support for achievement. Today, SOCCA is a nimble organization that is enhancing its capabilities.
SOCCA Research Committee Update: Driving Innovation and Collaboration Forward As Chair of the SOCCA Research Committee, I am thrilled to share our latest progress and upcoming initiatives. Over the past months, our committee has been energized by the dedication and enthusiasm of our members, whose collaborative efforts have resulted in significant advancements in the field of critical care anesthesiology.
Nominations Committee Update Volume 35 Issue 3 The strength of SOCCA lies in its members’ incredible talent and energy. Volunteering is one of the best ways to contribute to the Society. Each year, the SOCCA Nominations Committee reviews nominees and prepares an election ballot for available Officer and Director positions. During this election cycle, we will elect four members for the Board of Directors (for a 3-year term). Further details about SOCCA’s governance structure are outlined in our Society Bylaws.
“Is There a Doctor on Board?” A Primer on In-Flight Emergencies and Q&A with Dr. Ashish Khanna In-flight medical emergencies (IMEs) are estimated to occur in 1 of every 604 flights; given the tremendous volume of global air travel, 260 and 1420 IMEs may occur daily.1 Invariably, these events take place in a complex setting characterized by limited information and equipment. Many physicians have little personal experience responding to in-flight crises, and even seasoned anesthesiologist-intensivists will likely find these events challenging and stressful. This article briefly overviews clinical, logistical, and legal considerations relevant to managing in-flight medical emergencies.
Perioperative Use of Semaglutides: More Questions than Answers Global prevalence for obesity and type 2 diabetes are continuing to rise, with special concerns for the very high prevalence of obesity (>25% of adults) and Type 2 diabetes (>13% of adults) in several regions of the Americas, Middle East and amongst Pacific Island communities.
Program Director Q&A Dr Matt Wiepking is the Program Director for the Anesthesia Critical Care Medicine Fellowship at the Los Angeles General Medical Center and the University of South California, he has served in this role for the past 2 years.
Women in Critical Care – Member Spotlights The WICC Member Spotlight highlights our members’ day-to-day work lives. How do our members “do it all”? Balance their busy work life with their interests outside of work. These profiles highlight that although practicing as an Anesthesiology Critical Care attending may seem daunting as a trainee, it is a challenging yet fulfilling specialty.
Update on the Brain Death and Death by Neurological Criteria 2023 Guidelines In 2023, the American Academy of Pediatrics, Child Neurology Society, Society for Critical Care Medicine and the American Academy of Neurology released an updated set of guidelines for Brain Death/Death by Neurologic Criteria (BD/DNC). These were the first guidelines to provide recommendations for both adult and pediatric patients.
Cardiothoracic Critical Care Training – The Evolving Landscape Over the past few decades, critical care medicine has rapidly evolved into the cornerstone of modern healthcare. The recent pandemic made us aware of the need for critical care specialists. The demand for intensive care services has continued to rise in response to the increasing complexity and acuity of both medical and surgical conditions.
President’s Message It was great to see so many of you at the 2024 Annual Meeting, presented by IARS and SOCCA, in my old hometown of Seattle. We presented what has to be the most extensive lineup of critical care content ever at a SOCCA meeting. Many thanks to Allison Dalton and Kunal Karamchandani for an excellent group of topics and speakers. Although the “feel” of the meeting is a little different, I hope you would agree the spirit is very much alive.
Communications Committee Update I am excited to announce the long-anticipated expansion of our social media presence. In addition to our existing presence on Twitter, we are now on LinkedIn and Facebook. This expansion marks a significant step forward in our efforts to engage with you across multiple platforms.
Education Committee Update This year’s meeting was a bit different from previous years, with the addition of a three-day critical care tract of panels, a SOCCA co-sponsored panel in the non-critical care tract, and an ultrasound workshop presented by our SOCCA members.
Membership Committee Update SOCCA membership continues to grow, so it is an exciting time to be on the membership committee! The committee met at the annual meeting in Seattle in May and had extensive discussions about how best to continue to serve our members.
Clinical Practice Ad Hoc Committee Update The Clinical Practice Ad Hoc Committee (CPC) of the Society of Critical Care Anesthesiologists (SOCCA) was created to foster collaboration across subspecialties and enhance engagement among SOCCA members. Established as an ad-hoc committee, the CPC aims to integrate various subspecialties into joint projects with SOCCA, thereby broadening the scope of expertise and enriching the collective knowledge within the society.
Women In Critical Care Update (WICC) In keeping with our mission of offering mentorship and an opportunity to build a community, WICC presented a new format on March 28th, the Fireside Consultancy. This Fireside Consultancy was led by Dr. Hua, Co-Chair of WICC where 4 WICC participants presented focused issues that they were facing.
Coaching and Mentoring – Underutilized Resources for an ICU Fellow Coaching and mentoring are valuable tools in a physician’s professional development. They serve similar goals but have unique roles and boundaries. A mentor tells you how, but a coach asks you why.
Artificial Intelligence in Neuro-Critical Care Settings Introduction: Neuro-critical care constitutes a demanding, high-alert setting that requires expeditious decision-making by critical care teams in response to patient health status. The resource-intensive nature of neuro-critical care settings results in a substantial financial burden. As of 2016, the Centers for Disease Control and Prevention (CDC) reported an annual national healthcare spending cost of $40.6 […]
Large Language Models Take Center Stage: Potential for Critical Care Applications In 2022, the medical community was introduced to the capabilities of ChatGPT – a popular large language model (LLM) that performed exceptionally well in medical problem solving, scoring above 85% on both USMLE Step 1 and Step 2. ChatGPT is a chatbot composed of an advanced language model from the family of Generative Pretrained Transformer (GPT) models designed by OpenAI (San Francisco, California) in 2018.
Critical Care Anesthesiologists: Their Expanding Role Outside the ICU The first public demonstration of an ether anesthetic in 1846 marked a turning point in our ability to provide safe and effective medical care. It birthed the specialty of anesthesiology as we know it today.
President’s Corner Join us for the 2024 Annual Meeting, presented by IARS and SOCCA in Seattle, May 17-19. The education committee has created an outstanding program with a critical-care track running concurrently throughout the meeting. The format and content of the meeting look extraordinary, with more critical-care content than we have ever had before. There will be three SOCCA-sponsored breakfasts, and all committees and subcommittees will have the opportunity to meet in person throughout the meeting. In addition, a dedicated SOCCA session will run on Sunday afternoon until about 5PM, including additional educational panels, the SOCCA awards presentations, and the SOCCA business meeting. I hope everyone stays for the entire duration of this exciting meeting.
Communications Committee Update Our committee has experienced a dynamic year, marked by significant accomplishments. In September 2023, we released one of our largest issues to commemorate Women in Medicine Month, featuring insightful contributions from several of our dedicated members. The response was exceptional, reflecting our commitment to celebrating diversity and excellence in our field.
Education Committee Update As the new year approaches, the education committee would like to announce some new and exciting changes to the structure of the education committee, as well as our offerings for 2024. As you will read in this month’s Interchange, the SOCCA component of the 2024 Annual Meeting in Seattle will be undergoing significant changes. We are excited that we will now be able to incorporate three days’ worth of educational offerings as a part of the combined IARS/SOCCA meeting. With this change likely to last beyond 2024, the Annual Meeting subcommittee will be continuing our work on grading and developing annual meeting content for years to come.
Annual Meeting Evolution We would like to share with the SOCCA membership some of the changes around the annual meeting for 2024 as well as for future meetings. Unlike previous years where SOCCA had a separate meeting (a day before the IARS meeting) with a sprinkle of SOCCA sessions during the IARS meeting, the 2024 annual meeting in Seattle will be a combined IARS/SOCCA meeting. What this entails is an integration of SOCCA sessions within the IARS meeting, and the creation of a separate “critical care track” exclusively for content related to critical care medicine. This would ensure that SOCCA educational sessions will run throughout the duration of the meeting. In addition to the critical care medicine related education content throughout the IARS/SOCCA annual meeting, a dedicated half-day session of exclusive SOCCA content is also being planned after the IARS meeting ends. We believe that the SOCCA-only half-day meeting on Sunday, May 18 would allow us to present the various SOCCA awards as well as host the SOCCA business meeting and may provide an opportunity to accommodate additional education sessions. Discussions around the feasibility and logistics of this additional session are currently underway.
What We Need to Know About AI: A Snapshot for All Critical Care Anesthesiologists The integration of Artificial Intelligence (AI) in various industries has progressed rapidly in medicine, particularly in critical care. The number of articles published regarding AI in critical care medicine tripled from 2018 to 2020.1 From the use of AI to predict the likelihood of sepsis, intensive care unit (ICU) mortality, and length of stay, many predictive models have been developed for use in the ICU setting. It is essential for the modern intensivist to understand the basics of how AI works and how to analyze studies based on AI. This article aims to fulfill these two goals and provide a foundation of knowledge that can be used to implement AI in your practice.
What Every Intensivist Should Know About Using Data Science and AI in Prediction of Adverse Postoperative Events in the ICU Utility of Predictive Analytics in Critical CareIdentifying the underlying cause of clinical deterioration in postoperative patients in the intensive care unit (ICU) can be difficult.
Women in Critical Care: Year in Review SOCCA WICC ended the year with a Fireside chat featuring three Intensivists in different phases of their career to share their unique journeys in academia, professional life, and career challenges. Drs. Sheela Pai Cole, Brigid Flynn, and Emily Vail joined Drs. Tabaie and Siddiqui to host the fourth and final Fireside Chat for WICC in November. Dr. Tabaie moderated the panel and asked varied questions of the speakers about mentorship, balancing academic focus and clinical demands, strategies for saying ‘no’ to opportunities when stretched, and pulling back and re-engaging with an academic career due to family obligations. The panelists spoke with candor and authenticity and shared wise pearls of experiential learning and advice on resilience. The chat provided a welcome semi-formal atmosphere for the audience to hear from successful academic intensivists and have them share workplace experiences, offering a space for support and for practicing methods to achieve career advancement.
Intensivists in Private Practice Update As we wrap up this year, we would like to take this opportunity to highlight the Intensivists in Private Practice subcommittee and provide an update on some of our recent activities.
The Anesthesia Critical Care Medicine Fellowship Match Remains a Buyer’s Market for the Second Year in a Row Introduction
Perspectives on Pursuing an Anesthesiology Fellowship in Critical Care Medicine It is an exciting time to pursue an anesthesiology fellowship in critical care medicine (CCM). As we emerge from COVID-19, there is a renewed energy for scientific investigations, making connections, and integrating wellness strategies to mitigate burnout. Technological advances in hemodynamic monitoring, the use of artificial intelligence or data analytics, and application of novel biomarkers are all captivating areas of investigation. Moreover, the integration of bedside point-of-care ultrasound (POCUS) continues to grow and offers opportunities to be at the forefront of clinical care. If you’ve had a chance to attend recent regional or national anesthesiology or CCM meetings, you have likely noticed expanded opportunities to network and for mentorship at all stages of training. There has been a palpable energy around these connections and a desire to collaborate. It has been a real pleasure to connect with former colleagues, meet new friends and learn from a diverse collection of experts in the field.
Service Chiefs’ Advisory Council Update: 2024 and Beyond The SOCCA Service Chiefs’ Advisory Council (SCAC) aims to include representatives from every organization with an active anesthesiology critical care practice, specifically the one or two individuals with the broadest and most directly relevant administrative purview from each organization.
Emergent ECMO for a TE-Fistula: Fundamentals are Key IntroductionThis case report describes a young man who developed a tracheal-esophageal fistula (TEF) from endotracheal intubation with prolonged elevated cuff pressure after a traumatic fall. This case report describes the intra-operative management of profound hypoxia, shedding light on crucial pre-operative indicators that could serve as vital cues to prevent the occurrence of this potentially serious complication.
Job Board Read members-only job posts! Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. The goal of SOCCA is to offer numerous areas and opportunities for our members to engage and grow our Society, and our members have been very busy! by Miguel Cobas, MD, FCCM The strength of SOCCA is the wealth of talent and energy of its members. One of the ways to serve the Society is through volunteer activities. The SOCCA Nominations Committee annually evaluates nominees and develops an election ballot for available Officer and Director positions. This election cycle we will be electing our Secretary (2-year term) and two members for the Board of Directors (3-year term). Further details about the governance structure of SOCCA are described in our Society Bylaws.
by Jordan M. Stefko, MD, Michael Dougherty, DO, Danielle L Holland, MD, Bridget Hughes, PA-C, and Ron Leong, MD Introduction:Acute right ventricular failure (RVF) due to post-left ventricular assist device (LVAD) placement is challenging to treat with the management often limited to placement of either surgical or percutaneous mechanical circulatory devices. The Protek Duo® (LivaNova) is a percutaneous right ventricular support device (RVAD), which due to its relative ease of placement, has been a breakthrough in the management of post-LVAD implantation acute RVF. 1Cardiac perforation from placement of a Protek Duo cannula is a rare but potentially lethal complication. This case is the first to describe a patient who developed cardiac tamponade from a Protek Duo cannula perforation of the right ventricle. The report discusses preoperative and intraoperative management of this condition and relevant transesophageal echocardiography (TEE) imaging that aided in the diagnosis and surgical repair of the perforation. Early Career Intensivists: Bridging the Gap between Training and Practice for SOCCA Members The transition between clinical training to independent practice is notoriously challenging. The goal of the SOCCA Early Career Intensivist (ECI) working group is to help support members through this progression. Founded in 2021, the ECI provides junior members with resources and content tailored to their concerns and interests. “The purpose of the group,” says Chair, Dr. Alisha Sachdev, “is to engage all SOCCA members in the first ten years of their careers with specific programming to meet their needs early on.”
ECMO Education for Intensivists: Approaches and Potential Challenges Since the 2009 H1N1 pandemic, there has been exponential growth in the use of extracorporeal membrane oxygenation (ECMO) for severe cardiopulmonary disease.1 The increased utilization of ECMO has allowed the management of more complex and severe diseases, pushing the boundaries of critical care medicine (CCM) as a specialty. However, this increase in ECMO use means that more intensivists are likely to encounter and care for patients with ECMO, necessitating the evolution and standardization of specialized training in this field. by Christopher Choi, MD, Nibras Bughrara, MD, FCCM, FASA, and Kunal Karamchandani, MD, FCCM Bedside point-of-care ultrasound (POCUS) has become ubiquitous in the critical care arena and is an essential tool for intensivists. POCUS has been used extensively to diagnose various cardiovascular and respiratory pathologies in critically ill patients and is now an integral part of various diagnostic algorithms in the intensive care unit (ICU). Yet, despite the proliferation of various portable and handheld devices, POCUS during emergency airway management in critically ill patients has never taken off. Dr. Teresa Mulaikal, MD, FASE, is a cardiothoracic and critical care anesthesiologist, practicing at Columbia University in New York. Tess Russell, MD, Assistant Professor of Anesthesiology at Columbia University Vagelos College of Physicians and Surgeons, is a Texas transplant to New York City. Visit SOCCA’s Job BoardIf you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. I recently had several conversations with rising women medical students and residents wanting to know more about anesthesiology and critical care medicine as a career. Typically, in these situations, I think many of us feel compelled to give “the pitch” for why our lives are so great. And yes, recruitment into our subspecialty, particularly for women, is severely needed. How do you balance starting a career with having enough time for family or obligations outside work? Does having young children make it difficult to launch your career, or can you really do it all? A diverse workforce has the potential to mitigate healthcare disparities, and improve patient satisfaction. 1 Diverse leadership offers key benefits as described by 14 members of Forbes Coaches Council in a recent publication. 2 In the last 50 years, the number of women graduating as physicians has increased; these trends have been noted in the United States, Europe, and as well as low-middle-income countries1. Emerging demographic trends in Critical Care Fellow recruitment from 2004-2017 highlighted the significant increase in female fellows from 29.5% in 2004 to 38.3% in 2014, (p < 0.001)2. Although the number of women graduating as physicians is increasing, those taking up critical care medicine and rising within organizations as leaders are painfully low. Colleagues,We had a fantastic SOCCA and IARS meeting in Denver. It was great seeing so many friends and colleagues and watching our packed conference room during the meeting. Even more impressive was the membership involvement with our new committees, task forces, and workgroups. The goal of SOCCA is to continue to offer numerous areas and opportunities for our members to engage and grow our society. I would like to start off by saying that it is a great privilege to be taking over as Chair of the Communications Committee from Dr. Brent Kidd (Immediate Past Chair and Editor); thank you to Dr. Kidd for his leadership and efforts on behalf of the Communications Committee. He oversaw the development of the two sub-committees focused on social media and SOCCA Interchange/Drip respectively and guided us with engagement with our members through the COVID-19 pandemic and beyond. It is a great honor to be the first woman editor of the SOCCA Interchange and I am excited to continue to build on the work done by the previous Chair. I have been involved with the SOCCA Communications Committee since 2021 and was Chair of the social media sub-committee in the past. As Chair I hope to continue to expand member engagement with our SOCCA Twitter account, promote the work of our members through the Interchange newsletter, and bring timely industry news to our members. I appreciate the mentorship and guidance of my colleagues in helping me develop the skills to take on this new role and look forward to any feedback on how we can serve the organization. As Chair of the Research Committee, I am thrilled and privileged to share with you the notable progress we’ve made in recent months. With the support and guidance of the Board we have grown our membership, been focused on deliverable products for our membership, and continued to increase the visibility and contribution of the committee to SOCCA and the wider community. SOCCA is growing! Thanks to the visionary leadership of our president, Dr. Michael Wall, SOCCA has now created what is known as the Clinical Practice Committee (CPC). This committee reports directly to SOCCA’s Board of Directors and has a singular function: enable our growing membership to participate as much as possible in creating the resources and programs of the future. One Year (and Counting!) of Action and EngagementWith the Women in Critical Care (WICC) section’s one-year anniversary, we presented several initiatives accomplished in the past year at the SOCCA 2023 annual business meeting. We have shared several Interchange articles, Fireside chats, and two webinars that have been well received—one on Wellness and a recent webinar on strategies to enhance women applicants in CCM. For the second year in a row, we have witnessed a decline in the number of applicants interested in anesthesiology critical care fellowships. The gap between the number of positions available and the number of rank lists submitted continues to increase, with only 0.65 applicants per position offered in the 2023 match cycle. This year an alarming 39% of positions were left unfilled post-match. These distressing statistics demand a serious reflection on the challenges we face and the necessary steps to ensure the future of our subspecialty. As we move forward after inspiring stories of anesthesiology intensivists as healthcare heroes and leaders of the COVID-19 pandemic, we must reflect on the past, current state, and future of our subspecialty. While it may be tempting to attribute the current lack of interest to a robust job market and attractive pay, perhaps an introspective approach and reflection are needed to understand other factors that contribute to our specialty’s diminishing appeal to today’s trainees? In recent years, the critical care community has debated the benefits of vitamin C in septic shock. Vitamin C is thought to have antioxidant effects that attenuate tissue injury mediated by inflammation1. A controversial retrospective analysis to evaluate the efficacy of vitamin C demonstrated a major reduction in mortality, AKI, and vasopressor duration2. This fascinating result led to several prospective trials and meta-analyses3, 4. Most recently, a large trial showed that patients in intensive care who received vitamin C therapy had a higher risk of death or persistent organ dysfunction5. With this result, the community has explored alternative therapies to manage septic shock. Vitamin B12, hydroxocobalamin, may be the next in line for evaluation, scrutiny, and debate. Implementing Pathways to Anesthesiology: Promoting Diversity, Equity, Inclusion, and Success. O’Conor et al. International Anesthesiology Clinics (2023) 61:1.SummaryAn interesting review article that is relevant to our field. The article touches on what we constantly encounter: a gap between equality and equity for anesthesiologists from underrepresented minorities in Medicine (URiM). While there are “advertised” equal opportunities for anesthesiologists hired at different stages of their careers, there remains a gap between what is advertised as equality and what is actually exercised of equity. IntroductionHemorrhage from or around a tracheostomy is a relatively common and possibly life-threatening complication. Complications from a tracheostomy can be early or late and can be related to the placement of the tube, prolonged time duration of tracheostomy tube requirement, or abnormal healing at the surgical site. Tracheo-arterial fistulas represent a rare but often lethal complication from tracheostomies. This case report describes a patient who developed a fistula between a mature tracheostomy site and the innominate artery. The report discusses important practical considerations for preoperative and intraoperative management of this condition and describes the most common risk factors, diagnostic approach, and surgical technique. Dr. Jessica Cassavaugh is a T32 Research fellow and Clinical Instructor in the Department of Anesthesia, Critical Care, and Pain Medicine at Beth Israel Deaconess Medical Center. She completed her anesthesiology residency and critical care fellowship at the University of Pittsburgh Medical Center. Her current research focuses on estrogen-dependent regulation of inflammatory and hypoxic signaling, especially as it relates to cardiovascular and metabolic diseases. We are no longer in a world where—as current or future leaders of our respective medical communities—we can remain impartial to discrimination. Workplace mistreatment, discrimination, and microaggressions can limit access to resources and opportunities for growth. It can fuel persistent disparities experienced by caregivers and patients belonging to marginalized communities. As leaders we can’t not see, not hear or not act on inequalities. Read members-only job posts.If you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. Colleagues,Seeing so many SOCCA members in person at the SCCM meeting in San Francisco last month was great. SOCCA members were well-represented on many SCCM panels, workshops, roundtables, and other educational events. The SCCM anesthesia section reception was exceptionally well attended and could have easily been a SOCCA business meeting! We look forward to seeing everyone in person at the annual meeting in Denver in April. Over the recent years, it is no secret that SOCCA has made enormous strides in both its membership and mission. We have seen our ranks swell to over 1,150 in 2022 and our committees and workgroups similarly multiply as we seek to engage and impact all realms of critical care touched by anesthesiologists. The Communications Committee has the unique privilege of supporting and promoting all of these various initiatives in addition to continued general engagement with membership. I encourage all of our members both new and veteran to engage with us as well through our three main products: the Interchange Newsletter, SOCCA Drip Blog, and Twitter (@SOCCA_CritCare). Each of these outlets serves as a way to bring relevant up to date information to the membership on SOCCA webinars, society opportunities, recently published literature, and so much more! We are also always looking for exceptional content from the membership and welcome your submissions to these outlets as well. We are extremely excited and are looking forward to our first in-person SOCCA annual meeting since 2019! The Annual Meeting Program Planning Committee has been working hard over the last year and has put together an outstanding program that promises to deliver exceptional educational content. The meeting will kick off on Thursday night with the opportunity to network with colleagues during the SOCCA Women in Critical Care Meetup and the SOCCA Early Career Group Networking Events. The membership committee started off the new year with an Early Career Intensivists Zoom meet up in early February. The guest speaker was SOCCA board member Dr. Ashish Khanna, and the discussion was led by Early Career subcommittee members Drs. Lauren Sutherland, Christy Idichandy, and Alisha Bhatia. Participants on the call ranged from critical care fellows to anesthesiologist intensivists in their first few years of practice. We had a lively discussion about issues faced during the first few years out of fellowship, including establishing relationships with our surgical colleagues and getting involved in research. Dr. Khanna provided motivation and insight to everyone on the call and members benefited from hearing from multiple viewpoints. The optimal storage temperature of transfused platelets for surgical and traumatic hemorrhage remains controversial. Standard practice since 1969 has been to transfuse platelets at room temperature (22o). This practice is based on decades old research demonstrating that platelets are removed from the circulation more quickly when stored at 4o than platelets at room temperature.1 Since the most common indication for platelet transfusion is thrombocytopenia due to oncologic disorders in order to prevent bleeding, the increase in circulatory time with room temperature platelets was preferred. February 3rd marks Elizabeth Blackwell’s birthday. Dr. Blackwell (3 February 1821 – 31 May 1910) was a British physician, notable as the first woman to receive a medical degree in the United States, and the first woman on the Medical Register of the UK. In addition to being an academic infectious disease specialist, she was an advocate for social justice and equity for women. She founded the New York Infirmary for Women and Children in 1857 along with her sister Emily, and she played a significant role in the American Civil War by organizing nurses and educating women and girls. It is important when looking at history to include the contributions of Black women physicians who have equally contributed in the struggle to achieve the successes of today. In the book ‘Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century’, Jasmine Brown (Beacon Press, January 24, 2023) shares the incredible stories of nine pioneering Black women physicians beginning in 1860, when a Black woman first entered medical school. The stories of Dr. Rebecca Crumpler, Dr. Edith Jones, and Dr. Joycelyn Elders inspire and serve as a source of motivation to many young physicians on this Women Physician’s Day, when we celebrate the accomplishments of women doctors before us, and their struggles. We have come a long way since the days of these pioneering women physicians. However, much work remains to be done, and WICC and SOCCA hope to play an essential role in closing this gap. Financial Disclosures: Dr. Wunsch has research funding from the U.S. Department of Defense (DOD), U.S. National Institutes of Health (NIH), and Canadian Institutes of Health Research (CIHR). Conflicts of Interest: Dr. Wunsch is an author of the upcoming book, The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care (Greystone Books, May, 2023). This year marks the 70th anniversary of the opening of the first modern intensive care unit (ICU). Located in The Municipal Hospital of Copenhagen, the unit possessed many components that are recognized as integral to critical care today: a dedicated area set aside for the sickest patients, 24/7 coverage by specialized staff, frequent monitoring of vital signs, invasive mechanical ventilation, and blood gas analysis [1]. Although situated across the ocean, there was an American connection; the unit was opened by a trailblazing anesthesiologist, Bjørn Ibsen, who had trained for a year at the Massachusetts General Hospital. Ibsen’s pioneering work was born out of his generation’s health emergency, a polio epidemic [2]. Not unlike today’s struggle with the coronavirus disease 2019 (COVID-19), Ibsen also faced the deadly respiratory sequela of a viral infection. By application of knowledge and experience gained during his anesthesia training in Boston and Copenhagen, he was able to diagnose and treat hypercapnic respiratory failure. His novel intervention and subsequent work in establishing the first ICU saved countless lives and changed the face of medicine forever. As our critical care community recovers from the arduous pandemic response, appreciation of the connections with our predecessors may enable us to better cope with stresses we have experienced. Such origin stories may help us to feel proud of our identity, gain perspective on the struggles we encountered, and feel invigorated for what is to come. This is the story of a visionary who laid the kindling for the field of critical care medicine. Severe maternal morbidity in the United States has increased 200% from 1993-2014, with maternal mortality rising to a rate most recently estimated as 17.4:100,000 making this a major public health issue.1 Half of these deaths occurred in the beginning of the postpartum period and 60% of the total deaths were classified as preventable.1 This rate is subject to disparities with the incidence of severe maternal morbidity being higher in every racial and ethnic minority category compared to non-Hispanic white women.2 The most common etiologies of maternal mortality in the United States is cardiac disease, followed by hemorrhage, and then sepsis.3 These high-risk patients would benefit from a dedicated obstetric intensive care unit (OB ICU). Between 1-3% of pregnancies require an ICU admission based on studies in high income countries.4 This number is likely to rise with the increase in maternal morbidity and should prompt a consideration of the best way to deliver critical care to this special population. Introduction:Neostigmine is a reversible acetylcholinesterase inhibitor that functions as a parasympathomimetic drug that has an on-label use for reversing neuromuscular paralytics. In addition, it is indicated in the off-label treatment of acute colonic pseudo-obstruction and critical illness associated ileus. Neostigmine is associated with side effects such as bradycardia, asystole, and pulmonary side effects including bronchospasm and increased pulmonary secretions1,2. There are no studies or case reports describing the use of neostigmine in lung transplant patients. Presented is the case of a 68-year-old comorbid male who underwent bilateral lung transplantation with a post operative course complicated by ileus that was treated with a series of IV neostigmine boluses resulting in increased pulmonary secretions and oxygen requirements. Point-of-care ultrasound (POCUS) has become an integral part of the anesthesiologist and intensivist toolbox for the diagnosis and management of various disease states especially as ultrasound systems become more ubiquitous in our hospitals and increase in portability and ease of use1. This has been emphasized by the ABA in adding the application and interpretation of POCUS cardiac, lung, and abdominal imaging to the Applied Exam2. Working with residents and fellows, I often wonder about the most efficient and effective way to teach these skills in a busy clinical setting. How do we best integrate this into the trainee curriculum? How many exams are necessary for a trainee to become competent (independent)? Should residents strive for some sort of certification? There are many reasons why makeover shows are so popular. There is nothing like watching someone or something remain unchanged for years, emerge new and transformed. Sure, it’s hard work, very expensive, and usually doesn’t happen without arguments and some tears. But the result is almost always for the better. I think it’s time for anesthesiology and anesthesiologists to have a makeover. Read members-only job posts.If you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. Colleagues,I hope you all had a happy Thanksgiving and have a happy and healthy holiday season (so far), avoiding COVID, RSV, adenovirus, and Influenza. Good Grief. The education committee has planned an extraordinary annual meeting which will take place in Denver, Colorado on April 14, 2023. On Saturday April 15th, there is an impressive lineup of educational events during the IARS, AUA, and SOCCA-aligned meeting day. Most importantly, I hope you plan to attend the SOCCA Women in Critical Care and SOCCA Early Career group meet-up and networking events between 7:00-9:00 PM on Thursday, April 13. There is also a reception on Friday, April 14, from 7:30-9:30 PM. It will be great to see everyone in person again. As we approach the new year, we look forward to providing educational content to all of our SOCCA members and to the critical care community at large. The annual meeting subcommittee has been busy compiling a fantastic program with an outstanding group of speakers for what will hopefully be our first in person annual meeting in many years. We strive to ensure a meeting that will highlight the recent advances in critical care medicine and are also working with the research committee to bring the latest in cutting edge research to the meeting attendees. As a professional organization dedicated to the support and development of anesthesiologists who care for critically ill patients, SOCCA’s aims include fostering community and advocacy. SOCCA has therefore organized and promoted efforts to better understand the national anesthesiology critical care practice landscape. Two such efforts—respective surveys of the SOCCA and American Society of Anesthesiologists membership—have yielded valuable insights [1, 2]. However, our conceptualization of the national landscape remains incomplete. Organizational membership surveys, by definition, reach only members of those organizations and reflect only the responses of those who choose to participate, which serves to introduce bias. For example, compensation as self-reported in such surveys will be naturally weighted to reflect the prevailing standards at the institutions with the most respondents, and those standards themselves will be highly influenced by local or regional market forces and institutional culture. Despite evolution in many areas of critical care medicine, refractory cardiopulmonary failure continues to have high morbidity and mortality. In patients with severe cardiopulmonary failure refractory to medical therapy, mechanical circulatory support (MCS) is more commonly being utilized for both short and long-term support. MCS for circulatory shock includes intraaortic balloon pump (IABP), minimally invasive percutaneous ventricular assist devices (pVADs, e.g., Impella), external and durable LVADs, and venoarterial extracorporeal membrane oxygenation (ECMO); venovenous ECMO is utilized for isolated pulmonary failure. MCS can salvage patients with severe disease to allow time for recovery, facilitate corrective procedures, or bridge to transplantation. The evolution of these therapies underscores the constantly evolving nature of critical care medicine and the importance of innovation in improving patient outcomes. This article brings to your attention Dr. Meghan Lane-Fall, an extraordinarily achieved female physician-scientist who continues to excel in many aspects of Anesthesiology and Critical Care. I invited Dr. Lane-Fall to be the center of this story because I am impressed and inspired by her remarkable achievements and her capacity to remain approachable. I am an Assistant Professor of Anesthesiology at the University of Colorado School of Medicine in Aurora, Colorado, where I attend in the operating rooms and the Surgical Trauma ICU (STICU). Throughout my early career as a physician-scientist, I have been dedicated to studying critically ill patients, trauma, and multi-organ dysfunction. We hope you are well and have seen the new uploads on our Women in Critical Care website (SOCCA) and our column in the SOCCA Interchange. We are adding more content and intend to bring new Webinars, Fireside Chats, and—hopefully—some more creative content designed for the busy woman in CCM. Disclaimer: This is a work product of Women in Critical Care and does not represent the views of the Society of Critical Care AnesthesiologistsBackground: Despite the increasing percentage of female intensivists and their multifaceted involvement in healthcare over the last decades, to date, their representation in physician workforce, academic positions and leadership roles in critical care remains disproportionately low. Artificial intelligence (AI) is a revolutionary inclusion to current medical practice, particularly in the field of Critical Care medicine. The actualization of AI is empowered with the intellectual acumen to analyze and generate vastly complex data, as well as integrate from experience, based on recognition of formed patterns. This is achieved through machine learning and perception, compounded by natural language processing, and automated simple repetitive tasks or exposure. These are attributes or skills born from the innovative integration of human intelligence and computer systems. Thus, allowing for a multitude of decision-making and task-executing functions. Critical Care widely encompasses an intricate and detail-oriented multidisciplinary approach in diagnosing diseases and analyzing their progression with simultaneous treatment interventions. While the established conventional approach to medical management has proven to be undoubtedly reliable, it is also unremarkably challenging and time-consuming to medical professionals in the face of disease progression and overwhelming workload. The field of Critical Care establishes multiple landscapes and opportunities in which AI is a transformative asset to researchers and Critical Care physicians alike. Ankylosing Spondylitis (AS) is an inflammatory rheumatic disease that primarily affects the spine, although other joints and organs can become involved. AS and its parent disease, Axial Spondyloarthritis, are not rare, and affect at least 2 million and 5.9 million adults in the United States alone, respectively (1,2,3). To augment recruitment to our specialty, we need to start at the grassroots. The COVID-19 pandemic shed light on a lack of critical care training among practicing anesthesiologists, as well as lack of appreciation for the specialty in the global medical community. A large contributing factor is the myopic perspective of our specialty offered on the standard boilerplate anesthesiology rotation. Medical student exposure to anesthesiology is almost exclusively dedicated to intubation and the role of the intraoperative provider: a rote sequence of injections and dials, staying quiet so as not to wake the beast across the drapes. We love to show off our cheap thrills: the magic of propofol, the placement of arterial lines, and we stick to cheeky truisms: “physiology and pharmacology in action,” “our patients are 100% compliant!”, “we protect patients from the surgeon!” But in doing so, we are selling ourselves short. It’s time to draw back the curtain and show them how much the role of a modern-day anesthesiologist and intensivist can transcend this role. Read members-only job posts.If you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. Colleagues, next year’s annual meeting will be in Denver, Colorado, on April 14, 2023. We have received many excellent submissions for next year’s annual meeting, and now the education committee has the difficult task of putting together the program. Some panels not selected for the annual meeting will be shifted to SOCCA webinars in 2023. More to follow. Committee on Research Update: Nationwide Clinical Practice Patterns of Anesthesiology Critical Care Physicians published in Anesthesia and Analgesia Two years ago under the leadership of Drs. Robert Stevens and Matthew Warner the SOCCA Research Committee formed the SOCCA Data Subcommittee which was charged with expanding the portfolio of survey information that would be of interest and utility to our membership. The SOCCA Membership Committee has been hard at work putting together a variety of programs for all of our members at various stages of their careers. For our graduating fellows, we put together a new “SOCCA Fellowship Exit Brochure” to make sure all of our newly minted intensivists are aware of everything SOCCA has to offer to them. This brochure was distributed with the help of the Program Directors committee. Our fellowship subcommittee also planned our annual Job fair, which occurred on October 5. The strength of SOCCA is the wealth of talent and energy of its members. One of the ways to serve the Society is through volunteer activities. The SOCCA Nominations Committee annually evaluates nominees and develops an election ballot for available Officer and Director positions. This election cycle we will be electing 3 members for the Board of Directors (3-year term). Further details about the governance structure of SOCCA are described in our Society Bylaws. SOCCA is pleased to announce the debut of the Innovators Award.Created through a generous anonymous donation, we plan to award one deserving recipient $10,000 for a true innovation, that is, something that introduces a new device or technique, changes clinical practice, or could improve clinical outcomes. I was exposed to research early in my training as an anesthesiology resident at the University of Maryland in the late 1990s, where I had the fortune of training with Dr. Jane Matjasko, our department chair. As a pioneer in neuroanesthesia, she worked diligently to understand the complexities of anesthetic effects on the brain. She was one of the inaugural members of SNACC (Society of Neuroscience in Anesthesiology and Critical Care) and among the first graduates of the Women’s Medical College of Pennsylvania (now Drexel University). She inspired me to become an academic anesthesiologist who was passionate not only about patient care but also about asking questions, being industrious, and finding the answers through research. IntroductionAnesthesia Critical Care Medicine (ACCM) is the oldest ACGME board-certified subspecialty within Anesthesiology and has seen tremendous growth over the past decade. In an effort to organize, streamline, and create a fair and equal process for fellowship recruitment, ACCM fellowship programs have participated in the SFMatch process since 2014. Over the past nine years we have increased the number of fellowship programs offering positions in the match by 35% and increased the number of positions by 58%. Despite the expansion at the programmatic level, the interest in the field has yet to catch up to the need, and we remain with unfilled positions throughout the country. A milestone in transplantation was recently announced by United Network for Organ Sharing (UNOS) commemorating the completion of over one million transplants in the United States.1 This achievement reflects a steady increase in annual transplant volumes with over 400,000 transplant recipients alive today. It is commonly understood that anesthesiologists are instrumental in peri-operative care of both organ donors and organ recipients. Less widely recognized, but equally important, is the involvement of anesthesiologists in patient selection, risk assessment, coordination of care for pre-operative optimization, and post-operative care. This includes the provision of critical care services for potential transplant candidates with end-stage organ failure, care of high acuity post-operative patients, management of post-transplant complications, and supportive care for organ donors.2 Does Fluid Administration During Induction and Intubation Prevent Cardiovascular Collapse?Russel DW, Casey JD, Gibbs KW, et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation. JAMA. 2022;328(3):270-279. doi:10.1001/jama.2022.9792Nearly one in five patients suffers from cardiovascular collapse while undergoing intubation in the intensive care unit. This is defined as severe hypotension necessitating vasopressors, cardiac arrest, or death. The PREPARE II investigators sought to determine if the administration of a 500ml bolus of intravenous crystalloid solution prior to induction might prevent this collapse. The study was conducted at Vanderbilt University Medical Center in Tennessee, University of Alabama at Birmingham, Louisiana State University School of Medicine and Ochsner Medical Center in New Orleans, Lahey Hospital and Medical Center in Massachusetts, Hennepin County Medical Center in Minnesota, University of Mississippi Medical Center in Jackson, Wake Forest Baptist Medical Center in North Carolina, Oregon Health and Science University in Portland, University of Washington in Seattle, and Baylor Scott & White Medical Center in Texas. As I sit here writing a piece about work-life balance for women critical care physicians, I feel compelled to paint the picture of my current situation: in-house on call at 9pm on a Friday night, an AirPod in one ear teleconferencing my children to say goodnight, strapped into a portable breast pump, eating the fastest thing I could get from the hospital cafeteria (which is invariably fried), all while typing away at this piece in the physician work room. I am awash in irony. Is this the image of the prototypical woman intensivist? Not at all. Am I currently burned out? Actually, I don’t think so. Have I been burned out at some point during my medical career thus far? Definitely. How do I refine my career plan to achieve work-life balance and sustainability for a satisfying and productive professional career? Unclear, check back later. Our realities changed during the pandemic and many people asked a very important question, possibly for the first time in their lives: what brings me joy and fulfilment? Is my choice of career a good fit for me? Outside of medicine, it is this feeling of being unfulfilled that has led to what is being dubbed ‘The Great Resignation’. Amongst physicians, the lack of connectedness and satisfaction with one’s specialty has led to high rates of burnout. Pre-pandemic literature on burnout suggested that engaged physicians tend to have less burnout. Engagement outside of clinical work can be driven by continued learning, faculty development and mentorship, having a social network and many more things. For me, engagement included interacting with my trainees, seeking ways to improve my clinical practice and finding mentorship from other physicians in my area of interest. This is where the role of belonging to a professional organization became very important. A 2018 viewpoint published in JAMA Internal Medicine highlighted four archetypes of “mentorship”: the traditional mentor, the coach, the sponsor and the connector.1 The authors explain, “To put it simply, the mentor guides, the coach improves, the sponsor nominates, and the connector empowers, but always the mentee benefits.” As I read this article, I was struck by how rare it is for one person to be able to fulfill all these needs, and how I was lucky enough to have a mentor, Dr. Hannah Wunsch, who can and does embody all four roles. Where We AreOver the past decade, the need to promote gender diversity in medicine has been embraced by several medical societies. In the USA in 2017, 33% of critical care trainees and 26% of ICU physicians were women. There are many reasons for this disparity and work is being done to understand these reasons to some extent. It was noted in literature that an explicit focus on “eliminating gender inequity will help to gradually change societal views of the roles played by women and men critical care physicians so that it will become the norm for women and men to be both critical care physicians and leaders in critical care.” Read members-only job posts.If you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. SOCCA is pleased to announce the debut of the Innovators Award. Created through a generous anonymous donation, we plan to award one deserving recipient $10,000 for a true innovation, that is, something that introduces a new device or technique, changes clinical practice or could improve clinical outcomes. The innovation should be expected to have an immediate effect on health care delivery. This award is an extension of the Society’s growing interests in research, education and engagement. We encourage interested members to apply. Colleagues, as you all know, our road trip to Hawaii was canceled due to COVID, again. However, our Education Committee and the IARS rallied and quickly changed gears to a 100% virtual annual meeting. Although we all missed seeing each other in person, the meeting was incredibly successful and well attended. At the SOCCA annual meeting on Friday, we had four very lively educational sessions and aligned sessions with the IARS, AUA, and SOCCA. We then ended the day with our young investigator award presentations. On Saturday, the next day was the IARS | AUA | SOCCA aligned meeting day. We sponsored a review course lecture and a panel on evidence-based emergency airway management, which generated many comments and discussions. On behalf of the SOCCA Education Committee, we would like to thank you all for another successful SOCCA Annual meeting this past spring. While we were disappointed that the increase in COVID cases led to a last-minute transition to a virtual format, the enthusiasm for educational talks, presentations of current research, and networking opportunities could not be fettered. The members of the SOCCA Research Committee are moving into summer with great energy and enthusiasm. Our members have continued to advance a variety of initiatives in support of the SOCCA vision “to promote and advocate for current and future critical care anesthesiologists through collaboration and innovative patient care.” The Research Committee would like to highlight some of the recent literature contributions of its members. Dr. Carlee Clark is an Associate Professor in the department of Anesthesia and Perioperative Medicine at the Medical University of South Carolina where she is Chief of the Anesthesia Integrated Clinical Center of Excellence and Vice Chair of Clinical Operations. She is currently serving on SOCCA’s Board. Dr. Michael O’Connor is a Professor in the Department of Anesthesia and Critical Care, Section of Pulmonary and Critical Care Medicine, Department of Medicine, at The University of Chicago. He also serves as a Vice-Chair of Academic Affairs and as the Executive Medical Director of Critical Care Services at the University of Chicago Medical Center. Even prior to curricular changes necessitated by the COVID-19 pandemic, adult medical education had been evolving from a primarily in-person lecture-based structure to a more interactive and reflective approach to learning. Meeting UpdatesWomen in Critical Care’s Mission Statement and Vision:Mission: To provide a community of mentorship, sponsorship and support that promotes the recruitment, development, advancement, and well-being of women in Critical Care Anesthesiology.Vision: To foster women leaders in Critical Care Anesthesiology. How long have you been a SOCCA Member? Pro/Con Discussion of Integrated Critical Care Training with the Program Director, current chief fellow and a practicing graduate of OHSU Read members-only job posts—including roles with: By the time you read this newsletter, you will have been informed that our annual meeting—in conjunction with the IARS’—for this coming March has been transitioned from in-person to virtual. This will mark the third consecutive year that we are not meeting in person and our second full virtual meeting. It’s a long time! I will start out by saying that I share everyone’s disappointment in the annual meeting being (necessarily) converted to virtual yet again. Still, as the months drag on, we all become more adept at living in the “virtual meeting” era. The Communications Committee has experienced this first hand and has been hard at work spreading the many messages of SOCCA via these virtual avenues over the past two years from interactive webinars and educational content, to new initiatives and committees. I think it is safe to say that we have begun to collectively see the fruits of this labor in the metrics we follow from webinars joined, links clicked, and webpages visited. Just in terms of website traffic we have seen our unique visitors/sessions double year over year. I attribute this to all of the committees that are hard at work making sure that SOCCA produces a continual stream of quality content and opportunities for engagement from our membership. The main mission for the SOCCA Membership Committee is to coordinate all membership activities for SOCCA. Our membership numbers and interest in SOCCA continue to grow. This interest and growth are a direct result of our members’ engagement and efforts to truly make this society desirable and valuable to each of the members and all of the Anesthesiology Critical Care community. This past year our focus was to launch a strategic structure realignment intended to better serve the members of SOCCA and the Anesthesiology Critical Care community with the goal of increasing engagement, diversity, and opportunities for members to contribute to the current and future of SOCCA. The SOCCA membership committee decided to make subcommittees this academic year for better creativity and engagement amongst its members. In the fellowship subcommittee, we held a job search webinar in the fall for the current critical care fellow class. We were able to invite panelists from both the private and academic settings; we were also able to include a current program director and academic chair. Comfort with virtual conferences may be one positive to come out of the COVID-19 pandemic, as we had good participation from all over the country. Highlights included: discussion of timeline for job search, growth of private practice opportunities, approaches to contract negotiation, and types of ICU settings available. The webinar is available to view for SOCCA members as well as a follow-up thread in the Docmatter community. As we start the new year with some bittersweet memories from 2021, we are again reminded that the pandemic still exists with the most recent surge again filling hospitals and ICUs alike. This current surge with the highly transmissible Omicron variant has not only overwhelmed hospitals but has also impacted the critical care workforce across the board. This has again upended many a plan, including the scheduled in-person annual meeting in Hawaii this March which has been converted to a virtual-only format. Although the decision was not easy, we believe that it was in the best interest of our members and the society in general. A lot of behind-the-scenes activity and hard work has gone into making this transition seamless and we are confident that we will be able to provide our membership, the same high quality and enriching content that the in-person meeting would have provided. For this, we would like to thank our administrative and education staff partners from the IARS, SOCCA and AUA. It was not easy to suddenly pivot and reorganize everything on the same dates as the actual in person meeting, within a less than two months span, and we would have not been here had it not been for their tireless efforts. The combined IARS/AUA/SOCCA meeting will be held virtually from March 17-20, with the dedicated SOCCA meeting day on Friday, March 18; and aligned SOCCA-IARS content on Saturday, March 19. Inspired by positive experiences as an undergraduate, I signed up for the opportunity to gain research experience during residency in the Columbia University Apgar Scholars program. When Dr. Margaret Wood advised me, as a junior resident, that a career conducting clinical research path would require additional research methods training and dedicated time away from patients, I was astonished. Clinical work is exciting and energizing. The roles are clear, the gratification can be immediate, and positions are secure. In contrast, early in my clinical training, reinvesting my efforts in a parallel but separate career path felt uncertain and risky. I could not imagine, at that time, how complementary my clinical and research work would become. We had our first ‘kick off’ meeting for Women in Critical Care. We had 59 pre-registrants and 17 participants for the first zoom meeting on February 23. Our objective was to introduce the mission as well as to decide a structure and goals for the year. We discussed a website launch as well as a first, official meeting on March 17 at the 2022 SOCCA Virtual Annual Meeting where we will have an invited guest speaker: Dr. Deborah Cook (a truly inspiring woman intensivist). Despite the fact that incoming senior residents have had experience in the intensive care unit (ICU) as interns, they may have insufficient skills for advanced level care processing. In order to address this gap we initiated a three day “ICU Boot Camp,” delivered at the end of PGY-2 year. The purpose of the curriculum is to equip junior residents with the foundational knowledge and skills required to transition efficiently into the senior resident role. Additionally, this training increases resident confidence and sets expectations for faculty regarding the starting performance level of the newly minted senior. The curriculum covers commonly encountered clinical scenarios, diagnoses, treatments, monitors and devices in a systematic manner. One of the largest challenges faced by leaders in healthcare during the Covid-19 pandemic was making difficult decisions in the face of ambiguity. This parallels what is taught in business school where future leaders are taught how to make management and financial decisions with limited information. If you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. The period between Thanksgiving (some would even say Halloween) and New Year’s Day feels like a sprint to the end, a mad rush of preordained traditions that fills us with a sense of the tried and true, the old leading to the new, the past looking towards the future. So, this is a good time for a look back at 2021, the second and (hopefully) final act of our very own modern Greek tragedy, a year where nearly 400,000 fellow citizens died as a consequence of a disease we didn’t even know existed a little over 2 years ago. Despite another year of pandemic-related challenges in the clinical practice of intensive care medicine, the SOCCA Research Committee continues with enthusiasm as we move towards the end of 2021. Our three subcommittees (Data, Research Collaboration, Scientific Writing) have been extremely productive. As educators, we strive for a mindset of innovation in both how and what we teach in Critical Care Medicine. The intensivists of tomorrow are expected to be clinically excellent, adept in responding to changes in the healthcare environment and also competent in the administrative arena. With the holiday season upon us, in the US and globally, ICUs (Intensive Care Units) are still struggling with the deadly COVID-19 pandemic. For the first time in our history, hospital systems are forced to scramble to allocate scarce resources such as nursing, respiratory therapists, ICU beds, oxygenation, and drug treatments that lack adequate amount of literature support. Dr. Pinxia Chen currently practices at Saint Luke’s University Health System in Bethlehem, Pennsylvania and has been with her group for five years. Dr. Chen is originally from the South Jersey/Philadelphia area and started her career with an anesthesiology residency at Penn State Medical Center in Hershey and a fellowship in critical care at the Cleveland Clinic. Dr. Chen stated that she then looked for academic jobs with a strong anesthesiology presence in the ICU. However, the academic jobs available in her preferred geographic location left something to be desired and her current position in private practice did allow for strong clinical involvement by anesthesiologists in the critical care setting. When Dr. Chen started there were only two people in the group with formal critical care training. That number has grown considerably since that time. Peter Safar, the creator of the first intensive care unit (ICU) in the United States, father of cardiopulmonary resuscitation, pioneer of the modern ambulance design, and three-time nominee for the Nobel Prize, repeatedly delivered a very simple message: physician-scientists are in danger of extinction.1 Welcome to the Fall edition of Interchange! First and foremost, on behalf of the Society, I would like to congratulate all those young colleagues that have selected Anesthesia/Critical Care as their subspecialty. This issue is dedicated to you, our newest members. I would like to start by saying it is an honor to take over the Communications Committee at SOCCA and subsequently as editor of Interchange. I have to give immense credit to my immediate predecessor Craig Jabaley for continuing to maintain—and even expand—the committee’s roles throughout the initial waves of the COVID pandemic. I hope to continue that process and build upon the foundations provided to better serve our organization. To that end we have created two subcommittees to better focus on the varying roles of the Communications Committee. These two subcommittees will focus on Twitter and SOCCA Interchange / Drip respectively. I would encourage any of our members who don’t yet follow us on Twitter (@SOCCA_CritCare) to do so as well as frequent our blog (SOCCA Drip) to stay up to date on all things SOCCA including webinars, meetings, and organizational opportunities. Read members-only job posts—including roles with University of Washington, Keck School of Medicine of USC, and Albany Medical Center—at SOCCA’s Job Board. The COVID-19 pandemic has had a significant impact on critical care education and fellowship recruitment. Adherence to the social distancing guidelines required the Critical Care Fellowship applicants and the fellowship programs to adapt to the world of virtual interviewing for the 2020-2021 recruitment season. Initially, virtual interviewing was envisioned as a temporary solution to the ongoing pandemic with the hope of returning to in-person interviews for the next recruitment season. Unfortunately, virtual interviewing is likely the new norm for critical care fellowship interviewing, given the unrelenting pandemic. Given this new reality, fellowship programs must understand the advantages and disadvantages from an applicant’s perspective for this new era in the fellowship recruiting process. The COVID-19 social distancing guidelines have required the fellowship programs and the applicants to adapt to the world of virtual interviewing. The virtual interviewing process has undoubtedly been an uncharted path for the vast majority of applicants and the fellowship programs. Here, I provide advice to prospective interviewees and fellowship programs on navigating the world of virtual interviewing as the virtual interviewing format is here to stay for the foreseeable future. On behalf of the SOCCA Education Committee, we would like to extend our thanks to our new members. It is heartwarming to see such an overwhelming enthusiasm to advance the educational mission of SOCCA. As SOCCA membership grows, the Education Committee has realigned its structure to create working groups, dedicated to meeting the education needs of our SOCCA members and the anesthesiology critical care community at large. The last few months have been a testing time for any practicing intensivist in the United States. We have been working overtime fighting the delta COVID sweeping through the country. Despite this, the SOCCA Education Committee aptly supported by the rest of the SOCCA membership has continued to produce remarkable new critical care education content. We are deeply appreciative and truly admire each of you as you deal with this once in a lifetime ‘ICU pandemic.’ Our update highlights our working groups that have been extremely busy in developing diverse educational content and adapting to the ever-changing landscape imposed by the COVID-19 pandemic. The Early Career Working Group has been working hard to put together some exciting content for this fall. First off will be our Job Seminar for Fellows on October 21 at 6pm EST. This webinar has been specially arranged for our members who have just started their fellowships and are starting to look for jobs and plan their careers. Please join us for what promises to be a lively discussion with your co-fellows from around the country. Our panelists will include department chairs, program directors, members in private practice, and recent fellowship graduates. The strength of SOCCA is the wealth of talent and energy of its members. One of the ways to serve the Society is through volunteer activities. The SOCCA Nominations Committee annually evaluates nominees and develops an election ballot for available Officer and Director positions. This election cycle we will be electing a Secretary (2-year term) and 3 Board of Directors (3-year term). The Secretary position serves as the entry position for eventual advancement to Society President. Further details about the governance structure of SOCCA are described in our Society Bylaws. Searches are often conducted within academic departments to find suitable candidates for leadership succession. This is usually done either when a vacancy emerges, following a retirement or when a new role is created. Internal searches are carried out to offer inclusion to emerging talent and add diversity to the pool of academics already holding administrative roles. Finding a good fit for a leadership role is an inexact science. Undertaking robust research may offer professional gratification and a betterment of our specialty that cannot be gleaned from clinical excellence alone. It has to be said my journey through research has been an evolved one, catalyzed by clinical questions, collaborations, mentorship and a pursuit of an ever-sharpening question around the role of oxygen and other gasotransmitters in perioperative inflammation and critical illness. To my mind, I have been very fortunate to be in an environment at Beth Israel Deaconess Medical Center which affords academic time, mentorship and understands the committed investment it takes to develop a home-grown clinically active researcher. Out of hospital cardiac arrest is a highly morbid and clinically challenging public health issue. Imposter syndrome is the internal struggle to trust our knowledge and capability, and it follows many of us through each facet of training and career. I first experienced it in medical school. Time and experience is a good antidote, but the real remedy is mimicry; “fake it until you make it.” The other day I was listening to one of my favorite podcasters (not in the medical field) about how she was forcing herself to wear regular clothes for five days in a row, as during the pandemic she had been wearing sweatpants for over 400 days and she had reached a point where she wanted to feel normal again. Read members-only job posts—including roles with The University of Kansas Health System, Oregon Anesthesiology Group, and University of Florida Department of Anesthesiology—at SOCCA’s Job Board. I was a second-year anesthesia resident when my teachers and mentors encouraged me to go the annual Society of Critical Care Anesthesiologists (SOCCA) meeting. At my very first meeting, I found the atmosphere very family-like, very open, very healthy and a lot of positivity all around. Ten years later, I chaired my very first SOCCA meeting at the recently concluded SOCCA Annual Meeting in 2021. I never thought that a decade of association with the SOCCA would get me here, and neither did I ever think that I would one day chair a virtual meeting. A big welcome to all our new members to the SOCCA Membership Committee! We look forward to collaborating with you all. The main mission for the SOCCA Membership Committee is to coordinate all membership activities for SOCCA. Our membership numbers and interest in SOCCA continue to grow. To answer the asks of our members (‘I want to be more involved, but how do I do it?’), the SOCCA Membership Committee has launched a strategic structure realignment intended to better serve the members of SOCCA and the Anesthesiology Critical Care community. The realignment should foster increased engagement, diversity, and opportunities for members to contribute to the current and future of SOCCA. Our center has supported 43 patients with COVID-19 ARDS on ECMO. Of these, 8 cases (19%) were in peripartum women, and their rate of survival was 86%. Notable points regarding the pregnant cohort (4 patients) include the fact that all neonates born on ECMO were preterm and required intubation but ultimately survived. Happy New Year and I hope you are keeping warm! I’d like to take this column to introduce some of the activities and tools that SOCCA members can look forward to as this (surprisingly) cold winter turns to Spring. You may first notice that this newsletter (formerly the Interchange) has a new format! Instead of that stodgy old pdf (that few people read), we have now moved into a platform accessible from your computer, handheld, or even Anesthesia workstation. This platform is more dynamic and flexible, allows better integration of online content, is more closely aligned with our website and Twitter page, and (hopefully) more fun to read.
“Part of this complete breakfast.” This is the closing line of nearly every breakfast food commercial since at least the mid-1980s. The final scene universally depicts two mainstays: the product, and a cup of orange juice. In popular culture, citrus fruits are crucial to balanced nutrition and provide essential vitamin C. Colloquially, this nutrient is well known to stave off scurvy; but, medically, it has far more powerful potential as a tool to combat the sequelae of infection.
Is Vitamin C (ascorbic acid) the new and improved answer to decreasing sepsis-related mortality? It’s unclear. Up until this point, ascorbic acid has been studied in small cohorts of mostly cancer or burn patients. Studies in these populations have had variable results, some showing no difference in outcomes and others displaying impressive benefits. Continue Reading…
Dr. Todd Dorman MD, FCCM is the Senior Associate Dean for Education Coordination, the Associate Dean of Continuing Medical Education, the Vice-Chair for Critical Care and a Professor of Anesthesiology and Critical Care Medicine at the Johns Hopkins University School of Medicine. He is a past president of the Society of Critical Care Anesthesiologist and the Society of Critical Care Medicine and was the 2017 SOCCA Lifetime Achievement Award Winner. Continue Reading…ACCM Fellowship Match
I wanted to provide an update on the ACCM fellowship match. The ACCM fellowship application process has been managed by SF Match for four match cycles now, and we are in the midst of our fifth. So far it has largely been viewed as successful, and most programs report seeing a larger number of applications since the match was instituted. At the time utilizing a match was agreed upon, many programs worried that they would lose applicants to the vagaries of the match who otherwise they would have been certain to recruit. Continue Reading…Update on Clinical Research Consortium: Collaborative Research Initiative for Perioperative Clinical and Translational Science Meeting
Towards the end of last year, a consortium of academic anesthesiology organizations launched an initiative to help establish a clinical trials network in the U.S., which would focus on perioperative medicine, critical care, pain management, and peri- and post-partum care. Continue Reading…SOCCA 2018 Annual Meeting and Critical Care Update
Welcome to the SOCCA 2018 Annual Meeting and Critical Care Update, a meeting I am confident you will find rewarding with many valuable takeaways and networking opportunities. The members of the SOCCA Committee on Education, Drs. Adam S. Evans, Sheila Pai Cole, and Peter Von Homeyer, have developed a cutting-edge education program, addressing the latest advances in critical care and investigating the most pressing issues in anesthesiology. Continue Reading…April 28 is Aligned Meeting Day
The attendees of the SOCCA Annual Meeting will have the opportunity to take advantage of a special Aligned Meeting and SOCCA Focus on Critical Care Day on Saturday, April 28, complimentary as part of their registration fee. Thought leaders in anesthesiology will present a wide selection of robust education sessions, highlighting pioneering topics in anesthesia and celebrating advances in education, science, research and the art of anesthesiology. Continue Reading…Job Board
Have you visited SOCCA’s Job Board recently? Recent listings include positions with Mercy Medical Group of Sacramento, CA; Southern Arizona VA Health Care System of Tucson, AZ; and Oregon Health & Science University of Portland, OR. Continue Reading…Call for Articles for SOCCA Interchange
If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please submit your proposal/article to Vivian Abalama, CAE, at [email protected] on or before Friday, April 20, 2018. If your article is chosen for the newsletter, we will contact you for editing and formatting. Continue Reading…Young Investigator Award Presentations: 1st Runner Up “Mostly Dead is Slightly Alive” has been for more than 40 years the maxim for Dr. Lance B. Becker when somebody claims that a cardiac arrest (CA) patient is dead. We believe that our failure in improving outcomes in CA has grounds in the “myth of the single magic bullet.” For decades, the mainstream of resuscitation science was represented by unsuccessful clinical trials targeting single pathways while expecting miracles. Unfortunately, we have not had very positive outcomes and still we are questioning if epinephrine should be routinely used during cardio-pulmonary resuscitation. Continue Reading… Cardiac output monitoring is essential for understanding flow and pressure relationships in critically ill patients after cardiac surgery. While the Swan-Ganz catheter is the traditional gold standard, new technology has used relatively non-invasive methodology to estimate cardiac output. Long time interval (LTI) analysis of the arterial blood pressure waveform is one such method. Continue Reading… The SOCCA Research Committee is enthusiastic and energized heading into the 2021-2023 term! As we reflect on the past two years, there has been substantial growth in committee activities. Under the leadership of committee Chair Dr. Robert Stevens and Vice-Chair Dr. Matthew Warner, the committee developed several short surveys designed to assess the current state of anesthesiology-led critical care, including: clinical practice patterns, research initiatives and mechanisms of support, current and future models of anesthesia-based ICU training and education, anesthesiology intensive care engagement in the COVID-19 pandemic, and point of care ultrasound utilization in clinical practice. Continue Reading… We previously reviewed data related to the risk of healthcare workers contracting COVID-19 in December of 2020 (Interchange:31[3]). One study of front-line healthcare workers demonstrated a 4% positive COVID-19 testing rate compared to just 0.33% for the general population. In a survey study of 105 anesthesiologists and intensivists at a New York City hospital, 58% reported a workplace exposure (mostly related to airway management), 26% of those reported COVID-19-like symptoms after that exposure, but only 12% of providers tested were found to be positive for antibodies. Continue Reading… According to Oxford Languages, to “practice” means to pursue a professional activity or exercise a skill regularly and routinely to improve proficiency. I am an anesthesiologist who “practices” critical care medicine and the residency program director for more than seventy-six residents in a large training program. I am also a mother, a wife, sister, and daughter; and I have to practice being human every day. We are all human, and we deserve more competence and proficiency as we interact together. Often, my biggest challenge that demands practice for proficiency is the transition from work to life. Continue Reading… To at least some degree, we all entered medicine for altruistic reasons: helping others, finding meaning in providing comfort and care, and saving lives. We in critical care are especially driven to offer management of life-threatening disease states as well as solace and comfort to critically ill patients. This aspect has been highlighted in striking detail during the pandemic where, despite the grueling physical demands of working in ICUs during this time, the discomfort of PPE, and the trauma of watching so many people die and so many families suffer, we still find joy and reward in the lives we save and the families whose lives we touch by our compassion. Continue Reading… Twenty years ago, I was in the middle of my critical care fellowship year when we admitted a patient that was “found down.” The patient was comatose, and we really did not have a lot of information or leads to guide our therapy. The patient had been admitted to the surgical ICU on the presumption that he was a trauma patient, but after the initial work up found no injuries, we were left with a long list of possible diagnosis and extensive detective work in front of us. Continue Reading… The SOCCA Committee on Research is currently engaged in multiple efforts to expand the scientific objectives of the society. First, the committee has developed a series of short surveys targeted to SOCCA members to assess diverse aspects of anesthesiology-led intensive care. These include: clinical practice patterns, research initiatives and mechanisms of support, current and future models of anesthesia-based ICU training and education, anesthesiology intensive care engagement in the COVID-19 pandemic, and point of care ultrasound utilization in clinical practice. Continue Reading… There is no doubt that both SOCCA and its individual members are busier now than ever. SOCCA has expanded its efforts in every domain, and with this growth there is a need for continued evolution and revitalization of our communications efforts. Our blog, the SOCCA Drip, the Interchange newsletter, @SOCCA_CritCare, electronic mailers, and related efforts are all member-driven initiatives. In order to keep pace with increasing demands and feature the work done by our members within the organization and externally, we must come to embody the proverb, “many hands make light work.” Continue Reading… The SOCCA Early Career Working Group held its first meeting on January 28, and it was a success! We discussed how we want to organize the group and what we hope to accomplish together. Our top priority will be to keep fellows and early career members engaged in the society. We are currently planning to organize several webinars, including advice for residents applying for fellowship, advice for fellows applying for jobs, and early-career guidance for fellows reaching the end of fellowship before starting their jobs. Continue Reading… We are pleased to announce the newly published SOCCA Parental Leave and Lactation Recommendations. This initiative was undertaken in hopes of providing support for intensivists who are new parents by birth or adoption and/or breast feeding. The document exemplifies the role SOCCA takes to support all intensivists in their personal endeavors, to enhance mental and physical health and well-being, and to continue championing women in critical care. Continue Reading… Obstructive sleep apnea (OSA) is the most common form of sleep-related breathing disorder encountered in the perioperative setting. It is defined by recurrent upper airway collapse, potentially leading to decreased oxygen levels during sleep and an increased risk of long-term cardiovascular illness. While OSA is more prevalent in surgical candidates than in the general population, between 60-90% of patients remain undiagnosed. Continue Reading… COVID-19 has drastically changed how end-of-life care is practiced in the intensive care unit (ICU). Safety concerns for society limits family visitation but is contrary to patient and family-oriented care. This article provides an ethical analysis of the pros and cons of having family members present at the death of a critically ill patient with COVID-19 and provides a framework that can be used in future surges. Continue Reading… She was breathing laboriously and had all but lost consciousness. In the subcutaneous tissues of her right arm, a syringe pump was delivering morphine and midazolam to help her breathe more easily and prevent the seizures she had been having earlier. Her right cheek still twitched periodically. She was in her daughter’s home surrounded by her grandsons and daughter. Just yesterday she had opened her eyes and smiled at her loved ones, tracking their movements. Continue Reading… Postoperative pulmonary complications have been recognized and appreciated by physicians since symptoms of pneumonia were first described by Hippocrates, the father of western medicine, in 460 BC. Despite our extensive familiarity with this pervasive ailment, pneumonia remains the third-most common postoperative complication with an overall incidence of 1.3-1.8%. Continue Reading… Advance care planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their values, goals, and preferences regarding future medical care. The goal of ACP is to help ensure that people receive medical care that is consistent with their preferences during serious and chronic illness. At the Cleveland Clinic, we operationally defined ACP as having two elements: documentation of the surrogate decision-maker in the electronic medical record (EMR) for all adult patients and goals of care discussion documentation for seriously ill patients. Ideally, this conversation between a seriously ill patient with a chronic condition and their primary provider would happen long before the moment of a critical illness crisis. Continue Reading… Read members-only job posts—including roles with Emory University School of Medicine, Ochsner Health System, University of Arkansas for Medical Sciences, and University of Wisconsin School of Medicine and Public Health—at SOCCA’s Job Board. Continue Reading… Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. Continue Reading… The holiday spirit is here! There are ornaments and festive music everywhere, Thanksgiving is still fresh in our memories, and the winter chill heralds the arrival of major religious holidays as well as the New Year. Yet, this year obviously feels different. For almost 12 months we have endured a pandemic that has transformed every aspect of our lives and will leave profound marks in the way we conduct ourselves for the foreseeable future. Continue Reading… What a year! In continuing to improve well-organized bookcases and other real or virtual backdrops, we have clearly embraced the new normal. While the disappointment of missing real human contact associated with education is difficult to quantitate, there is certainly a silver lining to be appreciated. Developing and delivering didactic materials during a pandemic has required us to dig deep into the reserves of our creativity, and the results have been excellent to say the least. Continue Reading… On behalf of the Communications Committee, we invite you to take a look at the newly launched SOCCA Drip online. To provide a greater wealth of resources to members in a timelier fashion, SOCCA Drip will be regularly updated to feature both long-form content written by members and brief topical highlights from the popular media, peer-reviewed literature, relevant professional societies, and other sources that will be of interest to the membership. We will continue to aggregate the majority of these features into our quarterly Interchange newsletter. Continue Reading… Read members-only job posts—including a role with Oregon Health & Science University, which is seeking candidates for a Faculty Position for Anesthesiology Critical Care, as well as a position with Providence Sacred Heart Medical Center, whose combined Departments of Anesthesiology and Critical Care are recruiting an Anesthesiologist to join its staff. Continue Reading… This month we are featuring Dr. Jing Tao. Dr. Tao is an anesthesiologist and intensivist at Memorial Sloane Kettering Hospital in New York. She is originally from NYC, completed residency training at the University of Maryland, and then her critical care medicine fellowship at Brigham and Women’s Hospital. We asked Dr. Tao to reflect on her experience as a SOCCA member so far. Continue Reading… COVID-19 has caused immense stress on physicians. Anesthesiologists and critical care physicians have been at the forefront of pandemic response, whether caring for critically ill patients or facilitating surgical procedures amidst significant uncertainty. Health care providers are particularly vulnerable to mental health issues amidst risk of exposure, longer work hours, shortages of personal protective equipment (PPE), challenging resource allocation decisions, stress of caring for their loved ones, threatened financial and job security, and an overall decrease in social interactions. Continue Reading… The biting cold winter in Minnesota did not feel any different in January, 2020, but for the news wildly circulating over the internet, television, radio, and social media of a novel coronavirus spreading in the Chinese city of Wuhan, which would later be termed SARS-CoV-2. Everywhere else, people continued their life with minimal worry. In the new millennium, other potential pandemic threats related to SARS (2003), H1N1 (2009), MERS (2012), and Ebola (2014-2016) were readily managed with routine infectious disease principles and did not disrupt our life to any significant extent. Continue Reading… Particularly challenging in the chronically hospitalized, the immunocompromised, and those with cystic fibrosis, P. aeruginosa has found a niche in intensive care units around the world. P. aeruginosa is a very common, encapsulated, gram-negative rod that has been recognized for its highly evolved antibiotic resistance. Continue Reading… The risk to healthcare providers of intubating patients with COVID-19 is a global concern, but data are scarce despite the presumably high risks. Surprisingly, the results of a recent study published in Anaesthesia by El-Boghadadly et al. suggest that the risk of transmission, hospitalization, and/or self-quarantine may be slightly higher than 10%! Continue Reading… Jeanine P. Wiener-Kronish, MD, Henry Isaiah Dorr Distinguished Professor of Research and Teaching in Anaesthetics and Anaesthesia; Massachusetts General Hospital, Boston, Massachusetts was the 2020 SOCCA Lifetime Achievement Award Winner Continue Reading… The COVID-19 pandemic created a unique crisis in healthcare across the world. Due to the shortage of staff to cover surge intensive care units in many hospitals, the Society of Critical Care Medicine, among other organizations, recommended a tiered approach to forming surge capacity teams for coverage of additional critical care beds. These models seek to extend the expertise and oversight of intensivists, and other critical care professionals, to a greater number of patients via a multidisciplinary team. Continue Reading… A few months ago – what seems like a century – I daydreamed about all the good news that would come from our Annual Meeting in San Francisco. I was confident I’d be writing about how the meeting was a phenomenal success and how well SOCCA was positioned for the future. Continue Reading… Perhaps unsurprisingly, this issue of Interchange is devoted to COVID-19. As a professional society comprised of critical care anesthesiologists, SOCCA members have responded in numerous ways to the unfolding pandemic: clinical care at the bedside, reconfiguring perioperative spaces, leading surge responses at all levels, developing clinical and operational guidance at the national level, and remaining at the forefront of investigative efforts. In the meantime, the critical care fellowship match cycle has drawn to a close, and those of us in academic settings are both celebrating our departing trainees while preparing for the influx of new faces. Continue Reading… by Robert D. Stevens, MD, FCCM The SOCCA Research Committee met in-person during the February 2020 SCCM Congress in Orlando. We arrived upon several goals further outlined below. While progress has been slower than planned for obvious reasons, we remain committed to gradually ramping up over the coming weeks. Continue Reading… Given the extraordinary disruption to training and medical practice caused by COVID-19, the American Board of Anesthesiology (ABA) has taken swift action to relax policies, offering increased flexibility for anesthesiologists. The Board has also worked to provide seamless access to educational and mental health resources for impacted physicians. Continue Reading… Natalia Ivascu, MD (Weill Cornell Medicine) and Jonathan Hastie, MD (Columbia University Vagelos College of Physicians and Surgeons) are critical care and adult cardiothoracic anesthesiologists in New York City. Their leadership of a coordinated COVID-19 pandemic response across the New York-Presbyterian health care system was recently featured in NEJM Catalyst. Continue Reading… Among its many impacts, COVID-19 has spawned a plethora of early data and literature. That which is not high-quality may hinder progress toward our understanding of the disease. Critical care and, more broadly, perioperative medicine are clinical arenas that generate massive volumes of data. As we routinely care for patients with COVID-19 in those settings, these data hold promise to further our understanding of the disease. Continue Reading… Nicole King is an anesthesiologist and critical care physician at the University of Cincinnati. She is currently obtaining her Executive Masters in Clinical Quality, Patient Safety and Leadership at Georgetown University. She answered a call for volunteers in New York and staffed a repurposed operating room intensive care unit for a month. While there, she chronicled her experience via e-mail. Excerpts from those e-mails are reproduced below. Only minor edits have been made where necessary for readability and to guard privacy. Continue Reading… The COVID-19 pandemic has raised many ethical and moral dilemmas in the realm of public health, social order, duty of care, and fair distribution of resources. Difficult decisions must be made about how, where, when, and to whom resources should be allocated. Physicians and health care workers are bound by a duty of care, therefore, obligations to the patient’s well-being are generally considered to be primary. This is grounded in the principle of beneficence, among others. There is also a reciprocal obligation placed on health systems to provide the best possible infection control modalities at the disposal of healthcare workers, to provide them preferential access to care should they become ill, and to consider the well-being of the families as critical to supporting healthcare workers. Continue Reading… Telework, or telecommuting, is an alternative work arrangement where “employees perform tasks elsewhere that are normally done in a primary or central workplace”. According to the US Bureau of Labor Statistics, more than 25 million people were telecommuting in 2018, and the number of telecommuters increased 115% between 2005 and 2015. Workplace social distancing, including telework, has been considered a possible mitigation strategy during influenza pandemics, and a number of companies and governments have encouraged workers to telecommute because of the current COVID-19 pandemic. Continue Reading… Of all the disruption created by Coronavirus Disease 2019 (COVID-19), nothing remains more constant than its enormous uncertainty. How the immediate and long-term future of the pandemic will play out remains unclear. Yet, it is certain that the world is now fundamentally different. COVID-19 has and will continue to adversely impact individual and population health, both directly and indirectly. Continue Reading… Read members-only job posts—including learning about a role with the International Anesthesia Research Society (IARS), which is seeking candidates for the position of Medical Officer for the IARS-FDA SmartTots Public-Private Partnership—at SOCCA’s Job Board. Continue Reading… Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. Continue Reading… This is being written as COVID-19 unfolds in the United States, and I hope you are safe and secure. My submission is actually overdue owing to local involvement in disaster preparedness and response planning, and I know many of you are in similar positions within your institutions. This should serve to remind us, as well as our professional colleagues and administrative partners, of the broad skill sets we bring to the table. These skill sets not only include clinical care but the ability to build teams, make decisions, and effectively communicate. Continue Reading… This time of the year the SOCCA Education Committee turns its focus toward the final planning of the Annual Meeting in San Francisco. This year the meeting will comprise up to three days of content beginning with a new board review course on Thursday, May 14; followed by the dedicated SOCCA day on Friday, May 15; and finally aligned SOCCA-IARS content on Saturday, May 16. Continue Reading… With two months of 2020 already behind us, the Communication Committee is collaborating with the Board of Directors and SOCCA’s other committees to create a unified communication strategy moving forward. This is an exciting time for SOCCA: membership is on the rise, the inaugural SOCCA board review course is forthcoming in conjunction with the Annual Meeting, and a clinical trials group is beginning to coalesce. Continue Reading… Media attention concerning the outbreak of a novel coronavirus in December of 2019 has steadily increased over preceding weeks, and at the time of writing there is early evidence of community spread in the United States. The World Health Organization (WHO) has declared the coronavirus disease 2019 (COVID-2019) outbreak to be a Public Health Emergency of International Concern, and significant efforts are underway to better understand the disease’s clinical features, transmissibility, and potential treatment options. Continue Reading… Worldwide, candidiasis remains the most the important and common fungal infection with crude and attributable mortality rates of 42% and 27%, respectively. There has been a recent deluge of drug-resistant Candida auris (C. auris) infections in intensive care units (ICUs) worldwide. In the United States alone, C. auris has led to hundreds of deaths in the past three years largely concentrated in Illinois, New York and New Jersey. Continue Reading… The evolution of critical care ultrasound in North America has been remarkable. Rapid technological advances have moved cardiac ultrasonography from the sole domain of cardiology and into the hands of the bedside intensivists. The increased availability of this disruptive technology, paired with an evolving appreciation of its applicability to the critically ill patient, have led to widespread adoption by intensivists across the nation. Prediction of Patient Deterioration on the General Care Floor: Making the Connection with ICU Admissions & Resource Utilization – A Special Series on Perioperative Patient Safety A late-night code blue alarm ringing through a hospital’s hallways is not new to our ears. We as anesthesiologists and intensivists have been ‘first responders’ to these adverse events and also ‘first receivers’ of these patients in the ICU. This ‘4am’ patient deterioration phenomenon may be a simple lack of appropriate surveillance systems or maybe a more complex interplay of underlying patient physiology and concurrent disease insults. Continue Reading… Jarva Chow recently reviewed notable trials from 2019 at the Anesthesia Year in Review session during SCCM’s 49th Annual Congress in Orlando, Florida. Six particularly relevant trials are summarized in this article. Continue Reading… Read members-only job posts—including roles with the Department of Anesthesiology at The University of Vermont /University of Vermont Medical Center and St. Luke’s University Health Network—at SOCCA’s Job Board. If you would like to post a job, please email a short description and/or PDF flyer including location, contact information, and closing date to SOCCA Society Director, Vivian Abalama, IOM, CAE at [email protected]. Continue Reading… Interchange seeks to deliver timely, relevant, and high-quality content to SOCCA members. Contributions from members are not only welcome but essential to ensure that Interchange meets these goals. If you are interested in authoring content concerning clinical challenges, emerging research findings, member accomplishments, or anything of general interest to the membership, please reach out to [email protected]. Continue Reading… It is my hope that this issue of the Interchange finds you well. 2020 promises to be a year in which SOCCA will continue to evolve and advance the profession of anesthesiologist intensivists. Continue Reading… It is my pleasure to take the helm of editing Interchange, but I must first acknowledge the antecedent efforts of Kevin Hatton. Kevin advanced the content, consistency, and formatting of the newsletter while also soliciting contributions both from the Society’s leadership and membership, alike. It will certainly be my goal to maintain forward momentum in these areas. Continue Reading… Have you visited SOCCA’s Job Board recently? Read members-only job posts—including a position with the Department of Cardiovascular and Thoracic Surgery at the University of Louisville School of Medicine—at SOCCA’s Job Board. Membership Committee Update At the recent SOCCA Board meeting prior to the annual Anesthesiology conference, we continued to explore means by which to grow and sustain the organization’s membership. Understanding our membership patterns, and the challenges our members face, is key. One critical issue that we have identified is member loss during transition periods: namely residency to fellowship and fellowship to faculty. Continue Reading… There has been a lot happening at the program director level over the last year, and that is by and large substantively good news. One critical topic that bears reporting is the outcome of the Anesthesiology Critical Care Fellowship match that took place in the spring of 2019. The associated trends here bear close review as the news is not entirely positive. Continue Reading… The restriction of trainee work hours in 2006 transformed post-graduate medical education. While intended to promote work-life balance and wellness, the undesired consequence was limitation of experiential clinical learning opportunities. Simulation Based Medical Education (SBME) has helped fill this gap by providing an opportunity for deliberate practice with immediate feedback, enhancing acquisition of medical knowledge and skills. Continue Reading… The aerospace industry is rightly recognized as a model for the utility of high-fidelity simulation, and the medical education community has sought to apply and extend this experience. However, a staggering amount of research, engineering, and resources underlies the success of aerospace simulation, which is likely underappreciated by physicians. Continue Reading… Since the first organ transplant from a brain-dead donor performed in 1963 by a Belgian surgeon, the topic of organ donation and brain-dead donors has often been a moral and ethical impasse amongst the public as well as physicians. Intensivists, along with Neurologists, have become the primary referring physicians for these donations. Continue Reading… Landmark trials over the past three decades have fostered appreciation for the potentially injurious effects of mechanical ventilation. Current approaches to lung protective ventilation include the limitation of tidal volumes (VT) to 6 ml/kg PBW, restriction of plateau pressures (Pplat) to no more than 30 cm H2O, and attention to driving pressures. Continue Reading… Sooner or later, many of us will be faced with an unpleasant reality: a major health problem requiring medical care. Often, this may entail surgery or critical care. In theory, physicians should be well-prepared for this eventuality. After all, we have a great deal of first-hand knowledge about the perioperative environment and should be comfortable negotiating difficult or uncomfortable situations. Why then do we feel so much stress when these problems hit close to home? Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please review the submission guidelines, then submit your proposal/ article to the Newsletter Editor, Craig S. Jabaley, MD at [email protected] on or before January 17, 2020. If your article is chosen for the newsletter, we will contact you for editing and formatting. Thank you. Continue Reading… I hope that you are having a great summer. The contributions from many SOCCA volunteers are helping develop exciting projects with deliverables I believe the membership as a whole will find engaging and valuable. In this issue of the Interchange, I would like to highlight some the current efforts by the Education and Research Committees since they met in May in Montreal. Continue Reading… It has been my privilege to be Editor of the SOCCA Interchange. It is a daunting task…but worth the work. This work has easily demonstrated to me the power of our Society and its membership. The vast knowledge, experience, and ability to collaborate, frequently with short notice, is exciting, invigorating and a testament to you all. Continue Reading… Read members-only job posts—including a position with Montefiore Health System in New York City—at SOCCA’s Job Board. Continue Reading… The SOCCA Education Committee has undergone substantial changes in the past year. We have grown to become 12-person strong and we have developed clear directives, focusing on the SOCCA strategic goals. Coordinating a successful annual meeting remains the prime focus of the committee and planning for the next annual meeting (to be held in San Francisco) has already begun under the direction of Peter Von Homeyer MD, FASE, the annual program chair. Continue Reading… The SOCCA Research Committee has embarked on a strategic realignment intended to best serve the members of the Society and of the Anesthesiology Critical Care community, at large. The Research Committee has traditionally worked to aggregate and analyze data on Anesthesiology Critical Care practices and on SOCCA membership. Continue Reading… Nearly three years ago SOCCA dove into #SoMe with its twitter account @SOCCA_CritCare, and since that time has covered 3 SOCCA conferences, 2 ASA meetings, and shared #CriticalCare content with over 800 followers. We had our most engaging twitter exchange yet during May’s annual meeting (#SOCCA19) and the aligned meeting days with the International Anesthesia Research Society (IARS) and the Association of University Anesthesiologists (AUA). Continue Reading… At the most recent SOCCA Annual Meeting, it was my privilege to present the SOCCA Distinguished Service Award and the Hilmar Burchardi Award to two well-deserving SOCCA members. Below are transcripts from my presentation of these awards. Continue Reading… While anesthesia-related intraoperative mortality is rare, all-cause postoperative mortality, defined as death within the first 30 days of surgery, remains common. Overall, 30-day postoperative morality occurs in approximately 1-2% of all patients—approximately 1,000 times more frequently than anesthesia-related intraoperative mortality. Continue Reading… While there is some disagreement about the details, many observers of the medical profession believe that we are sailing into the teeth of an intensivist shortage, especially with an aging population that has a greater expectation for complex care late in life. The severity of this shortage is hard to assess, as conclusions have varied widely depending on the methodology used. Continue Reading… For the past few years, we’ve highlighted members and their achievements in this ongoing series. This month, we will highlight Vivian Abalama,CAE, IOM, the SOCCA Society Director from the IARS. Without her, many of the Society’s day-to-day functions would not exist and our Physician leadership, committees and others would surely be lost. Continue Reading… Adult acute respiratory distress syndrome (ARDS) remains a serious problem, accounting for or complicating close to 10% of all ICU admissions, and with an associated mortality in the 35-45% range. Robust clinical evidence for ventilatory management has helped to create established and accepted guidelines for parameters such as ideal tidal volume of 4-8 cc/kg predicted body weight, optimal PEEP to avoid hypoxemia and de-recruitment while minimizing barotrauma, and this has resulted in improved survival outcomes in patients with ARDS. Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please review the submission guidelines, then submit your proposal/ article to the Newsletter Editor, Craig S. Jabaley, MD at [email protected] on or before October 15, 2019. If your article is chosen for the newsletter, we will contact you for editing and formatting. Thank you. Continue Reading… This contribution to the Interchange is being written before our annual meeting in Montreal. Montreal promises to be an exciting time where SOCCA members will be presented with numerous educational and networking opportunities. This gathering will also see various SOCCA committees meeting to determine goals that will further our mission of supporting and developing anesthesiologists who care for critically ill patients. Continue Reading… Communication is the action of exchanging information and ideas. It is a give and take. It is a part of our everyday lives…in the everyday interactions we have with our families, friends, co-workers, patients and their families. Communication is a two-way street and relies on a free-flowing give and take of ideas. Continue Reading… As we approach the annual SOCCA meeting, it is a great time to reflect on the benefits of being a member of SOCCA. We, therefore, asked a few current SOCCA members why they belong and this is what we heard. Continue Reading… According to SOCCA bylaws, the work of the nominating committee is to recommend a slate of candidates for board and executive committee elections to the SOCCA board, and to suggest candidates for the two awards given out by SOCCA in alternate years: the Burchardi and Lifetime Achievement awards. Continue Reading… An important and exciting role for Critical Care Anesthesiologists is the development and utilization of new tools and therapies to treat patients with severe, life-threatening injuries. It seems as though every time I round in the ICU, I encounter something new in one or more of my patients. Continue Reading… As a Critical Care Anesthesiologist, do you ever wonder what to say when the nurse asks you what blood pressure you want to target? Or do you ever wonder if all the effort you have put into resuscitating your patients is successful? Are you confused about how to use new and novel technologies to measure end-organ perfusion? Then you definitely need to attend this panel at the upcoming SOCCA 2019 Annual Meeting and Critical Care Update. Continue Reading… Many of us grew up in an era prior to the rise of social media and the continuous 24/7 availability that technologies provide (or inflict) on us. As a Critical Care Anesthesiologist, I work to provide the best care to my patients and social media may provide me with an opportunity to learn about new research and to interact with my peers and peer researchers in a more rapid and effective manner. Continue Reading… As Critical Care Anesthesiologists, we are responsible for diagnosing organ dysfunction, treating various pathologies, coordinating care with consultants and nurses, and communication with patients and their families. We support patients and families through the phases of illness and recovery, and, at times, we shepherd them through palliation and changes in goals of care. Continue Reading… Have you visited SOCCA’s Job Board recently? Recent listings highlight a position with the University of Louisville School of Medicine Department of Cardiovascular and Thoracic Surgery. Continue Reading… Subramaniam B, Shankar P, Shaefi S, et al. Effect of intravenous acetaminophen vs placebo combined with propofol or dexmedetomidine on postoperative delirium among older patients following cardiac surgery: the DEXACET randomized clinical trial. Continue Reading… When discussing physician wellness, it is hard to avoid the most profound expression of unhappiness and despair, that of ending one’s own life. Suicide among physicians has been a hot topic lately, and rightly so: it is commonly cited that between 300 and 400 physicians in the United States take their own lives every year. Continue Reading… Wasserstein RL, Lazar NA. The ASA’s Statement on p-Values: Context, Process, and Purpose. The American Statistician. 2016;70(2):129-133. Continue Reading… I was pleased to review Hematologic Challenges in the Critically Ill (1st edition, October 30, 2018, Springer Publishing, ISBN 13: 978-3319935713, 437 pages, $159.99) which was edited by Dr. Howard L. Corwin and SOCCA past president Dr. Aryeh Shander. The books was written by dozens of contributors from across the globe. In their comprehensive volume, Drs. Shander and Corwin describe the pathophysiology of hematologic disorders and explore the latest evidence-based assessment and treatment of anemia and coagulopathy in the critically ill. Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please review the submission guidelines, then submit your proposal/ article to the Newsletter Editor, Kevin Hatton, MD at [email protected] on or before June 28, 2019. If your article is chosen for the newsletter, we will contact you for editing and formatting. Thank you. Continue Reading… The New Year promises to be an exciting and productive time for SOCCA. The SOCCA Board of Directors held a strategic planning retreat in September 2018 to discuss the future of the organizations and review the information from the SOCCA membership survey. Thank you for your support and participation in the membership survey. We gained valuable insight and knowledge that helped shape our strategic plan conversation. Continue Reading… The SOCCA Education Committee is primarily charged with creating educational content for the Annual SOCCA Meeting. To date, this has been our priority focus and we are working hard to develop a unique and challenging annual meeting for 2019. Continue Reading… As influenza season begins in the United States, we should reflect on the nature of the virus, pathological presentation and treatment considerations. Multiple types of influenza exist, with type A accounting for the most severe manifestations in humans and responsible for the major pandemic outbreaks, notably in 1918, 1957, 1968, and 2009. Types B and C also infect humans but result in a more typical seasonal infection. Continue Reading… Loss of domain is a situation in which the majority of the viscera are outside of the abdominal wall, as may occur with large hernias. In this report, we discuss the surgical approach to repair of the abdominal wall and reduction of the abdominal viscera, and we highlight the significant anesthetic challenges associated with these repairs. Continue Reading… Have you visited SOCCA’s Job Board recently? Recent listings highlight a position with the Oregon Health & Science University of Portland, Oregon. Continue Reading… Burnout, as defined by a loss of enthusiasm for one’s work, a decline in work satisfaction, and an increase in emotional detachment and cynicism, is a growing concern in medicine. In Medscape’s National Physician Burnout and Depression Report 2018, a survey of over 15,000 physicians, 42% of all respondents reported feeling burned out, including 48% of intensivists (the highest rate among all specialties). Continue Reading… Mike Fierro is an anesthesiologist and critical care medicine physician at the Medical College of Wisconsin. His practice includes general adult anesthesiology and critical care in the Cardiovascular Intensive Care Unit at Froedtert Memorial Lutheran Hospital. He has maintained the SOCCA Twitter account since 2016. Continue Reading… Corticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis. Rochwerg B, Oczkowski SJ, Siemieniuk RAC, et al. Crit Care Med. 2018;46(9):1411-1420. This review and meta-analysis sought to further elucidate the efficacy and safety of steroids in sepsis given newly published randomized controlled trials in this arena. The authors searched published and unpublished sources for randomized […] Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please review the submission guidelines and submit your proposal/article to Vivian Abalama, CAE, IOM at [email protected] on or before May 24, 2019. If your article is chosen for the newsletter, we will contact you for editing and formatting. Continue Reading… In an environment where we are frequently asked to provide survey responses, our recent SOCCA survey was an outlier. In the positive sense. 161 of you provided feedback that will help shape the future of SOCCA. While 53% of you were satisfied with SOCCA, we clearly have areas in which we can improve. General themes included the need for ongoing educational content delivered in various forms (e.g., on line content for just in time use) as well as professional development resources. It is also clear that there is considerable desire by members to become more involved in SOCCA activities. Continue Reading… Hello!! It is my pleasure to introduce myself to you as the newest editor of our SOCCA Interchange Newsletter. I have been a part of the Newsletter now for a number of years, writing and editing a wide variety of interesting and informative pieces under the direction of previous editors that have mentored me in many different ways. Continue Reading… Chronic pain syndromes are a persistent problem in the United States, with conservative estimates suggesting a cost $560 to $635 billion dollars annually. Chronic pain following intensive care unit (ICU) survival is difficult to quantify, as patient populations vary across hospital centers and within different ICU settings; however, current evidence demonstrates that anywhere from 12-60% of patients remain affected by chronic pain at 6-months to a year following ICU admission, which contributes to a significant portion of diagnoses nationally. Continue Reading… Bedside percutaneous tracheostomy is a common, well-tolerated bedside procedure for critically-ill patients with prolonged respiratory failure. In this report, we present an uncommon and potentially dangerous complication of this procedure Continue Reading… Despite surgical patients presenting to the operating room (OR) sicker than ever before, the intraoperative period has, paradoxically, become far safer. Current estimates of intraoperative mortality are less than 1 in 100,000 patients. However, 30-day postoperative mortality is still significant at 1-2%, a fact that suggests that if 30-day postop mortality were considered a disease, it would be the third leading cause of death in the United States. Continue Reading… The medical field has finally begun to recognize the impact of job satisfaction and burnout. While much attention has been paid to how changes in the work environment affect this state of affairs, less thought has been given to how variables outside the hospital or clinic could impact physician well-being. This is particularly relevant to critical care medicine: in Medscape’s 2018 Physician Lifestyle Report, which polled over 15,000 physicians across 29 specialties, a whopping 48% of critical care physicians reported feeling burned out. Continue Reading… The European Society of Intensive Care Medicine (ESICM) recently published a consensus statement and clinical recommendations regarding the fluid management of neuro-intensive care patients (NIC), including comatose (GCS < 9) patients with severe traumatic brain injury (TBI), high-grade aneurysmal subarachnoid hemorrhage (SAH), severe arterial ischemic stroke (AIS) or intracerebral hemorrhage (ICH). Continue Reading… The SOCCA Membership Committee would like to welcome all of our current members, as well as, new Critical Care Anesthesiology faculty and fellows to the 2019 academic year! Overall, our current membership remains strong. Maintaining a strong and engaged membership is important to the long-term health of SOCCA. We’ve been able to maintain this strong membership level because of you! Continue Reading… Jeff Vender, MD, MCCM, MBA is the Emeritus, Harris Family Foundation Chairman of the Department of Anesthesiology at NorthShore University HealthSystem in Evanston, Illinois and a Clinical Professor at the University of Chicago Pritzker School Of Medicine. Dr. Vender was the recipient of the SOCCA Lifetime Achievement Award in 2018. Continue Reading… Nicholas Sadovnikoff, MD, FCCM, will receive the Shubin-Weil Master Clinician/Teacher: Excellence in Bedside Teaching Award at the Society of Critical Care Medicine’s (SCCM) 48th Critical Care Congress during the American College of Critical Care Medicine Convocation/SCCM Awards Presentation held on Monday, February 18, 2019. Continue Reading… Have you visited SOCCA’s Job Board recently? Recent listings include positions with University of Michigan School of Medicine and Anesthesia Associates of Morristown, New Jersey. Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please review the submission guidelines and submit your proposal/article to Vivian Abalama, CAE, IOM at [email protected] on or before December 3, 2018. If your article is chosen for the newsletter, we will contact you for editing and formatting. Continue Reading… Hopefully this edition of SOCCA Interchange you well and enjoying summer. There has been considerable discussion and deliberation by the leadership of SOCCA that will be of interest. Continue Reading… Leaders of academic anesthesiology organizations have recognized that there is a need to conduct large pragmatic trials in order to answer important questions in anesthesiology-related research. Although there are several successful anesthesiology clinical trial networks around the world, there is no collaborative network in the United States. There are several factors that enable anesthesiology researchers today to conduct large and efficient trials, in line with recommendations of the National Institutes of Health. Continue Reading… Dr. Sean Josephs, MD is an Associate Professor of Clinical Anesthesia at the University of Cincinnati in Cincinnati, OH. He is board certified in Anesthesiology and Critical Care Medicine. Continue Reading… Chimeric Antigen Receptor (CAR) T cell therapy is a promising novel cancer treatment modality recently approved by the Food and Drug Administration for relapsed/refractory B cell liquid tumors. Though its use is currently limited to a few designated centers across the US, if this line of therapy continues to deliver on the hype and new indications continue to arise as expected, it is likely that in the coming years it will be coming to a hospital (and an ICU) near you. Continue Reading… The National Board of Echocardiography (NBE) is ready to administer the very first edition of the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM). Continue Reading… Have you visited SOCCA’s Job Board recently? Recent listings include positions with Anesthesia Associates of Morristown, New Jersey; American Anesthesiology of Atlanta, Georgia; and Midwest Physician Anesthesia Services of Columbus, Ohio. Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please submit your proposal/article to Vivian Abalama, CAE, at [email protected] on or before September 10, 2018. If your article is chosen for the newsletter, we will contact you for editing and formatting. Thank you. Continue Reading… SOCCA wants to hear from you! We’ll be collecting feedback on how SOCCA can better serve its members. Keep on the lookout for the member survey—it’s coming out in July and one survey participant will be awarded a free 2019 Annual Meeting registration! Continue Reading… Happy New Year and I hope you are keeping warm! I’d like to take this column to introduce some of the activities and tools that SOCCA members can look forward to as this (surprisingly) cold winter turns to Spring. You may first notice that this newsletter (formerly the Interchange) has a new format! Instead of that stodgy old pdf (that few people read), we have now moved into a platform accessible from your computer, handheld, or even Anesthesia workstation. This platform is more dynamic and flexible, allows better integration of online content, is more closely aligned with our website and Twitter page, and (hopefully) more fun to read. Continue Reading… “Part of this complete breakfast.” This is the closing line of nearly every breakfast food commercial since at least the mid-1980s. The final scene universally depicts two mainstays: the product, and a cup of orange juice. In popular culture, citrus fruits are crucial to balanced nutrition and provide essential vitamin C. Colloquially, this nutrient is well known to stave off scurvy; but, medically, it has far more powerful potential as a tool to combat the sequelae of infection. Continue Reading… Is Vitamin C (ascorbic acid) the new and improved answer to decreasing sepsis-related mortality? It’s unclear. Up until this point, ascorbic acid has been studied in small cohorts of mostly cancer or burn patients. Studies in these populations have had variable results, some showing no difference in outcomes and others displaying impressive benefits. Continue Reading… Dr. Todd Dorman MD, FCCM is the Senior Associate Dean for Education Coordination, the Associate Dean of Continuing Medical Education, the Vice-Chair for Critical Care and a Professor of Anesthesiology and Critical Care Medicine at the Johns Hopkins University School of Medicine. He is a past president of the Society of Critical Care Anesthesiologist and the Society of Critical Care Medicine and was the 2017 SOCCA Lifetime Achievement Award Winner. Continue Reading… I wanted to provide an update on the ACCM fellowship match. The ACCM fellowship application process has been managed by SF Match for four match cycles now, and we are in the midst of our fifth. So far it has largely been viewed as successful, and most programs report seeing a larger number of applications since the match was instituted. At the time utilizing a match was agreed upon, many programs worried that they would lose applicants to the vagaries of the match who otherwise they would have been certain to recruit. Continue Reading… Towards the end of last year, a consortium of academic anesthesiology organizations launched an initiative to help establish a clinical trials network in the U.S., which would focus on perioperative medicine, critical care, pain management, and peri- and post-partum care. Continue Reading… Welcome to the SOCCA 2018 Annual Meeting and Critical Care Update, a meeting I am confident you will find rewarding with many valuable takeaways and networking opportunities. The members of the SOCCA Committee on Education, Drs. Adam S. Evans, Sheila Pai Cole, and Peter Von Homeyer, have developed a cutting-edge education program, addressing the latest advances in critical care and investigating the most pressing issues in anesthesiology. Continue Reading… The attendees of the SOCCA Annual Meeting will have the opportunity to take advantage of a special Aligned Meeting and SOCCA Focus on Critical Care Day on Saturday, April 28, complimentary as part of their registration fee. Thought leaders in anesthesiology will present a wide selection of robust education sessions, highlighting pioneering topics in anesthesia and celebrating advances in education, science, research and the art of anesthesiology. Continue Reading… Have you visited SOCCA’s Job Board recently? Recent listings include positions with Mercy Medical Group of Sacramento, CA; Southern Arizona VA Health Care System of Tucson, AZ; and Oregon Health & Science University of Portland, OR. Continue Reading… If you have an interesting case report, an idea for a pro-con discussion, a review idea, or an opinion on a recently published article, please submit your proposal/article to Vivian Abalama, CAE, at [email protected] on or before Friday, April 20, 2018. If your article is chosen for the newsletter, we will contact you for editing and formatting. |
