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The Unit: The Official Newsletter of the ACEP Critical Care Medicine Section - Fall 2014

Is High Frequency Oscillatory Ventilation Really Dead?

An interview with Neil MacIntyre, MD on Rescue Ventilation and Conducting Clinical Research

 Neil MacIntyre

 Neil MacIntyre, MD 
Duke University

Dr. Neil MacIntyre is Chief of Clinical Services and attending in pulmonary and critical care at Duke University. He was involved in the original ARDSNet trials, and an author on the 2004 N Engl J Med high vs low PEEP in ARDS study.

Tonna: I had heard that you felt that the trials done on the oscillator were not done as well as they could have been to show their strength. Is that fair to say?

MacIntyre: Yes, I had some problems with the way those two trials were done. I would have done them differently. In terms of running an oscillator, you have to know what you’re doing, because the settings and the control panel are not intuitive. For instance, you usually have to reduce the rate to improve CO2 clearance. You usually are dealing with fairly substantial mean airway pressures, so hemodynamic issues can be important. One of the problems I have with both of these trials—more with OSCAR than OSCILLATE—frequently there were centers that had very little experience with oscillators and even if they did, they didn’t have 24/7 coverage with experts in oscillation, and I think that can hamper the effectiveness of the oscillator in both of these trials.

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Notes from the Chair

EvieMarcoliniThe summer has flown by, and October is getting closer as we are all anticipating a great time in Chicago for ACEP14. The Critical Care Medicine Section has been very busy with a few projects as well as preparing a very interesting section meeting.

The first project is a grant, together with our colleagues in the International Emergency Medicine Section. Ayan Sen has spearheaded this effort and secured a $4,000 ACEP section grant, along with Hani Mowafi and Janet Lin from the International Emergency Medicine Section. “Project PICC: Promoting an International Coalition in Critical Care” is the first part of a project designed to bring together physicians in critical care from around the world, including developing countries. We recognize that the academic efforts and discoveries based on first world medicine resources are not always (if ever) possible to expedite in most of the world. We also recognize that there are important findings from developing world medicine that may shed light on our practice. We will have Ayan describing this exciting project and its future prospects at the section meeting. You may want to get involved.

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‘Sen’ timents: A Tryst with Global Emergency and Critical Care: Project PICC

AyanSenOn a recent trip to India, my country of origin, I heard that a relative in her 60s had passed away . . . she had pneumonia and sepsis. Her daughter, after complaining about a litany of perceived errors in her care, asked me with an air of inevitability “People don’t survive when they have septicemia…do they?”

I didn’t know how to answer the question. I stood and stared and mumbled something incoherently until it dawned on me . . . while we grapple with early goal-directed therapy, PROCESS, and whether to check venous saturation or central venous pressure in sepsis, the developing world paradigms may be a little different. A recent Indian Intensive Care Case Mix and Practice Patterns (INDICAPS) study found that one out of every eight patients in India die from infections contracted in ICUs. INDICAPS also found that 26% of the patients in ICUs contracted sepsis, 42.2% of them fatally.1

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Critical Care Board Exam Calendar

Critical Care Board Dates at a Glance!

Application Cycle, Exam and Practice Path Dates for Internal Medicine, Anesthesia, Surgery and Neurocritical Care Pathways.

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Therapeutic Hypothermia after Cardiac Arrest: Is This Therapy in Need of Resuscitation?

It has been over 50 years since the inception of cardiopulmonary resuscitation (CPR). Despite all the advances in modern medicine, only three therapies have been shown to improve survival after cardiac arrest: high quality CPR, early defibrillation, and therapeutic hypothermia (TH)… or so we thought? During the last decade, the importance of post-cardiac arrest care has taken center stage. In fact, the 2010 American Heart Association (AHA) guidelines on CPR, added post-cardiac arrest care as the fifth link in the chain of survival, with therapeutic hypothermia being the most important component. In 2002, two landmark articles were published that demonstrated the efficacy of TH post-cardiac arrest.1,2 These studies found that cooling patients to 32˚C-34˚C for 12-24 hours after out-of-hospital cardiac arrest (OHCA) with initial rhythms of ventricular fibrillation (VF) or ventricular tachycardia (VT) resulted in significant improvement in survival with good neurological outcome.Since then, numerous non-randomized data emerged supporting TH. It has even reached level I support in the AHA guidelines for OHCA VF/VT arrest. 

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Section Activities at ACEP14

ACEP Critical Care Medicine Section
Meeting Agenda
Tuesday, October 28, 2014

Business Meeting (1:00 – 2:30 pm)

Educational Symposium (2:30 – 5:00 pm)

    Career Strategies for the EM Intensivist
(David Huang, MD)
Roundtable Talk:
Targeted Temperature Management
History of Resuscitation
(Joseph Shiber, MD)

The Section Social Hour will immediately
follow the meeting.

Special thanks to Vidacare™ for their sponsorship.

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St. Luke’s University Hospital Surgical Critical Care Fellowship

Specialty certification pathway: American Board of Surgery (ABS)

Length of fellowship: 2 years

Number of fellows: 3


First year:
   Surgical critical care : 3 months
   Trauma: 3 months
   General surgery (mostly acute care): 4 months
   Elective: 2 months

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