American academy of pediatrics section on critical care

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American Academy of Pediatrics

Section on

Critical Care Medicine

MAY 2007

A Note from the Chair

by: Alice Ackerman

As I look at the calendar I realize it has been almost a year since the last SOCC newsletter. This has been another exciting year for the section. Our session at the 2006 NCE held in Atlanta was well-attended. At that time, the executive committee worked on further development of the strategic plan, which has since been published on our section's website.

We presented our Distinguished Career Award to Dr. David Nichols, who made an eloquent speech that was stimulating and upbeat. At this NCE we introduced a new format for the "business meeting" that had usually occurred over lunch. Instead, we had a nicely attended reception, while the poster presentations were up, and we were able to update the group on section issues while folks enjoyed a glass of wine and some substantial hors d'oeuvres. In addition, we held drawings for door prizes (American Express gift cards) which were well received. In all, this reception provided the opportunity for folks to mingle, for the executive committee to meet with the membership, and for much appreciated time to relax and get to know one another. We plan to make this reception an ongoing part of our future programs. Each year the abstracts presented get better and better. Please encourage your fellows and colleagues to submit their best work to the section program for next year, which will be back in San Francisco.

In this Issue

A Note from the Chair PREP ICU New Investigator Research Award Update 2007 NCE Program Drug Update PICU Course Update ACGME Residency Review Committee Critical Care Scientist Development Program Infant CPR Anytime Section New Members AAP Grand Rounds Calendar of Events Section Membership

Page 1-2 Page 2 Page 3 Page 4-5 Page 6-7 Page 8 Page 8 Page 9-11 Page 11 Page 12 Page 13 Page 13 Page 14

The executive committee is happy to welcome our two new members: Ed Conway, who is the liaison from the Society of Critical Care Medicine, where he serves as Chair of the Pediatric Section; and Megan McCabe, currently a pediatric critical care fellow at Johns Hopkins, who joins us as the post-residency fellow member of the executive committee.

The other exciting news to tell you about is the coming to fruition of a several-year dream that Tim Timmons, and a group of pediatric intensivists have been working on, supported by the section. This is the advent of what will be called PREP-ICU, an AAP-sponsored product for life-long learning and ongoing selfassessment. The team has been hard at work for a few months now, and you should see the official product become available shortly. We wish to thank Tim and his group for their ongoing efforts. This will be a professionally developed educational tool that will be of immense help to practicing intensivists who are in the process of maintenance of certification. You will be able to access it through the Pedialink page on the AAP-members only website.

A new organization, the Council of Pediatric Subspecialities, is under development. It is composed of two representatives of each official pediatric subspecialty and is currently supported by AMSPDC (the pediatric chairs group) and the APPD (the pediatric program directors). The initial representatives to this organization as it started up were myself, representing the AAP, and Donald Vernon, representing the ABP. One member must be a program director. At the recent SCCM pediatric fellowship director's meeting in Orlando, Richard Mink was elected to serve as the program director representative, and will serve as the SCCM member. In October at our next section meeting, the AAP representative will be elected.

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This is the newsletter of the Section on Critical Care of the American Academy of Pediatrics. The opinions expressed herein do not necessarily reflect the opinions of the American Academy of Pediatrics.

Editor: Mary Lieh-Lai, MD -

Staff: Sue Tellez - stellez@

Designer: Sandie Prondzinski - sprondzinski@

A Note from the Chair

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That election will give you yet another reason to attend the coming NCE. We have a dynamic program planned. The first day of our section's program (October 28, 2007) will see a morning on "disaster preparedness," the afternoon will be the traditional abstract presentations, and the distinguished career award presentation, followed by the reception and abstract awards ceremony. The following day (October 29) we are planning a joint program with the sections on emergency medicine and child abuse on "the abused child in the hospital."

I strongly encourage you all to make plans to join us in San Francisco, and to encourage your fellows and colleagues to submit abstracts for presentation. If you come, be sure to plan to stay for the reception, where we will vote for the new representative to the Council on Pediatric Subspecialties, hold the raffle for the door prizes, and present the awards for best abstracts.

The AAP is a great organization, but our section can remain vibrant only if we have the interest and participation of the entire population of pediatric intensivists. We welcome new faces and will find a way to help you get and stay involved in section activities. This year the section election will be conducted by e-mail. Please watch your mailboxes for the ballot which should reach you in a few weeks.

I look forward to seeing you all in October. As always your executive committee wants to hear from you. Please feel free to contact us with your ideas, concerns and projects.


Alice D. Ackerman, MD aackerman@

New Investigator Award


The American Academy of Pediatrics (AAP) is pleased to announce the upcoming release of PREP ICU, a life-long review and education series for pediatric intensivists. PREP ICU is the product of an ongoing collaboration between members of the Section on Critical Care and the AAP Department of Education. From the trusted Pediatric Review and Education (PREP) program developed by the AAP to help pediatricians prepare for the American Board of Pediatrics Program for Maintenance of Certification in Pediatrics? (PMCP?), PREP ICU was developed to meet the specific education needs of pediatric intensivists. This web-based self-assessment and review series will offer eight peer-reviewed questions and critiques monthly. Members of the

PREP ICU Advisory Board include:

? Dana Braner, MD ? Susan Bratton, MD ? Edward Conway, MD ? Richard (Tad) Fiser, MD ? Bradley Fuhrman, MD ? Mary Lieh-Lai, MD ? Anthony Pearson-Shaver, MD ? Ann Thompson, MD ? Jeremy Garrett, MD, Co-Editor ? Otwell Timmons, MD, Co-Editor

PREP ICU will be available late summer 2007. For more information, contact Monique Evelyn at (847) 434-4728 or mevelyn@.


SOCC New Investigator Research Award Update

One of the unique benefits of AAP SOCC membership for fellows and junior faculty in academic practice is the New Investigator Award from the Section, now in its 10th year. This competitive award, from $7,500 to $10,000, is available to fellows in Pediatric Critical Care or faculty within 2 years of completing their fellowship who are members of the Section. The applications have been judged on the criteria of innovation, significance, approach, environment and aptitude of the investigator. New for 2007, we will include "financial need" as a metric. We recognize many young investigators are already supported in a senior scientist's large lab; such projects would likely proceed with or without this award. We would like to be able to make a more substantive impact this year, by including financial need as a factor. In addition, many of the projects funded in the past have been bench research endeavors. In subsequent years, we would like to especially encourage applicants with clinical research or non-traditional research projects to apply as well.

The table is a list of all previous New Investigator Award winners and their project titles. We're sure you'll recognize a number of these individuals who are well on their way to establishing productive investigative careers.




Title of Abstracts

1996 1996

Heidi V. Connolly, MD University of Rochester School of Medicine, Rochester, NY

Paula Ann Chorazy, MD Medical College of Wisconsin

"Tissue Oxygen Delivery: Implications for Cellular Hypoxia"

"Modulation of Oxyradical Toxicity by Glutathione Redox Elements"

1997 1998 1999 1999 2000 2001 2002 2003/ 2004 2005 2006

Jeannette C. Cocabo, MD Washington University School of Medicine St Louis, MO

JoAnne E. Natale, MD, PhD Johns Hopkins Hospital Baltimore, MD

Scot Bateman, MD Harvard School of Public Health Boston, MA

Neal Thomas, MD Penn State University College of Medicine Hershey, PA

Sree Chirumamilla, MD Medical College of VirginiaChildren's Medical Center,Richmond, VA

Lara Primak, MD University Hospital of Cleveland C leveland, OH

Melissa C. Evans, MD Medical College of Virginia Richmond, VA

"Neurophysiological Consequences of Aborted Apoptosis"

"Glutamate Transporters in Newborn Cerebral Hypoxia-Ischemia"

"Neutrophil and Platelet Sequestration in Diffuse Lung Injury"

"Collectins and Inflammation in Multiple Organ Dysfunction"

"Traumatic Brain Injury Induced Cell Proliferation in the Mammalian CNS"

"Vasopressin Antagonism following Cardiopulmonary Bypass"

"Use of Protein Synthesis Inhibitors for Metabolic Down-Regulation in Shock"

No award/funding not available

Janet Rossi, MD Children's Memorial Hospital Chicago, IL

Eman Al-Khadra, MBBS, MPH Brigham & Women's Hospital Boston, MA

"The Role of Myosin Light Chain Kinase in Acute Lung Injury and Sepsis"

"Role of Panton-Valentine-Leukocidin in the virulence of Community-Associated MRSA"


American Academy of Pediatrics National Conference & Exhibition October 27 - 30, 2007 San Francisco, CA


Sunday, October 28, 2007

SOCC Educational Program

8:00 am ? 12:00 pm 8:00 ? 12:00 pm 8:00 ? 8:10 am 8:10- 8:55 am 8:55 ? 9:40 am

9:40 ? 9:55 am 9:55? 10:40 am 10:40 ? 11:25 am 11:25 ?12:00 pm

"Disaster Management: The PICU Perspective "

Introduction John P. Straumanis, MD, FAAP

Disaster Management: What Makes Children Different? Joan E. Shook, MD, MBA, FAAP

Hurricane Katrina: A PICU Perspective and Lesson Lutifat A. Kashimawo, MD, MB, ChB, FAAP Leron J. Finger, MD, FAAP

Coffee Break

Triaging Mass Casualties: Who Gets in the PICU J. David Roccaforte, MD

Avian Flu: Can PICUs Be Prepared Richard A. Schieber, MD, MPH, FAAP

Panel Discussion

SOCC Scientific Abstract Presentation Session

1:00 ? 6:00 pm

1:00 ? 1:30 pm

Presentation of Distinguished Career Award

1:30 ? 2:45 pm


2:45 ? 3:00 pm

Coffee Break and Poster Review

3:00 ? 4:15 pm


4:15 ? 4:30pm

2006 New Investigator Research Award: Presentation and Findings

Role of Panton-Valentine-Leukocidin (PVL) in the Virulence of Community-Associated Methicillin Resistant S. Aureus (MRSA) Eman Al-Khadra, MD, MPH, FAAP

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American Academy of Pediatrics National Conference & Exhibition October 27 - 30, 2007 San Francisco, CA


4:30 ? 6:00 pm

SOCC Reception/Poster Review and Awards Ceremony

Outstanding Abstract Awards

Monday, October 29, 2007

Joint Educational Session ? Sections on Critical Care, Child Abuse and Neglect, and Emergency Medicine 8:00 am ? 11:00 am

"The Abused Child in the Hospital: Issues for Emergency Physicians, Intensivists and Hospitalists"

Moderators: Vincent J. Palusci, MD, MS, FAAP and John P. Straumanis, MD, FAAP

8:00 am

The Abused Child in the Emergency Department Robert A. Shapiro, MD, FAAP

9:00 am

The Abused Child in the Intensive Care Unit Heather T. Keenan, MD, FAAP

10:00 am

The Abused Child in the Hospital Michael E. Ruhlen, MD, FAAP


Drug Update - Summer 2007



1. Vials of propofol and rotaglide look alike. Rotaglide is a lipid-based emulsion of egg yolk, olive oil and glycerin used for atherectomies, knee arthroplasty and to lubricate cardiac stents. The vial looks like propofol manufactured by Baxter and is the

same size as the 200 mg/20 mL vial of propofol. An anesthesiologist picked up the vial of rotaglide thinking it was propofol.

However he could not aspirate the drug and upon rechecking, realized it was rotaglide.

2. Vials of norepinephrine and bumetanide (Bedford Laboratories) look alike. An order of 1 mg of bumetanide was written for a patient. Instead he was given 4 mg of norepinephrine. The patient developed chest pains, ventricular tachycardia and ST elevation and required admission to the ICU.


Rotaglide labels (left) looks like propofol (right), especially when the vials are turned.

Look alike vials have similar labels and caps

3. Instead of 0.9% NaCl, 23.4% NaCl was used to mix with a chemotherapeutic agent. The 2-year-old died. 4. A 44-year old woman died after receiving 8000 mg of phenytoin IV instead of 800 mg. The nurse actually had to draw up the

medication from 32 vials (50 mg/mL, 5 mL) 5. Errors from Opiates

? Look alike names and packages ? hydromorphone (Dilaudid) and morphine: confusion arises from look-alike o dose packaging, name similarity and the misconception that dosing of the 2 drugs is similar on a mg/mg basis o Equianalgesic Dose (mg/kg/dose) 0.1 mg of IV morphine = 0.015 mg IV of hydromorphone

? Dosing errors ? o increasing continuous opiate infusion rates to provide a bolus dose and forgetting to turn the rate back o Inaccurate use of opiate patches o Oversedation of patients when PCA is used "by proxy"

? Respiratory Failure ? o failure to monitor for respiratory depression

? Confusing MSO4 (morphine sulfate) and MgSO4 (magnesium sulfate): these abbreviations should not be allowed.

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