The Society of Critical Care Anesthesiologists

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 (22^o). This practice is based on decades old research demonstrating that platelets are removed from the circulation more quickly when stored at 4^o 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 secretions^1,2.  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?