The Society of Critical Care Anesthesiologists

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?

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 vabalama@iars.org.

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 vabalama@iars.org.

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.