AAP Critical Care News: Sept 97

CRITICAL CARE NEWS
Volume 4 Number 3
September, 1997

The Newsletter of the Section on Critical Care of the American Academy of Pediatrics.

IN THIS ISSUE:

2nd Annual Distinguished Career Award: Dr. Peter Holbrook
New Investigator Award Recipients
1997 Fall Program Scientific Schedule
Survival Strategies: Critically Ill Children in a Managed Care Environment: A Review of the 1997 Conference
Suggestions and Comments

Peter R. Holbrook, MD, FAAP, Children's National Medical Center, Washington, DC was the choice for the second annual Distinguished Career Award given by the Section. This award carries with it a plaque honoring the Dr. Holbrook and an honorarium of $1,000. The award will be presented on Sunday, November 2 between 1:30 p.m. - 2:00 p.m. Dr. Holbrook will give a 20 minute presentation entitled, "The Paradigm of Pediatric Critical Care."

This is the second year that the Section on Critical Care will fund a New Investigator Research Award. This year's recipient is Jeanette Chua Cocabo, MD, Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, One Children's Place, St. Louis, MO 63110. The title of her research proposal was "Neurophysiological Consequences of Aborted Apoptosis." Dr. Chua Cocabo will be presented a $10,000 grant to pursue her research plan this year.
The award was judged on the following criteria: scientific merit, clarity of the presentation, likelihood of productivity by the investigator, sponsor's evidence of appropriate academic environment ,and relevance to critical care.

The program for this year is somewhat different than in the past. The first day, Saturday, November 1 will consist of two educational programs. The morning session is a Symposium on Computer Technology in Critical Care and Transport Medicine held jointly with the Sections on Computers and Transport. The afternoon session is a general session open to all meeting attendees. The three hour program is entitled, "Mock Trials for the Practitioner: Keys to Criminal, Medical Malpractice, and Expert Witness Testimony." It is directed by Fernando Stein, MD, FAAP and promises to be both educational and entertaining. Detailed descriptions are as follows:

1. Title: Mock Trials for the Practitioner: Keys to Criminal, Medical Malpractice, and Expert Witness Testimony
Description: This three hour session provides a live demonstration of medical-legal issues confronted by the pediatrician and pediatric subspecialist. Two expert trial attorneys, a State Supreme Court Justice, and physician-actors use real cases in a simulated courtroom to demonstrate key issues in criminal, medical malpractice, and expert witness testimony. This demonstration has received the highest critical acclaim from institutions throughout the country and provides invaluable information in an unforgettable manner.
This session will be unique in that it is a Section Program for the Practitioner meaning that the general attendees as well as members from our session will be able to attend. Fernando Stein, MD will be the lead in organizing this presentation and it promises to be extraordinary.
2. Title: Symposium on Computer Technology in Critical Care and Transport Medicine
Primary Topic Area: Advances in Computer Technology
Description: These three or four 45-60 minute didactic lectures/panel discussions will compose a 1/2 day combined session and cover exciting new advances in the application of computer technology to critical care and transport medicine. Topics include: Telemedicine, Computerized Databases, Education, and Use of the Internet/Web.
Once again, this session is not what we have done in the past. It will be a 3-way joint educational program for 1/2 day with the Sections on Computer Medicine and Transport. It also promises to be very informative and entertaining.

Sunday, Nov. 2

8:45-9:00 Continental Breakfast
9:00-9:15 Introduction and Welcome: Brahm Goldstein, MD

Morning Abstract Session:
Moderators: TBA
9:15-9:30 CVVH: Errors in fluid replacement due to inaccuracy of IV pumps. J. Sarich, BSN; P. Vanderford, MD. Kapiolani Center for Women and Children, Honolulu, HI.
9:30-9:45 Hemolytic uremic syndrome associated with invasive streptococcus pneumoniae infection. G.R. Cabrera, MD; J.D. Fortenberry, MD; J. S. Butler, MD; B.L. Warshaw, MD; B.G. Cooperstone, MD; C.R. Chambliss, MD. Emory School of Medicine, Egleston Children's Hospital, Centers for Disease and Control, and Scottish Rite Children's Medical Center, Atlanta, GA.
9:45-10:00 A pediatric sedation unit: A mechanism for safe, effective, uniform sedation for children. L. Lowrie, MD; A.H. Weiss, MD; C. Lacombe, RN; P.A. Tripi, MD. Case Westerm Reserve University and Rainbow Babies and Children's Hospital, Cleveland, OH.
10:00-10:15 Pediatric Intensive Care Units in 1995: Numbers, Characteristics and Distribution. C.A. Gonzales, MD, MPH; A.G. Randolph, MD, MSc; W.H. Perloff, MD, PhD; T.S. Yeh, MD. University of California at San Francisco, Children's Hospital Oakland, San Francisco, CA and University of Wisconsin Children's Hospital, Madison, WI.
10:15-10:30 A new quantitative method to estimate outcomes of children admitted to the Pediatric Intensive Care Unit (PICU). R. Sachdeva, MD, PhD; L. Jefferson, MD; D. East, RN; J. R. Beck, MD; B. Brudy, PhD. Baylor College of Medicine, Houston, TX.

10:30-10:45 Coffee Break

Moderators: TBA
10:45-11:00 Oxygen transport in critically ill infants following heart surgery. A.F. Rossi, MD; H.S. Seiden, MD; R.P. Gross, RN, MSN; R.B. Griepp, MD. The Mount Sinai Medicine Center, New York, NY.
11:00-11:15 Pediatric non-heartbeating donors: The potential benefits of a protocol. T.K. Koogler, MD; A.T. Costarino, Jr., MD. The Children's Hospital of Philadelphia, Philadelphia, PA.
11:15-11:30 Amrione relieves serotonin induced pulmonary hypertension without affecting dynamically perfused capillary surface area. L.E. Fisher, Jr., MD; C.M. Steinhart, MD; J.D. Catravas, PhD. Medical College of Georgia, Augusta, GA.
11:30-11:45 Cardiovascular effects of acute carbon monoxide (CO) toxicity in a piglet model. D.M. Lopez, MD; L. Singer, MD; J. Weingarten, MD; J. Glickstein, MD; E.E. Conway, Jr., MD. Albert Einstein College of Medicine, Bronx, NY.
11:45-12:00 Effect of Permissive Hypercapnia on Myocardial ATP metabolism measured by surface spectroscopy (31-P NMR) in a porcine model. G. Reyes, MD; M. Thummala, MD; W. Betz, MD; I. Horowitz, MD; G. Mander, MD; N. Alperin, MD; R. Sulayman, MD; T. Husayni, MD; D. Jaimovich, MD. Hope Children's Hospital, Oak Lawn, IL and Univ. of Illinois, Chicago, IL.

12:00-1:30 Lunch
1:30-2:00 Presentation of Distinguished Career Award

Sunday, Nov. 2

Afternoon Abstract Session:
Moderators: TBA
2:00-2:15 Cost effective use of muscle relaxants - A decision analysis. J.S. Rubenstein, MD; W. Colin PharmD; D. Jackson; C. Lockwood; J. Molloy; L.M. Marx, PhD. University of Rochester Medical Center, Rochester, NY.
2:15-2:30 Nasogastric tube size is a major determinant in the promotion of gastroesophageal reflux in children. N. Noviski; F. Serpir; Y. Ben Yehuda; B.A. Goreinstein; A. Mendelberg. Massachusetts General Hospital, Boston, MA and Edith Wolfson Hospital, Tel Aviv, Israel.
2:30-2:45 Institution of a trauma system reduces emergency department time for severely injured children. D.D. Vernon, MD; E.M. Diller, MPH/HSA; P.J. Nechodom, MPH; R.A. Furnival, MD; K.W. Hansen, BSN; J.M. Dean, MD. University of Utah and Primary Children's Hospital, Salt Lake City, UT.
2:45-3:00 Weaning pediatric patients with acute respiratory failure from mechanical ventilation-starting the process. M.A.Q. Curley, RN, PhD.; J.C. Fackler, MD. Children's Hospital, Boston, MA and John Hopkins Hospital, Baltimore, MD.
3:00-3:15 Comparison of manual ventilation using a self inflating resuscitator (SIR) vs. a volume resuscitator Neovor in unilateral lung disease. V. Saldajeno, MD; N. Kissoon, MD; L. Johnson, MD; S. Murphy, PhD. University of Floriday/Health Center, Nemours Children's Clinic, Jacksonville, FL.

3:15-3:30 Coffee Break

Best Abstract Awards - In-Training, Basic Science, and Research
Moderators: TBN
3:30-3:45 Best In-Training Abstract
Systemic hemorrhage increases heterogeneity of microvascular oxygen extraction. H.V. Connolly, MD; T.E.J. Gayeski, MD, PhD. University of Rochester Medical Center, Rochester, NY.
3:45-4:00 Best In-Training Abstract
Peroxynitrite crosses human erythrocyte ghost membranes. A.J. Macfadyen, MD; Y.X. Zhuang, MD; J.S. Beckman, PhD. University of Alabama at Birmingham, Birmingham, AL.
4:00-4:15 Best In-Training Abstract
PEEP determined by the inflation point causes overdistension. K.M. Creamer; L.L. McCloud; L.E. Fisher; I.C. Ehrhart. Medical College of Georgia, Augusta, GA.
4:15-4:30 Best In-Training Abstract
Inflation relative to closing volume effects pulmonary vascular resistance hysteresis. K.M. Creamer; L.L. McCloud; L.E. Fisher; I.C. Ehrhart. Medical College of Georgia, Augusta, GA.
4:30-4:45 Best In-Training Abstract
Macrophage inflammatory protein-2 predicts acute lung injury in endotoxemia. M. Kalyanaraman, MD; S.M. Heidemann, MD; A.P. Sarnaik, MD. Wayne State University, Detroit, MI.
4:45-5:00 Best Basic Science Abstract
Incidence of fat and bone marrow embolism with the use of intraosseous infusion during cardio-pulmonary resuscitation. M.Y. Hasan, MD; N. Kissoon, MD; M. Fiallos, MD; T. Abdelmoncim, MD; L. Johnson, MD; S. Murphy, PhD. University of Florida/Health Center and Nemours Childeren's Clinic, Jacksonville, FL.
5:00-5:15 Best Clinical Abstract
Ventilator withdrawal at the end-of life. J. Burns, MD; K. Outwater, MD; M. Geller, CCRN; J. Griffith, PhD.; D. Todres, MD; R. Truog, MD. Harvard Medical School, Children's Hospital, Boston, MA.

Abstracts Accepted For Poster Presentations

The Butterfly program: A template for institutional change in the care of children living with life-threatening illness - progress and problems. M. Levetown, MD. Univ. of Texas Medical Branch, Galveston, TX.
Survival and outcome of severe pediatric traumatic brain injury in a community- based children's hospital. K.M. Winterhalter, MD; R.M. Hackbarth, MD; J.S. Kopec, MD; N.E. Hassan, MD; M.A. Stoiko, MD; T.V. Ringer, MD; D.J. Sanfilippo, MD. DeVos Children's Hospital at Butterworth and Michigan State University College of Human Medicine, Grand Rapids, MI.
Evaluation of a real-time blood glucose monitor in children with diabetic ketoacidosis. J.A. Coss-Bu, MD; L.S. Jefferson, MD; S. Stone-McCord, MS; C. Ou, PhD; C. Watrin, MS; K.C. Copeland, MD. Baylor College of Medicine, Houston, TX.
Prediction of brain death by measurements of scalp temperature. R.J. Trevino, MD; F. Stein, MD; L.S. Jefferson, MD; Y. David, Ph.D.; D. Walding, B.S.B.E.; S. Stone, MS; D. Pham, PE; W. Moore, MD; G. Miller, MD. Baylor College of Medicine, Houston, TX.
Pulmonary embolism in children: Clinical characteristics and outcome. M. Kalyanaraman, MD; H.M. Uy, MD; A.P. Sarnaik, MD. Children's Hospital of Michigan, Detroit, MI.
Safe and effective deep sedation with Propofol of children undergoing painful procedures in the outpatient setting. K.S. Powers, MD; E. van der Jagt, MD; J.S. Sullivan, MD; J.S. Rubenstein, MD; R.S. Litman, D.O. University of Rochester Medical Center, Rochester, NY.
Determination of systolic blood pressure via pulse oximeter in transported pediatric patients. B. Gilmore, MD; W. Hardwick, MD; J. Noland, RNP; D. Patton, RN. The Children's Hospital, Birmingham, AL.
Traumatic Brain Injury (TBI) in children: Does Barbiturate Coma (BC) effect outcome? M. Wilson; J. Ring; M. Quasney; E. Zorn; A. Lynch; W. Ray; and J. Deshpande. Le Bonheur Children's Medical Center and Crippled Children's Foundation Research Center, Memphis TN and Vanderbilt Univ., Nashville, TN.
A Description of the Air Transported Patients Who Are Admitted to the Pediatric Intensive Care Unit: Patient Characteristics, Procedure and Treatments. E.M. Diller, MPH/HSA; D.D. Vernon, MD; J.M. Dean, MD; P.J. Necholdom, MPH; L. Cood, M.Stat.; S. Night, BS; A.J. Suruda MD, MPH. Intermountain Injury Prevention and Analysis Center and University of Utah School of Medicine, Salt Lake City, UT.
The effect of bacterial Lipopolysaccharide (LPS) on hypoxic vasoconstriction after precontraction with different catecholamines in-vitro. A. Asuncion, MD; O. Tajiiri, MD; R.J. Lis, MD; V. Kvetan, MD; L. Singer, MD. Montefiore Medical Center, Bronx, NY.

The second annual conference on Managed Care and Pediatric Intensive Care was held April 4-6 1997 in Rosemont, IL. It was sponsored by the American Academy of Pediatrics Section on Critical Care, and the American Academy of Pediatrics. It was attended by over 100 physicians and allied health professionals who care for critically ill children. The title of the conference was "Survival Strategies: Critically Ill Children in a Managed Care Environment". The conference is part of an on-going education program by the Section to teach pediatric intensivists and related professionals how to survive in the managed care environment, and become proactive in seeking the highest quality of care for critically ill children in the world of managed care competition.
The nationally renowned faculty included pediatric intensivists, managed care executives, and lawyers. The conference featured lectures, workshops, and question-and answer sessions. Major topics included how managed care will affect critical care, how to develop pediatric marketplace networks, contract negotiations, physician organizations such as IPA's PPO's and PHO's and Medicaid. A lecture that generated a lively discussion was "The Managed Care Organization: The MCO Perspective" delivered by Jim Watson, Vice President of Provider Services, CIGNA Healthcare of Illinois. He claimed that HMO's provide better quality of care than fee-for-service, and that HMO's do not interfere in medical decisions. Needless to say, the audience strongly disagreed with him. Other lectures of interest where by Dr. Holbrook, who presented his experiences as a physician-executive, and described the intricacies of negotiating with HMO's. Richard X. Fischer of Sonnenschein Nath & Rosenthal and Dr. Jean Wright spoke on managed care contracts for physicians, and Dr. David Jaimovich lectured on pediatric networking.
Overall the conference was very well received by those who attended. The general consensus was that physicians need to continue to educate themselves on the business aspects of medicine so we can better prepared to negotiate with managed care companies, and preserve quality of care. We strongly recommend all interested physicians go to next year's conference to support this on-going effort by the Section on Critical Care of the American Academy of Pediatrics.
Gerardo Reyes, MD, FAAP
Director, Critical Care Training
Hope Children's Hospital
4440 West 95th Street
Oak Lawn, IL 60453

Please address all suggestions for future articles and/or comments to any of the following editors:
Brahm Goldstein, MD, FAAP, FCCM (Co-Editor)
Chief, Division Pediatric Critical Care
OHSU 3181 S.W. Sam Jackson Park Road
Portland, OR 97201 Tel 503-494-8194 Fax 503-494-4953
goldsteb@ohsu.edu
Timothy S. Yeh, MD, FAAP, FCCM (Chairperson)
PICU, Children's Hospital of Oakland
747 52nd St.
Oakland, CA 94609
Tel 510-428-3714 Fax 510-601-3923
timbobyeh@aol.com
Otwell Timmons, MD, FAAP
PO Box 32861
Charlotte, NC 28232-2861
Tel 704-355-7815 Fax 704-355-3116
otimmons@carolinas.org

The success and utility of this newsletter is dependent upon input from Section members. Ideas for articles, job listings, and notices of upcoming events related to Pediatric Critical Care are welcome.