SCCM Midwest Chapter

Are you interested in getting more involved with SCCM Midwest Chapter? Great networking opportunity and a chance to gain and share knowledge.
Please complete this short survey and we may be reaching out to you soon!
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Our 6th Annual Symposium is off to a great start! We're looking forward to seeing everyone today at Fairbanks Hall in Indianapolis and learning from our wonderful speakers and abstract presenters.

Calling for ABSTRACT SUBMISSIONS for our Annual Critical Care Conference! Submit via RedCap by AUGUST 15!
Interested in learning from some incredible critical care speakers and meeting others in the field? Join us September 13 in Indianapolis. Registration: sccmmwc.starchapter.com/meet-reg1.ph...

It's not too late to register for THURSDAY's FREE Virtual Webinar with Dr. Michael Ries. Learn all about Tele-Critical Care and earn some CME!
When: Thursday, July 31 at 6pm CST
RSVP required! Email SCCMMWC@gmail.com to claim your spot.

Register now for the 6th CC Conf in Indianapolis - here is all the info needed- free to members, reduced for trainees and $45 non-member. www.canva.com/design/DAGtR...

Abstracts are due by August 15 at QR.
@pharmacytodose.bsky.social @sccmcriticalcare.bsky.social

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Management Recommendations:
● Due to elevated risk, it is recommended to monitor closely for early identification of sepsis and management of multiple-organ dysfunction like AKI and cardiorespiratory decompensation, conditions that often prolong the length of ICU stay.

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Pathophysiologic effects related to Sepsis:
● A chronic, low-grade, altered inflammatory state, which triggers a massive inflammatory response to an insult

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Management Recommendations:
● Close monitoring is needed for early detection of VTE in obese children and adolescents who have comorbidities and coagulation factor deficiencies.

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Pathophysiologic effects related to Venous Thromboembolism:
● High risk for thrombus formation with comorbidities and coagulation factor deficiencies

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Pathophysiologic effects on the Renal System:
● AKI
Management Recommendations:
● Early recognition of AKI, prevention of fluid overload, appropriate drug dosing for obesity, and avoidance of nephrotoxic drugs are essential to improve outcomes in obese children with AKI.

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● Abnormal ECG in obese children necessitates further investigation to identify cardiac anomalies, as ECG changes are infrequent in this population.
● Delivering high-quality CPR is a cornerstone to improve outcomes in obese children with cardiac arrest.

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Management Recommendations:
● Subclinical cardiac dysfunction has been documented in obese adolescents with no hypertension.
● Hypertensive crisis in obese children is most likely from secondary causes.

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Pathophysiologic effects on Cardiovascular System:
● Elevated total body volume, plasma volume, cardiac output, and venous return -> causing hyperdynamic circulation + heightened intracardiac filling pressures
● Elevated peripheral resistance and left ventricular afterload

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● It may be beneficial to extubate on higher PEEP and to administer noninvasive ventilation rather than HFNC after extubation.
● Monitor for postoperative respiratory complications in obese children with OSA

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● Anticipate the need for higher tidal volumes to prevent underventilation and higher PEEP to prevent airway collapse over regular settings.
● Higher PEEP trials to prevent airway collapse may be useful

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Management Recommendations:
● CPAP or BiPAP may be preferred support over HFNC.
● Plan for difficult-to-bag mask ventilation (2 persons preferred) and difficult airway.
● Ventilator settings: Calculate tidal volumes based on ideal body weight.

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Pathophysiologic effects on the Respiratory System:
● Decreased chest wall compliance and pulmonary reserve.
● OSA

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Pharmacology Recommendations for sedatives and analgesics:
● It may be better to utilize multiple mini-loading doses to limit adverse effects like respiratory depression.
● Maintenance dosing can be done utilizing lean body weight

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Pediatric Obesity in the ICU
Definitions:
CDC - BMI > 95th percentile for age and sex. (Children >2 Y)
WHO - BMI > 97.7th percentile for the sex-specific weight for recumbent length (Children < 2 years)
Epidemiology:
1 in 5 US children and adolescents.

~Are you interested in learning more about Telehealth in the Critical Care realm?
~Would you like to get free CME?
If you answered YES to the above questions, please join us on July 31 at 6pm CST for a FREE online webinar presented by Dr. Ries.
Email SCCMMWC@gmail.com to receive the link.

Happy Fourth of July!
We hope everyone enjoys the fireworks, parade, and barbecues. Stay safe and have a lovely weekend 🇺🇸

~Midwest Chapter's 6th Annual Critical Care Conference~
September 13, 2025 in Indianapolis
Not a SCCM-MWC member? Not a problem! Register as a guest - we'd love to have you.
Registration is Open! sccmmidwestchapter.org/meet-reg1.ph...

!Save the Date!
Midwest Chapter's 6th Annual Critical Care Conference will be on September 13 in Indianapolis.

Have research that you're looking to publish? Submit your research abstracts no later than August 15 for consideration.

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Prognosis: Remarkable recoveries are possible – Even profoundly hypothermic patients can survive with appropriate rewarming and critical care. Always resuscitate hypothermic cardiac arrest aggressively in the ICU.

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Rewarming & Support: Use active rewarming for moderate/severe hypothermia (warmed IV fluids, forced-air blankets, etc.).
If core < 30 °C with instability (SBP < 90, ventricular arrhythmias) or in cardiac arrest, initiate extracorporeal rewarming (ECMO).

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Pseudo-STEMI: Hypothermia can mimic myocardial infarction – Osborn waves may resemble ST elevations.
🚫 Do not thrombo-lyse based on J waves; fibrinolysis will worsen hypothermic coagulopathy. Focus on rewarming and re-check the ECG once normothermic.

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ECG findings: Osborn J waves (J-point elevation) are classic in hypothermia. ~80% of patients < 30 °C have J waves.
Expect sinus bradycardia, prolonged PR/QRS/QT, atrial fibrillation or VF as temp falls. VF is common below 28 °C; asystole below 20 °C.

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Diagnosis pearls: Use low-reading thermometers and measure core temp (e.g. esophageal or rectal) for accuracy.
In profound hypothermia, check pulse and breathing for 30–45 s (heart may be extremely slow) before starting CPR. Handle gently to avoid VF.

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Clinical stages:
Mild (32–35 °C) – conscious, shivering;
Moderate (28–32 °C) – impaired consciousness, shivering may cease;
Severe (< 28 °C) – unconscious, vital signs present. Cardiac arrest can occur below ~24 °C.

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Hypothermia ❄️ = core body temperature < 35 °C.
Can be primary (cold exposure) or secondary (illness, intoxication, trauma). As core temp drops, organ function slows; severe hypothermia causes bradycardia, hypotension, and arrhythmia risk.