The Impact of the Society of Critical Care Medicine’s Flagship Journal: Critical Care Medicine: Reflections of Critical Care Pioneers : Critical Care Medicine

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CCM 50TH Anniversary Articles

The Impact of the Society of Critical Care Medicine’s Flagship Journal: Critical Care Medicine: Reflections of Critical Care Pioneers

Bartlett, Robert H. MD1; Carlet, Jean MD2; Cook, Deborah MD3; Gattinoni, Luciano MD4; Harvey, Maurene MPH5; Jacobi, Judith PharmD6; Parker, Margaret M. MD7; Sprung, Charles L. MD, JD8; Suter, Peter MD9; Thompson, Ann MD10; Vincent, Jean-Louis MD, PhD11

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Critical Care Medicine 51(2):p 164-181, February 2023. | DOI: 10.1097/CCM.0000000000005728
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Abstract

The Society of Critical Care Medicine (SCCM) was founded in 1970 when 29 physicians met in Los Angeles. The nascent field of critical care realized that it needed a forum to focus on critical care research, clinical care, and training, and thus the society inaugurated its journal, Critical Care Medicine (CCM) in 1973. The journal has been pivotal in developing the field of critical care. The journal has benefitted from thoughtful leadership and from hours and hours of contributions from authors, reviewers, editors, and staff who recognize the importance of this venue for the development of the field. The journal had tremendous impact on the career development of so many intensivists in terms of the information and perspectives they were exposed to and the opportunities that they had to share hypotheses, research, and opinions with their peers.

CCM represents a substantial investment of time, attention, and funding for the SCCM and its editors, reviewers, readers, and administrative staff. This article provides reflections about the relevance and importance of CCM from some of the pioneers who had important roles in the evolution and development of critical care. Their thoughts have important lessons for what the Society, and its members should expect from CCM in the future, and what advantages members should expect to derive from a journal focused specifically on this discipline.

THE EVOLUTION OF SURGICAL CRITICAL CARE: CCM AS A VENUE TO DOCUMENT PROGRESS

Robert H. Bartlett, MD

FU1

BIOGRAPHY

Dr. Robert Bartlett received his medical degree from the University of Michigan and trained in surgery at Peter Bent Brigham Hospital. After serving on the faculty of the University of California, Irvine, he returned to Michigan in 1980 and became Director of the Surgical ICU, Program Director of the Surgical Critical Care Fellowship, and Director of the Extracorporeal Life Support (ECLS) Program. Dr. Bartlett developed ECLS (extracorporeal membrane oxygenation [ECMO]) from the laboratory through the first successful clinical trials to routine practice worldwide. ECLS has led to new understanding of the pathophysiology of renal, cardiac, and pulmonary failure which provides the basis for much of modern critical care. He founded the Extracorporeal Life Support Organization which is the international consortium of ECMO centers. Dr. Bartlett continues laboratory and clinical research at the University of Michigan where he is Professor of Surgery, Emeritus.

REFLECTIONS

The first ICUs began in the 1960s, usually as a corner of the recovery room where the new cardiac surgery patients had to be managed overnight. The doctors and nurses who cared for those patients called themselves “intensivists” or “critical care practitioners.” Some of those physicians and nurses established professional societies to share their experience with the new idea of concentrating the sickest patients in a single place where monitoring and mechanical ventilation was practiced. In the 1990s, the American Board of Medical Specialties authorized fellowships in critical care by the American Board of Surgery and the American Board of Internal Medicine. Other specialty boards followed. Today, medical students aspire to be critical care specialists. All of this occurred in my practice lifetime.

The journal CCM was initiated in 1973 by a surgeon, William Shoemaker. The activities of the new SCCM were reported in the journal. Soon articles on basic research and clinical practice in critical care were reported. The journal became the place to publish studies on sick patients which overlapped the traditional specialties and journals of medicine, surgery, pediatrics, nursing, and bioengineering.

Development of ECMO (1–5) and liquid ventilation are examples of this type of research. My teams have published 30 articles in CCM describing the development of those projects as they grew over the last 50 years. The editorial policies of the journal have always been clear. The reviews were scholarly and fair. The publications record progress in critical care over the years. The next 50 years will be even better.

Acknowledgments for influencing my career: Frances Moore, Robert Gross, Joseph Murray, Donald Hill, Luciano Gattinoni, Phil Drinker, Alain Coombs, Ted Kolobow, and all of my patients.

THE IMPORTANCE OF PROVIDING BROAD EXPOSURE TO NEW CONCEPTS AND DIVERSITY OF OPINION

Jean Carlet, MD

FU2

BIOGRAPHY

Jean Carlet received his medical degree from the University of Paris. Jean became qualified in cardiology, internal medicine, and medical intensive care. In 1980, Jean became the head of the ICU at St. Joseph Hospital (Paris). He has had a particular interest in sepsis, acute respiratory distress syndrome (ARDS), severe infections, nosocomial infections (especially ventilator-associated pneumonia), infection control, proper use of antibiotics, antimicrobial resistance, ethics, end of life issues, and quality of care. A sabbatical with Julie Gerberding (a future director of U.S. Centers for Disease Control and Prevention) at San Francisco General Hospital expanded his horizons about different approaches to delivery of care and infection control. He has been President of the European Society of Intensive Care Medicine (ESICM), cochair of an SCCM annual meeting with Michael Levy, and President of the World Alliance Against Antibiotic Resistance.

Jean continues a parallel career as a very amateur lyric singer and has been courageous but imprudent enough to sing the death of Posa, from Don Carlo, and other songs, during some of the ESICM president dinners!

REFLECTIONS

A good medical journal should look somewhat like “French cuisine.” All the ingredients must be there, ready to be added in appropriate amounts at the appropriate time to make a dish to be proud of. The use of excellent and very fresh ingredients is of paramount importance. The “menu” must be eclectic, with traditional dishes, but also original, surprising, outside-the-box creations. The offerings should appeal to a variety of tastes and include small plates and large servings, coming from many countries. The journal CCM fulfills those characteristics and qualities since 50 years!

For topics which have remained controversial for decades (sepsis, ARDS, selective decontamination of the digestive tract, stress gastric ulcers prevention, best positive end-expiratory pressure [PEEP]…), CCM continues to have an obligation to introduce readers to relevant controversies. Pro-con debates followed, after the “combat,” by some wise take-home messages proposed by respected and impartial people have been and should continue to be helpful for our specialty.

To take an example, I have witnessed the evolution of our understanding of sepsis, and I have been proud to be part of this evolution as a clinician, journal reader, reviewer, author, and editorialist. Let me focus on my experience with sepsis and CCM. This entity, called in the past “sepsis syndrome,” is not a precise disease but remains a very complex syndrome. It has been a very important but also a very controversial topic for many decades. CCM provided many manuscripts about sepsis over this past half century: 4,478 articles have been published on this syndrome in the journal. This averages 91 articles per year…a pretty impressive contribution to the field! Many guidelines and symposia concerning sepsis have been published by CCM and Intensive Care Medicine simultaneously concerning sepsis, like the Surviving Sepsis Campaign. These coordinated publications of key documents are evidence of constructive international cooperation (6). Those articles are highly valued and widely read by CCM subscribers. However, although CCM has published so many worthwhile articles on a myriad of key topics, in my view, the journal is getting away from publishing fundamental basic science, physiology, or very provocative studies. I think that efforts to encourage and publish those kinds of articles should be an important objective for the journal.

Sepsis is one of the best examples of a critical care topic that evokes strong, sometimes emotional opinions. CCM has helped expose readers to the relevant issues. Roger Bone’s editorials and commentaries were for me one of the most influential and memorable CCM articles. Roger was one of the many pioneers and leaders on this topic who published regularly in CCM (7). He published many articles in the journal, and the titles of those articles showed how passionate he was concerning sepsis syndrome, systemic inflammatory response syndrome, and septic shock: “To SIRS with Love” or “Sir Isaac Newton, sepsis, SIRS, and CARS” were prime examples (7). Jean-Louis Vincent, a well-known Belgian intensivist, was also inspirational and provocative in his published perspectives in CCM. A good example of his insight and his ability to expand the readers’ horizons was his editorial: “Dear SIRS, I am sorry to say that I don’t like you” (8). Overall, many authors produced investigations, editorials, and commentaries in CCM that helped move the field forward, improved patient care, and stimulated new ideas.

I was especially interested in the ongoing controversy about the role of corticosteroids for the treatment of sepsis, septic shock, and ARDS. Some of the most influential manuscripts regarding corticosteroids and sepsis or septic shock were published in the New England Journal of Medicine (NEJM) since they were important studies of great general interest and impact (9). They received considerable attention not only because they were important studies but also because they were published in this prestigious journal. However, long before these seminal studies, CCM published many smaller trials that were the foundation of the pivotal NEJM studies. In addition, following the NEJM articles, CCM published many studies, commentaries, and editorials which helped clinicians understand and apply to their clinical practice the results of the large NEJM trials. The larger trials would not have been possible without the preliminary trials published in CCM, and the interpretation of the trials for intensivists was greatly facilitated by the subsequent contributions in this journal.

The COVID-19 epidemic has provided yet another opportunity for CCM to demonstrate how the journal can respond to health emergencies by providing rapid turnaround for articles and by providing a forum for early observational findings and subsequent more consequential studies. Most “sepsologists” proposed adding coronavirus to the long list of microorganisms able to induce sepsis, septic shock, and ARDS. Having a forum to understand pivotal but complex trials like Randomized Trial of COVID-19 Therapy (RECOVERY) was also valuable for critical care providers (10). Although the RECOVERY study was published in the NEJM, the “Holy Grail journal,” this study had serious methodological weaknesses and would benefit from reassessment and discussion, an exercise in which CCM could have an important role, maybe in cooperation with Intensive Care Medicine. The RECOVERY trial has likely increased the use of steroids in severe but probably also mild cases of COVID-19 cases worldwide, which is, in no way, a trivial issue. Very few authors have emphasized the risk of this overconsumption (11). Studies looking at the risk benefit ratio of steroids in this setting are mandatory. It would be somewhat provocative, and CCM could have an important role to play.

To conclude, I do think that this large panorama in the published articles is a very important strength of CCM in terms of providing exposure to small studies, physiology, reviews, guidelines, pro-con debates, and editorials. CCMand a great French meal are both a moment of pleasure that I treasure and look forward to enjoying on a regular basis.

Acknowledgments for influencing my career: I do not want to finish this collaborative article without emphasizing that five scientists and teachers, among many others, illuminated my scientific carrier: Maurice Rapin, Jacques Acar, Jean-Marc Cavaillon, Bernard Régnier, and Julie Gerberding.

CCM’S ROLE IN ENHANCING THE DEVELOPMENT OF EVIDENCE BASED CRITICAL CARE

Deborah Cook, MD, FRCPC, MSc, DABIM

FU3

BIOGRAPHY

Dr. Cook practices intensive care medicine at St. Joseph’s Healthcare Hamilton. After internal medicine training at McMaster University, she completed critical care fellowship at Stanford University. As a founding member and two-term Chair of the Canadian Critical Care Trials Group, Dr. Cook has published widely on issues such as administering and withdrawing advanced life support, preventing complications of critical illness, clinical research methodology, and the ethical dimensions of practice and research. Dr. Cook is a Distinguished Professor in the Departments of Medicine, Clinical Epidemiology and Biostatistics, and Academic Chair of CCM at McMaster University. She enjoys family, friends, and exercising outdoors in all four of Canada’s beautiful seasons. She and her partner are walked bid by their big dog Rufus.

REFLECTIONS

Marking the milestone of 50 years of publishing means celebrating the reach and amazing achievements of CCM. From its inception, CCM embraced the burgeoning field of modern scientific investigation born of asking questions and seeking answers. Thirty years ago, medicine was shedding its history of devotion to the status quo and the illusion that published information was truth—simply because it was published! It was heartening to know that at CCM, debate was demanded, dogma was suspended, and innovation was encouraged. Increasingly, clinical research evidence had an important role informing, but never determining, practice.

The steadfast commitment of CCM editors to promote the skills needed to interpret clinical studies may have been initially discredited in some traditionalist circles. The late Bill Sibbald quickly recognized how critical appraisal was a powerful method to understand the literature and make valid inferences about study results. Demonstrating uncommon humility, he asked me to teach him evidence-based medicine during monthly telephone calls he tagged “Saturday Mornings with Bill.” Soon thereafter, he proposed to CCM a new series on Evidence-Based Critical Care, akin the original Journal of American Medical Association (JAMA) series. The editors agreed, and I was invited to lead the series. These were clear, powerful examples of reverse preceptorship and formal sponsorship, for which I was, and remain, extremely grateful.

For each study design, we proposed which patient scenario would lay the foundation for the specific critical appraisal scaffolding. Editors Bart Chernow and Joe Parrillo urged us to coauthor these articles with early career investigators and some scientists outside North America. Their touchstone was “build on, but also break with tradition.” Understanding physiology and pathobiology was paramount; considering healthcare context and patient preferences was also essential. We convened in-person in various U.S. cities, sometimes affiliated with the SCCM Congress. In these manuscript meetings, authors included Roger Bone, Christian Brun-Buisson, Charlie Sprung, Jean Carlet, Jean Louis Vincent, and others. They ensured that I developed my own approach to seek and respond to, or offer constructive critique. There was plenty to address, as the manuscripts were reviewed by practicing peers including CCM board members. These were formative experiences, brainstorming with giants in the field. I also learned how to help chart a course, commit to a body of writing, and guide a group of (largely senior) colleagues.

A dozen articles in CCM were solicited, written and edited including how to appraise an article about therapy, prevention, prognosis, and diagnosis—the fundamentals. Given the evolution of critical care, we considered other topics imperative such as how to assess thorny health technology reports and economic evaluation literature. This series in CCM birthed many Critical Appraisal and evidence-based medicine workshops at the SCCM Congress, American Thoracic Society Conference, and the International Symposium on Intensive Care and Emergency Medicine in Brussels. There, Jean-Louis Vincent encouraged us to translate critically appraised topics into several languages. We enjoyed more Belgian beer, frites, and chocolate in those years that I have ever had since!

Many landmark documents have been published in CCM, such as John Marshall’s Multiple Organ Dysfunction Score. As originally promoted by the late Ake Grenvik, topics in clinical ethics began to find a home. Publishing on end end-of-life care, CCM revealed how scholars can also be soulful—planting seeds that would grow in this and other journals. Roger Bone used to telegraph, “When we care for patients and family members, we should remember we will be in their shoes one day.” He also wrote poignantly in CCM about his own experience with terminal illness, calling attention to our shared humanity.

Discerning which scientific reports suit precious journal pages is not easy given today’s information avalanche. However, with Tim Buchman at the helm, the CCM editorial team have set intention and adapted throughout the digital revolution (whereby screenshot expertise can propagate questionable messages) and throughout the pandemic (which expedited a flood of reports—most well-intentioned—lacking factual veracity). A broad range of articles on experimental science, applied physiology, clinical research, systematic reviews, quality improvement, guidelines, and much more—continue to be found in almost every issue. CCM and the new Critical Care Explorations have flourished, including local studies with generalizable lessons, whereas international investigations are published with regularity. Building on recent trends, increasingly diverse interprofessional authors from around the world will populate the pages, mirroring multidisciplinary critical care practice, as well as clinical and academic leadership in our field.

Let us all try to play a small part helping to steward the legacy of CCM for the next 50 years!

Acknowledgments for influencing my career: My mentors were the amazing Gordon Guyatt and the late David Sackett. Informal mentors are the students, staff, ICU colleagues, and collaborators in Canada and around the world. They surely know who they are! My patients and families are the inspiration for everything.

CRITICAL CARE: THE PHYSIOLOGY BASED MEDICINE

Luciano Gattinoni, MD

FU4

BIOGRAPHY

Luciano Gattinoni graduated from the University of Milan (Italy) and trained in intensive care in Milan. His life changed after spending 2 years at the National Institutes of Health (NIH) with Theodor Kolobow, a visionary genius decades ahead of contemporary thinking, who was an experimental physiologist working with animal models. Luciano introduced the concept of lung rest by extracorporeal Co2 removal in acute respiratory failure, and he worked on the quantitative analysis of thoracic CT, which culminated in the “baby lung,” lung recruit ability, and mechanical power concepts. His subsequent research has focused on the pathophysiology and treatment of acute respiratory failure, with special focus on prone positioning, sepsis, and acid base disorders. He served as chief of Anesthesia and Intensive Care in Monza and Milan for 27 years. He has been President of the ESICM, President of the World Federation of Societies of Intensive and Critical Care Medicine, and President of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care.

For the last 50 years, Luciano has been playing and singing with his close friends in the Mnogaja Leta quartet.

REFLECTIONS

Fifty years exceed the span of a usual professional career, but some lucky few have practiced critical care over this long time period. This intensivist, given this opportunity, has had the good fortune to witness the “birth” of the specialty and to grow up within it, facing the joy and the troubles of its infancy, youth, and maturity. During the last half century, NEJM, Lancet, and JAMA remained the most appealing publication targets for young (and not-so-young) investigators. However, these highest profile journals seldom publish truly novel ideas, unconventional approaches, or out-of-the-box thinking, which are the foundation upon which our newly fledged discipline grew up. Through the years, CCM, our “house,” has welcomed such work and has faithfully tracked the evolutionary steps of our field.

Over this past half-century, my main interest has been ARDS. It is fascinating to realize that during the first decades of CCM, the vast majority of clinical and experimental articles regarding ARDS dealt with applied physiology. It was rare for its published studies to include more than 20 patients or more than 10 experimental animals, but such work often forms the basis of our current clinical understanding. Can you imagine a prestigious “old guard” journal publishing the effects of prone positioning—currently used worldwide—in seven ARDS patients (12)? CCM, the oldest journal dedicated to our specialty, reported perhaps the first data addressing barotrauma resulting from mechanical ventilation (13,14) during an era in which the tidal volume recommended for ARDS was 15 mL/Kg (15).

The enthusiasm and the passion of youth were reflected in the first 20 years of our field’s development. If 10 cm H2O of PEEP seemed good, 20 cm H2O should be better. (The opinions of many current colleagues still hold to that logic.) Consequently, the threshold for “low PEEP” was as high as 20 mm Hg (16). Contemporaneously, many physiologic studies taught us the strict associations among mechanical ventilation, hemodynamic impairment, and fluid management. Keeping pace with the spirit of the time, some issues of CCM, commendably in my opinion, were devoted in their entirety to specific topics with therapeutic import and potential for the critically ill, such as oxygen dissociation curve (17), alternative hemoglobin solutions, and perfluorocarbons (18). New experimental techniques, such as high-frequency jet ventilation, appeared and disappeared during the evolution of our specialty. With time, starting after the first 10 years of the journal’s publication, epidemiologic studies began to appear in increasing numbers, as did the proposal to better categorize and classify patients, for example by the Acute Physiology and Chronic Health Evaluation II score (19) or by previous health status (20).

During that first period, widely accepted, professional society guidelines for bedside practice were lacking. That initial paucity of guidelines contrasts sharply with the present time. Over the past 10 years, nine of the most highly cited articles in CCM have been guidelines (21). Indeed, from an early emphasis on applied physiology explored in a single center with few patients but many detailed measurements (such as metabolic rate, oxygen consumption, shunt fraction, ratio of ventilation to perfusions determination, esophageal pressure), we now observe, under the impetus of the evidence-based medicine approach, a progressive shift toward epidemiology, multicenter collaboration, big data collection, and sophisticated statistical analyses. Although many such articles are informative, such studies, unfortunately, require years to execute and an often-staggering financial commitment.

Huge clinical trials, big data scrutiny, and meta-analyses are all essential parts of the air of investigation that we intensive care providers and investigators breathe currently in our field. Fortunately, however, CCM maintains space to accept and comment on those physiologic studies of limited size that help elucidate and comprehend mechanisms of disease and response. Without understanding these mechanisms, rational therapy is impossible to identify and consistently apply.

The recent COVID-19 pandemic clearly reflects the limits of the epidemiological/statistical approach; after more than 2 years, we still debate the timing of intubation, the level of PEEP, and the relative utility of different forms of respiratory support without approaching the problem at its root. We remain uncertain as to what is the least dangerous modality of therapy in different stages of COVID-19, and above all, lack precise understanding of why certain hazardous interventions are dangerous. What is really lacking is an individualized approach based on applied physiology and personalized medicine. Consequently, we still need journal space for confirmatory studies, space for novel approaches through physiologic investigations, and space for serious experimental strategies.

I deeply thank CCM for what it has taught us over its first half century. I thank CCM for continuing to publish well designed experimental work—the gym of the young researchers—which may not enhance the impact factor but remains essential to inform rational practice.

Acknowledgments for influencing my career: I am in debt with hundreds of friends and colleagues, and I do not want to fail anybody. Therefore, I limit myself to quote masters who passed away: professors Giorgio Damia, Rossi Bernardi, Theodore Kolobof, Keith Sykes, and Danny Melrose.

CCM—THE ICU TEAM’S PLAY BOOK

Maurene Harvey, MPH, MCCM

FU5

BIOGRAPHY

Maurene Harvey has 50 years of critical care nursing experience. After several years practicing at the ICU bedside, she spent 35 years traveling around the world teaching critical care full time by invitation for various ICUs, organizations, and conferences.

She has been an active and committed member of SCCM since 1976 and on the governing board of the SCCM from 1992 to 2003. In 2002, she became the first nurse to be elected President of the SCCM. Her areas of special interest include humane care, ICU design, the art of nursing, postintensive care syndrome, and patient-family centered care.

Maurene was on the Editorial Board of CCM from 2005 to 2021. She received SCCM’s Norma Shoemaker Award for Nursing Excellence and SCCM’s Distinguished Service Award. In 2012, she was the only nurse in the first class of 20 to be inducted into the SCCM’s Masters in CCM.

Taking up a new challenge, Maurene and her husband Bill have just purchased an avocado farm on the coast in Santa Barbara and are building a home on the site.

REFLECTIONS

Before completing nursing school in 1966, I had decided to practice intensive care nursing. In 1974, 4 years after SCCM and 1 year after CCM were established, I began to work as a clinical instructor with Dr. Max Harry Weil, one of our founding fathers and the first president of SCCM. He continued to mentor me throughout my career. This early experience engrained in me a firm understanding and a deep appreciation of the value of the intensivist-led multidisciplinary critical care team.

My experience with such high-quality critical care delivery set my career on the path to pursuing two goals. The first was to teach what I had learned and to improve the practice in as many ICUs as possible. The level of care practiced in Dr. Weil’s Center for the Critically Ill in the seventies was so far beyond the standard of care, I left armed with knowledge that many were anxious to gain. It was important to keep up with developments in our rapidly changing field. CCM was my primary weapon.

My second goal was to advocate for the intensivist model (22). In the pursuit of the first goal, I interacted with thousands of critical care practitioners in the classroom, at the bedside, and on rounds in hundreds of ICUs around the United States and the world. My observations and interactions made me even more passionate about my second goal. For many years, most ICUs in the United States did not have intensivists. Most ICU nurses did not know what an intensivist was. It was apparent that the lack of intensivists significantly diminished the quality of patient care.

SCCM founding fathers embraced the need for a multidisciplinary team (23). They reiterated this vision when CCM was established (24). In 1973, very few SCCM members were nonphysicians. By 2020, nonphysicians comprised 48% of SCCM membership (25). In my years of involvement with SCCM and CCM, I worked with all of the CCM editors, most of SCCM’s presidents, and many other leaders in the field. During these interactions, it was clear to me that all of these leaders considered each team member’s input essential.

With advances in the science of critical care and the complexity of patient care, the number of different specialties and professions required to provide quality care has increased. Simultaneously, a rich body of evidence has been published showing the impact of optimal team practice on ICU outcomes (26). If ICU care is a team sport, then SCCM is our coach, and CCM is our play book. Yet, most critical care nurses that I have taught knew little about SCCM and had not read CCM. If CCM is the ICU team’s play book, our performance would improve if more team members read it!

SCCM and CCM both do a highly commendable job of embracing all members of the multidisciplinary team compared with other organizations in the field. However, when nurses, pharmacists, respiratory therapists, or rehabilitation specialists want to publish their work, they often turn to journals of their specific discipline rather than CCM. Critical care nurses often turn to the American Association of Critical Care Nursing’s journals which are not often read by other ICU team members. I have always wondered why more nurses who know the importance of the ICU team have not joined SCCM or submitted their work to CCM. Developing and implementing a plan for each patient is accomplished through team collaboration. CCM offers a platform intended to reach the entire team to advance patient care. Perhaps more research by journal staff is needed to determine why so many nonphysicians do not submit manuscripts to CCM or read it on a regular basis.

Our challenge is to keep the whole team is up to date on current knowledge, current controversies, and current standards of care. CCM needs to continue to assess how to reach the entire critical care team, all of whom need exposure to the vital content of our major journal.

Acknowledgments for influencing my career: Max Harry Weil, Norma J. Shoemaker, Barry Shapiro, Rob Taylor, and Phil Dellinger.

GUIDELINE PUBLISHING IN CCM ENHANCED CLINICAL PHARMACIST OPPORTUNITIES

Judith Jacobi, PharmD, MCCM, BCCCP

FU6

BIOGRAPHY

Judith Jacobi, PharmD, has been a member of SCCM since 1985 and was a founding member of the Clinical Pharmacy and Pharmacology Section in 1989 and Chair from 1991 to 1994. She was a member of multiple committees and served on the SCCM Council from 1999 to 2007 when she joined the Executive Committee as Treasurer and ultimately as the first pharmacist President from 2010 to 2011. She was named a Fellow in 1992 and Master of CCM in 2015.

Judi contributed to multiple guidelines including the 1995 and 2002 sedation and analgesia guidelines, the 2012 insulin infusion guidelines, the 2016 neuromuscular blockade guidelines, and is cochair of the glycemic control guidelines under development. She is the Co-Chair of the SCCM Leadership, Empowerment, and Development committee and member of the editorial boards of CCM and Critical Care Explorations.

Judi retired after 38 years as a critical care clinical pharmacy specialist, the majority at Indiana University Health Methodist Hospital in Indianapolis, Indiana, and is now a Sr. Consultant for Visante, LLC. and remains engaged with professional organizations, authorship, and as a community volunteer.

REFLECTIONS

As a new member of the SCCM in the 1980s, there were innumerable opportunities for the handful of clinical pharmacists since committees reflect the entire team. As a new practitioner in a very young field, my role models were individuals who were forging new pathways and breaking barriers. I set out to do the same and was thrilled to join the Sedation, Analgesia, and Neuromuscular Blocker Guideline Task Force in the early 1990s. This was an amazing opportunity for a community-based clinical pharmacist. This multiprofessional group referenced 15 randomized trials and 48 cohort studies. The full document was published as a stand-alone booklet in 1995, and an executive summary was published in CCM (27,28). Copies of the full document are probably rare—although I unearthed mine recently. Contributing to guidelines made me a more knowledgeable clinician and provided an entrée to publishing that was especially valuable for a clinically based practitioner with limited research focus.

Although it may be surprising to current young practitioners, at that time, publications were only paper based. I have progressively purged the massive quantity of paper from my office but vividly recall how I ran to the copier to duplicate new articles from CCM and other journals for the members of my team and how the ever-expanding stacks of papers “to be filed” always threatened to topple. To develop guidelines, we would seek copies of paper journals in the library stacks, research older articles from microfiche, and slowly print a copy. Compared with current guidelines, it makes me realize the incredible advances in communications, data transmission, and electronic efficiency. Nevertheless, I will always miss the ability to highlight, circle, and annotate in the margins of those hard copy pieces of professional history.

Thankfully, guidelines and other committee work are published in CCM, as the official journal of SCCM. I was asked to lead the next version of Sedation and Analgesia Guidelines—a first for a clinical pharmacist and an important steppingstone to leadership and personal growth in publishing and critical review of the literature. I was able to work with a large and highly engaged multiprofessional group. I was a full-time clinician and spent weekends or days off working on this project. It took many years to produce a document with more literature to consider than in 1995, but most were small trails or observational in design. This set of guidelines was finally published in CCM in 2002.

CCM has always provided an avenue for publication of research and case reports by our growing number of critical care pharmacists. However, the development and publication of the Position Paper on Critical Care Pharmacy Services in 2000 was a turning point for the growth of our specialty (29). Although this article was jointly published in a pharmacy-specific journal, the acceptance by CCM was groundbreaking external validation. Similar CCM support for growing groups of critical care clinicians has been invaluable (30,31). The ability to have committee and task force work product published in a SCCM journal contributes significantly to the scholarly progression of junior clinicians.

The guideline process is now more mature, using the standard platform of Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format. In parallel with the incredible growth of SCCM, professionalism of the SCCM Staff, and prominence of CCM journals, there is a financial commitment to the success of guidelines. Since 2012, only 43% of critical care guidelines discussing pharmacotherapy have had a pharmacist author—but 100% of those in CCM (32). Guideline publication is now more succinct, and lengthy reviews have been eliminated, delivering focused responses to important clinical questions—assuming primary literature informs the response. The detailed supporting documentation is digital, and much more retrievable than that 1995 guideline! Although leading the insulin and glycemic control guidelines, the current support by a GRADE expert has been invaluable. This ongoing maturation of the process and quality will influence practice for years to come. Ultimately, quality primary research publications from scholars and researchers are essential, along with clinicians posing the questions that need to be studied. Pharmacists can contribute their research thanks to the availability of three SCCM journals. It is my wish that guidelines become more fluid and the update process less prolonged.

Having previous publication experience with CCM opened doors for me to write editorials, reviews, and to join the Editorial Board in 2008. Joseph Dasta, MS, RPh, MCCM, and Barbara Zarowitz, PharmD, FCCM, were the first pharmacists on the Editorial Board in 1993, and many other pharmacists have followed as board members, reviewers, and now senior board members. I have gained significant insight on identifying how articles are prioritized for publication and a heightened respect for those who make it happen every day. As a member of the SCCM journal editorial boards, I have seen impressive maturation of the publication process and standards, ironically when publication standards have fallen elsewhere.

The number of pharmacists as principal authors, SCCM committee leaders, and governance has continued to expand and accelerate. Licensed pharmacists who are Fellows in SCCM (n = 138) published in a variety of journals at least 7,129 times since 1984 with a median of 20 (interquartile range 9–43) per pharmacist recorded in Scopus or PubMed, and the majority were original research (33). The rate of publication had increased from 37 per year over the first 25 years to 388 per year in the last 2 years.

The support and opportunities that SCCM has given to practitioners from every specialty have been life changing, and although my attitude of forging ahead into new activities never changed, the early lessons about effecting change were invaluable, and the satisfaction of seeing an article though to publication is indescribable.

Acknowledgments for influencing my career: Joseph Dasta, David Angaran, Karen Shields, Dave Emery, Michael Murray, Doug Coursin, E. Wes Ely, David Martin, Tim Buchman, Pamela Lipsett, and the many dedicated nurses, pharmacists, physicians, and health professionals that I have been privileged to work with.

CCM: SOMETHING FOR EVERYONE

Margaret Parker, MD, FCCM

FU7

BIOGRAPHY

Margaret Parker received her MD from Brown University and trained in Internal Medicine at Roger Williams Hospital in Providence, RI. She was the first fellow ever trained in Critical Care at the National Institutes of Health. The entire cadre of intensivists who recruited Margaret to NIH left abruptly within months of her arrival. As the only fellow, she took over the management of the ICU by herself until she was joined by Joseph Parrillo (and very soon thereafter, Henry Masur), and together they built the strong department and training program that NIH has today. She worked at the NIH for 11 years, during which time she had four sons, and was one of the first women to be a leader in this emerging field—a particular feat in an organization (NIH) with few female role models. For many years, she was the “go to” clinician at NIH, the master of all intravascular access, the fellowship director, and a successful investigator. Margaret was very active in clinical research looking at cardiovascular function in septic shock. In 1991, she was recruited to Stony Brook University in New York as a Pediatric Intensivist—and passed her pediatric boards while working at Stony Brook full time. Her switch to Pediatrics was an unusual career move but one that was natural for her. She was one of the first intensivists with board certification in both internal medicine and pediatric based critical care.

Margaret joined the SCCM in 1983 and has been very active, serving as President in 2004. She joined the Editorial Board of CCM in 1991 and became an Associate Editor in 2008. In 2018, she became one of five Senior Editors.

Margaret has four sons and a step-daughter, and four grandchildren. She likes to ring bells with her church bell choir, along with her husband, Bob.

REFLECTIONS

I began my training in critical care in 1980 at the National Institutes of Health. In 1981, Joe Parrillo took over the Department and became an essential mentor to me. One of the earliest things he did was introduce me to the SCCM and to CCM. The SCCM has been my professional home since I joined the organization in 1983, the year I presented my first article at the Congress in New Orleans. CCM was the journal I most frequently turned to because of the broad content related to critical care not only to my specific area of interest, cardiovascular function in septic shock, but also essentially any critical care topic. CCM has been an important source of information and particularly valuable for discussions of controversial topics, such as the pulmonary artery catheter (34). One of my first publications was published in CCM (35). I published one of my early articles on hemodynamics in septic shock in CCM (36), and a few years later, one of our fellows published her first article, with me as senior author (37). CCM was a forum for education for me and for the trainees with whom I worked.

I was appointed to the Editorial Board in 1991, became an Associate Editor in 2008, and in 2021 joined four other Senior Editors in a more advisory capacity. Serving on the Editorial Board of CCM was a valuable experience on many levels. I learned a great deal from the articles I reviewed as well as from the other reviewers and especially from the Editors-in-Chief. My colleagues on the Editorial Board became part of my professional family, and many are very good friends. My Editorial Board activities were also important in supporting my promotions to Associate and eventually full Professor. My publications in CCM, as well as the Editorials I learned to write, contributed to my promotion packages as well.

In 1991 when I switched from adult to pediatric critical care, CCM’s value to my professional growth was even more apparent. There were no focused pediatric critical care journals at that time, so the pediatric content in CCM was particularly important to me. By the late 1990s, the SCCM had committed to starting a new journal, Pediatric CCM (PCCM), along with the World Federation for Pediatric and Intensive and Critical Care Societies. I was appointed as Chair of the Search Committee for the new Editor-in-Chief of PCCM, a position that was filled by Pat Kochanek. Pat’s enthusiasm and creativity led to the unquestioned success of the new journal. I was appointed to the Editorial Board of PCCM in 2001, when Pat began his term as Editor. Like CCM had in my early career, PCCM contributed to my professional growth in many ways. I became a Senior Associate Editor in 2018, a position in which I have continued to learn a great deal from Pat, and now Robert Tasker, the current Editor-in-Chief.

Over the years, CCM has proven to be valuable on many levels: advancing my own and others’ knowledge and understanding of issues around caring for the critically ill patient, hearing different voices on controversial topics, a forum to learn how to write—both original articles and editorial comments and as a factor in my professional development and career advancement. These many factors showed me that CCM does indeed have something for everyone.

Acknowledgments for influencing my career: Michael Passero, Joe Parrillo, Tim Buchman, Ann Thompson, and Fred Ognibene.

THE IMPORTANCE OF CCM TO MENTORSHIP AND CAREER DEVELOPMENT

Charles L. Sprung, MD, JD, MCCM, FCCP

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BIOGRAPHY

Charles Sprung graduated from State University of New York-Downstate Medical School and later trained in internal medicine and CCM at Kings County Hospital in Brooklyn, NY. He was the director of the Veterans Administration medical ICU at the University of Miami for 12 years and director of the general ICU at Hadassah Medical Center in Jerusalem, Israel for 25 years, where he is currently Director Emeritus. Charles is recognized for studies of steroids in septic shock and for his research on medical ethics, especially ICU end-of-life practices and triage. He also coordinated and/or participated in consensus conferences, recommendations, and guidelines, including the Surviving Sepsis Campaign, for 18 years and as a member of the council or executive committee of SCCM and ESICM for 21 years.

Charlie and his wife Rebecca are the proud parents of four children and 12 grandchildren. Charlie is proudest of his weekly “Saba (grandfather) day” when he takes one of his grandchildren on a special outing followed by dinner with quality time for conversation.

REFLECTIONS

CCM has provided multidisciplinary articles for 50 years on a diverse number of topics in different formats to improve the care of the critically ill. Many of these publications were written by senior investigators together with younger colleagues. Mentorship and sponsorship are integral components of training and career development and are essential to the evolution of our discipline. Thus, examining components of mentoring and sponsorship and the important role of CCM in these domains should assist professionals in recognizing the opportunities which CCM presents to these important professional responsibilities.

A useful definition of mentoring is “the professional, one-to-one relationship between a more experienced person (mentor) encouraging and supporting a less experienced individual (mentee) to maximize their potential for personal and professional advancement.” This usually entails imparting knowledge, qualities, skills, role modeling, and guidance in growth and development. Mentors confer knowledge about the “hidden curriculum” of critical thinking, professionalism, values, ethics, and the art of medicine not available from standard textbooks, lectures, and conferences (38). Mentors can have sustained influence instrumental in the mentee’s career development, professional success, and work satisfaction. Sponsorship, as distinct from mentorship, is also important. Sponsorship might be defined as “enhancing the visibility, credibility, and networks of talented individuals and promoting specific career advancement opportunities” (39). This often takes the form of finding opportunities for younger colleagues to participate in research, getting professional exposure through invited talks or editorials, finding out about job opportunities, receiving advice about funding and grant applications, and getting proactive, enthusiastic recommendations (when appropriate) for jobs or other opportunities.

My own experience is instructive. As a 4th year medical student in Brooklyn during a nephrology elective with Eli Friedman, a world-renowned nephrologist, I cared for two patients with sickle cell anemia and renal failure—the first patients in the world with sickle cell to undergo hemodialysis. As the medical student responsible for blood drawing on both patients, I was invited by Dr. Friedman to be an author—an extremely gracious and career changing offer (40). This offer was the main reason I caught my “research bug.” Over time, under the tutelage, mentorship, and sponsorship of some of the founders of critical care, Eric Rackow and Max Harry Weil, I published articles independently and began to have mentees of my own. Mentoring and sponsorship are aspects of my career which have been the most rewarding.

There is no greater gratification for me than watching students, residents, or fellows succeed in attaining their professional aspirations, especially if they decide to be investigators. As the director of the critical care fellowship programs in Miami and Jerusalem, every fellow was required to have a research project. This research project was an opportunity to learn how to perform research, write abstracts and manuscripts, present at conferences, and publish. It encouraged critical thinking and critical reading. It also provided networking opportunities by introducing mentees at meetings to collaborators and famous critical care personalities—thus providing opportunities to expand their research careers and introducing them to job opportunities, sometimes in career directions they might not have considered before their exposure to mentorship, sponsorship, and the intellectual rewards of clinical investigation.

As a CCM editorial board member for 25 years, I have observed the inside working of the journal firsthand. I have known the editors-in-chief (Bill Shoemaker, Bart Chernow, Joe Parrillo, and Tim Buchman) as colleagues and as friends. What has impressed me the most about the journal is the understanding that there are different perspectives to medical facts and publications. The editors make a special effort to produce articles that represent diverse perspectives, and to have editorials reflect not only the relevance of an article but also its deficiencies, differing opinions, and directions of potential future studies. I am certain CCM will continue to publish multidisciplinary articles with an openness to divergent viewpoints in the future.

CCM provides an ideal venue for mentoring and sponsorship. The journal provides projects which enable us to teach our younger colleagues how to critically read and understand the contributions of articles in our specialty. The journal provides opportunities to create articles and be involved in the submission process, to review submitted manuscripts with constructive suggestions, and to even join the editorial board. I am proud that several of my mentees have published important articles in CCM (41,42). The journal is an important avenue in training future generations to be critical thinkers, productive investigators, effective educators, strong clinicians, and humanistic providers and leaders.

Acknowledgments for influencing my career: Rebecca Sprung, Eli Friedman, Eric Rackow, and Max Harry Weil.

HOW IT ALL STARTED—AND WHY CCM REMAINS A KEY PLAYER

Peter Suter, MD, FRCA

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BIOGRAPHY

Peter Suter trained in internal medicine and intensive care in Switzerland and Germany. He was the Head of Intensive Care, University Hospitals of Geneva for 25 years. He engaged in many research projects involving pulmonary pathophysiology especially focusing on acute respiratory failure and mechanical ventilation. He was responsible for the first description of “best PEEP” (43) and published extensively on adverse effects of mechanical ventilation in terms of lung function, inflammation, immunology, and infection. In his career, he has been Dean of the Medical Faculty of the University of Geneva and President, Swiss Academy of Medical Sciences. Peter was a founding member and first president, ESICM.

Early in his career, Peter served his country as an air force pilot in the Swiss Army, flying the Mach-2 jet plane Mirage III for 15 years (1968–1982), in parallel with his ICU activities. This was impressive multitasking!

PERSPECTIVE

The foundation of the SCCM in the United States and several similar national bodies in Europe and elsewhere, in concert with new scientific journals such as CCM and Intensive Care Medicine contributed decisively to the establishment of a new domain in medicine and its development (44). I remember quite well the beginning of these ventures 50 years ago. An internist by training with a 1-year experience in an ICU in Switzerland, I looked for a fellowship abroad which would allow me to expand my horizons in terms of research activity and “state of the art” critical care practice. Among my teachers and colleagues in Europe, there was no doubt that the best places for such a training at that time were in the United States. In 1972, I began a 2-year fellowship in intensive care at San Francisco General Hospital and Moffit Hospital at University of California San Francisco. I did further training at Massachusetts General Hospital in Boston and then at the University of Pittsburgh Medical Center.

I discovered a contagious enthusiasm for this new domain in this country, led by outstanding personalities such as Barrie Fairley, Max Harry Weil, Mike Laver, Henrik Pontoppidan, Bill Shoemaker, Peter Safar, and Ake Grenvik. Coming from different medical specialties, their declared goal was to establish a spirit of excellence and teamwork in critical care, for the benefit of the patient (21,45). This was quite different from the situation at that time in Europe, where control of the ICU was a political battlefield between anesthetists, surgeons, and internists. It appeared less important to provide the best possible environment and care for the severely ill than keeping the prestigious new domain within their specialty. My experience in the United States, my exchanges with the “pioneers” at the SCCM meetings and my reading their articles in CCM remain unforgettable and shaped the rest of my professional activities. The foundation of the ESICM by a dozen of similarly motivated angry young men and women in the early eighties was a direct result of positive United States and less enthusiastic “battlefield” experiences in Europe.

What was the journal CCM in its early days for me? CCM was at the top of my reading list during the fellowship and later, due to its stimulating variety of topics, interesting for my research and clinical practice. Original articles of experimental or clinical studies enhanced my understanding and management of problems seen in the ICU (13). Reviews and guidelines improved my knowledge and framed my teaching of good approaches to common clinical challenges. The definitions of the essentials for teaching and training of both nurses and physicians were part of the attraction of CCM as a multidisciplinary approach to care, as opposed to the narrow perspective of so many other specialties (46).

In the early seventies, only CCM in the United States and Intensive Care Medicine in Europe offered such a specific focus of publications for our field. Some other major journals certainly brought exciting reports concerning CCM, but they did so much less often than CCM or Intensive Care Medicine. One of my first scientific articles was sent to and published in CCM. One of my teachers and role models pushed me to perform this investigation and to submit it to CCM. Why? “You will get a fair review; a fast reply, and it will be read by your colleagues in your domain.” He was right, and these key points kept the journal on my reading and publication list for the following decades as I worked in ICUs back in Switzerland.

CCM (and Intensive Care Medicine) remain essential reading for critical care professionals who want to be knowledgeable, thoughtful, informed, and forward thinking—they are a sort of trumpet and a horn in an orchestra playing to enhance knowledge and optimal critical care—with a few additional sounds for the background support of harmonious symphonies, including the violins of NEJM, the harp of the blue journal, the cello of The Lancet, the bass of JAMA, and contributions from many other “instruments.”

Acknowledgments for influencing my career: Marcel Gemperle in Geneva, Barrie Fairley, Myron Laver, Peter Safar, and Henrik Pontoppidan in the United States.

EVERYTHING CRITICAL TO CCM IS IN CCM

Ann Thompson, MD, MCCM

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BIOGRAPHY

After graduating from the University of Chicago and from Tufts University School of Medicine, Ann Thompson began pediatric residency at Tufts at the Boston Floating Hospital where she loved caring for critically ill neonates and children. She had no idea that providing intensive care could be a career, as the Floating had neither a neonatologist nor a pediatric intensivist. During her third year of residency at Children’s Hospital of Philadelphia, she discovered the subspecialty of PCCM. Drs. John Downes and Russell Raphaely guided her into a second residency in anesthesiology and a fellowship in critical care. Drs. Peter Winter, Peter Safar, and Ake Grenvik recruited her to Children’s Hospital of Pittsburgh as the director of PCCM. She and her colleagues built a division internationally recognized for its outstanding clinical outcomes, education, and research. She served as president of SCCM, chair of the American Board of Pediatrics' subboard of PCCM, a member of the Residency Review Committee for Pediatrics of the American Council on Graduate Medical Education, and a member of the founding board of World Federation of Pediatric Intensive & Critical Care Societies. She is currently the Vice Dean of the University of Pittsburgh School of Medicine.

Ann’s life is enriched by cooking and enjoying fine art, crafts, and kayaking.

PERSPECTIVE

Forty years ago when I was being recruited to Children’s Hospital of Pittsburgh, I explained to the very senior hospital medical director, who did not quite know what CCM was, that I loved pediatric critical care because of the combination of fast-paced, technology-intensive, complex multisystem medicine, rapidly evolving related science, and the opportunity to support patients and families through what was virtually always necessarily one of the most difficult and frightening periods in their lives. I also appreciated the richness (and challenges) of working with physicians from multiple specialties, along with nurses, therapists, pharmacists, and the rest of the healthcare team. I did not realize then how very unusual that kind of teamwork was elsewhere in medicine.

From their beginning, SCCM and CCM recognized this combination as the NorthStar for ICU care.

Pediatric critical care was a very young subspecialty then, even younger than adult critical care, and we had an acute need for information to support improved care of critically ill infants and children beyond the neonatal period. There was not yet a textbook in the field, and practice was based on first-hand experience and what could be gleaned from general pediatrics, neonatology, and pediatric anesthesiology texts and literature. CCM provided the focused information we sought. There were, from the first volume, articles addressing developing technology and its evaluation, use, and limitations; multiple organ systems and their dysfunction and interactions, early ideas about best management and resulting outcome; and education. Close attention to ethical concerns and psychosocial needs of patients and families soon followed (47). I used the guidelines published in CCM to help structure the PICU and the fellowship program I was charged with managing and improving, 1 year out of fellowship, and referred to them and other guidelines again and again over my decades as PICU director.

From the first issue, the journal reflected SCCM’s membership and included articles specifically addressing pediatric management in combination with articles addressing developing impressions of best management practices. Initially, the journal was heavy on articles describing individual ICUs’ clinical approach to common disorders and the outcome noted, an approach one of my colleagues described as “how we bake cookies.” Recognition that much of the practice of the time was derived from such limited experience in individual units, the journal instituted pro/con publications to “examine …alternative approaches and stimulate the exchange of ideas in areas not adequately covered elsewhere” (48), as well as to prompt studies that compared varying approaches, rather than adopt as “God’s truth” the approach in one’s own unit. But rather quickly, as critical care and SCCM matured, the journal began to reflect significantly more sophisticated efforts to answer the important questions of the field with controlled studies and, in turn, developed steadily higher expectations for the quality of the work published. One mark of CCM’s excellence is its continued discussion of controversies in the field. Although some of the major advances in the field have been highlighted in some of the higher impact journals reaching a very general audience, many of the smaller seminal studies that led to that work were published first in CCM.

Also, from the beginning, pediatric intensivists found a home for their work in CCM, often taking advantage of adult-focused studies to modify and report clinical practice, but also frequently reporting work inspired by questions about the relevance of adult-focused studies to care of children. In some cases, pediatric work actually led to change in adult management, most notably, perhaps, in the implementation of permissive hypercapnia, resurgence of ECMO, and the role of families in the ICU (47,49,50).

Over the subsequent decades, the journal has both prompted and benefited from basic science investigations that have led to translational studies that have in turn guided dramatically improved care. It has included work from the multiple professions critical to ICU multiprofessional teams, essential topics in ethics, guidelines for managing disorders common to critical illness, and educational priorities. The journal has helped spur important multi-institutional studies and expanded recognition of the importance of work occurring internationally. It has certainly stimulated connections between U.S. pediatric intensivists and others around the world.

As the subspecialty of PCCM has grown, with important inspiration from CCM publications, its inclusion in the content of CCM has also grown, to the point that by 1999 there was sufficient work of very high quality to exceed the capacity of CCM to publish it. When Geoff Barker, representing WFPCCS, and I, for SCCM, proposed that there be a new journal focused on pediatric critical care, the Editor-in-Chief, Joe Parrillo, and the editorial board and publisher were all supportive and helped launch PCCM, with Pat Kochanek as editor-in-chief. It was a pleasure for me to be appointed to its editorial board.

Both journals continue to thrive and serve as essential sources of data to support advancement of the science, multisystem management, multiprofessional teamwork, ethics, education, and family- and patient-centered care, all of which were keys to my own early attraction to critical care. It is essential that all of them remain core topics for the journal, even though there are now many sources of critical care information—each of these elements of our practice is indispensable for our field to be among the best and most satisfying in medicine.

Acknowledgments for influencing my career: John J. Downes, Russell Raphaely, Ake Grenvik, Peter Safar, and Bradley Fuhrman.

THE LEADING INTERNATIONAL CRITICAL CARE JOURNAL

Jean-Louis Vincent, MD, PhD, FCCM

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BIOGRAPHY

After graduation from the Université Libre de Bruxelles, Professor Vincent specialized in internal medicine and CCM, including a 2-year fellowship at the Institute of Critical Care Medicine in the University of Southern California with Prof Max Harry Weil. Returning to Belgium to the Department of Intensive Care at Erasme University Hospital in Brussels, he became Head of that department, a position he held for 18 years. He is currently consultant intensivist in the same department and Professor of Intensive Care Medicine at the Université Libre de Bruxelles. He is a Past-President of the ESICM, the European Shock Society, the Belgian Society of Intensive Care Medicine, the World Federation of Societies of Intensive and Critical Care Medicine, and the International Sepsis Forum. He is a member of the Belgian Royal Academy of Medicine and was made a Baron by the King of Belgium. He is the editor-in-chief of Critical Care, Current Opinion in Critical Care, and ICU Management and Practice. He has been a member of the editorial board of CCM for 32 years, including “senior editor” for more than 20 years.

Over the last 42 years, Jean-Louis’ “hobby” has been the International Symposium of Intensive Care and Emergency Medicine (ISICEM), an annual meeting in Brussels, which he launched in 1980 and which has grown from 200 participants to more than 6,000 persons.

REFLECTIONS

I do not consider myself a pioneer, but my teacher and mentor, Max Harry Weil, certainly was. As a founding member and the first president of the SCCM, Hal consistently stated that he wanted to avoid the SCCM and its journal, CCM, being labeled as “American,” arguing that CCM is a global discipline, not restricted to any one country or continent. This is a really important concept. Indeed, I remember Hal was quite cross when we entitled one of our first ISICEM Round Table conferences: “Circulatory shock: A European view”—I learned my lesson and have not repeated that mistake! It is so important to recognize that the world is flat. I do not like people asking, “How would you do it in Europe?,” as if “good” medicine is different in different parts of the world. The most important thing in CCM is to appreciate the pathophysiologic basis of the acute disease, which is the same wherever the patient is or comes from. Of course, some conditions may be more common in some countries than others, and we can learn from each other about this, but the science behind each disease is essentially the same (ignoring genetic factors). Obviously, resources differ, as do ethical and cultural attitudes, but optimal care should be the same. As we argued, the Surviving Sepsis Campaign guidelines should be seen as providing a general reference framework, valid everywhere, “…providing a common ground for all clinicians involved in decision-making …” (51), which can then be adapted to the individual patient and context. Our specialty is complex and requires physician reasoning at the bedside using a physiologic approach. After all, one cannot treat shock using blood pressure as the only target, and ARDS management is more complex than a tidal volume of 6 mL/kg for everyone and a PEEP level determined by a table.

Another important feature that was close to Max Weil’s heart was the multidisciplinary nature of critical care and his wish to reflect this in the journal, which does not separate topics according to a more “medically” or “surgically” oriented readership. As I like to stress, a surgical patient is essentially a medical patient with a scar! I hope that “medical” and “surgical” ICUs will disappear, to be combined in large departments of critical care, as is already the case in many places in the world. Likewise, hearing about “neuro-critical care” as a separate entity raises my blood pressure (52). When present, problems of sepsis, respiratory failure, shock, nutritional support, or electrolyte support, just to name a few, are similar in all critically ill patients regardless of whether they have an initially medical, surgical, or other status.

These features are the main reasons for my strong and faithful support of CCM over the years. Indeed, my first publication in the journal was in 1983 as a young intensivist. The article was on the time course of lactate levels (53), a topic sometimes incorrectly termed “lactate clearance,” ignoring the fact that time course of any substance in the blood is influenced by its production as well as its clearance (54). Some 40 years later, a cursory look at my CV shows that my name has been associated with close to 150 publications (excluding abstracts) in CCM, thus reaching close to four publications a year over my academic career.

Although some more general major journals may attract more large randomized, controlled trials than CCM, the results of these studies are usually negative (55). Progress in our discipline has been made more through results from smaller studies published in specialty journals such as CCM.

CCM is a truly international journal, appreciated by clinicians and healthcare practitioners around the globe for its consistent, reliable quality of publications combining excellence in science with useful and relevant clinical application.

ACKNOWLEDGMENTS

We would like to thank Henry Masur, MD, for editorial assistance.

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Keywords:

critical care; future; history; mentorship; physiology

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