Clinical Program

Members of the Division of Critical Care Medicine perform patient care, teaching and research in critical care in several ICUs: the Surgical Intensive Care Unit (SICU) at Duke, the SICU at the Veterans Affairs Medical Center (VAMC), and the Neuroscience ICU at Duke.  Divisional faculty also provides medical care in the Hyperbaric Center and the Pediatric ICU.

SICU Attending Staff

Patient care is provided in the SICUs at Duke and the VAMC under the co-directorship of faculty within the department. The Duke University Hospital SICU is a 16-bed, level-one trauma unit. In addition, it serves as a site for care of a variety of postoperative general and subspecialty surgical patients.

Attending staff from the Departments of Medicine, Surgery, and Anesthesiology provide 24-hour a day, seven days per week coverage. Dr. Alison Clay (Medicine), Dr. Mark Shapiro, Dr. Betsy Tuttle-Newhall, Dr. Steven Vaslef (Surgery), Dr. Nancy Knudsen, Dr. Eugene Moretti, and Dr. Christopher Young (Anesthesiology) share attending responsibilities.

The VAMC’s 8-bed unit serves as step-down and ICU. Open-heart patients, as well as post-operative general surgical, orthopedic, urologic, plastic, and other subspecialty surgical patients are treated in this unit. Attending staff coverage is provided by Dr. Attilio Barbeito, Dr. Scott Brudney and Dr. Shahar Bar-Yosef.

Training Program

Fellows

This is the fifteenth year the ACGME-accredited Fellowship in Critical Care Medicine has been offered by the department. The Fellowship program underwent ACGME review in 2006 as part of the review of the Residency Program in Anesthesiology. In addition to retaining full accreditation status, the program was awarded a special commendation recognizing the development and implementation of innovative web-based modules for the education and evaluation of Critical Care Fellows. The fellowship continues to attract a number of strong applicants. Additional training in Transesophageal Echocardiography (TEE) is now offered to Critical Care Fellows in collaboration with the Fellowship Program in Cardiothoracic Anesthesia.

Past graduates currently in practice include Larry Field (MUSC, Charleston, SC), Duane Funk (University of Manitoba, Winnipeg, Canada), Eugene Lujan (U.S. Naval Medical Center, San Diego, CA), Mihai Podgoreanu (Duke), Marcella Lanzinger (Germany), Maher Albaharani (Oman), David Coy (New Mexico), Patrick Neligan (University of Pennsylvania), Chiedozie Udeh (St. Thomas, Virgin Islands), Angela Joseph (Michigan), Kevin Patrick (North Carolina), Albert Hasson (Phoenix, AZ), Eugene Moretti (Duke), Faisal Masud (Houston, TX), Elliott Bennett-Guerrero (Duke), Nancy Knudsen (Duke), and Tony Huggins (Raleigh, NC).

Residents

First-year residents in anesthesiology are introduced to critical care medicine at the VAMC SICU. Here they have an opportunity to learn the skills needed to care for critically ill post-operative patients and those patients requiring intermediate levels of care.

Additional training in critical care medicine for CA-2 residents in Anesthesiology is provided in the 16-bed SICU at Duke University Medical Center (DN 2200). Residents gain additional experience in managing complex patients in this busy trauma/post surgical unit. One of the unique features that distinguish the Duke Critical Care experience for the residents in 2200 is the presence of Attending staff from the Departments of Anesthesia, Medicine, and Surgery. The varied backgrounds and training of the Attending Physicians allows the residents to gain multiple perspectives in the treatment of critical illness. The clinical and didactic components of this rotation are maintained at high levels with the input of the Critical Care Fellows and Attending staff.

CA-3 residents can choose to spend additional time in the DUMC SICU during their final year of training. During this time, senior residents have gained additional experience in managing complex ICU patients while acquiring more responsibility for daily rounds, decision-making, and education of junior members of the SICU team. Opportunities for training in TEE are also offered to senior residents during this elective rotation.

Medical Students

Instruction to medical students in Intensive Care Medicine is offered through the Duke University School of Medicine. A month-long rotation in SICU is available to fourth-year medical students from Duke and other institutions (both national and international) Students enrolled in this course join in daily rounding in the SICU at Duke University Medical Center. After an initial introduction to Critical Care Medicine, they participate in the care of critically ill patients by evaluating and presenting patients on SICU rounds, and taking in-house call with the residents. The students frequently cite the experience in managing complex medical problems and enthusiastic teaching by residents, fellows, and attendings as strong positives of this course.

With the recent re-structuring of the curriculum at the School of Medicine, a new Critical Care intersession (“Clinical Core”) has been instituted. This course is designed to give medical students a brief introduction to acute, in-hospital care early in their medical education. One-hundred, second-year Duke medical students are instructed by members of the Critical Care Division in the methods of critical care during the Clinical Core. Day one of this seminar is devoted to the presentation of a case to the students, followed by small group discussion of critical care issues raised by the case presentation. During the next two days, the students are given the opportunity to make rounds in the Duke SICU with Critical Care Medicine Attendings and explore related technologies such as invasive hemodynamic monitoring and mechanical ventilation. A month-long elective in Critical Care Medicine is available for those students who wish to further advance their knowledge.

The missions of the division--excellence in patient care, education, and research--continue to be well served. 24 hour a day/ 7 days a week Attending physician coverage in the Duke SICU continues to provide the highest level of care for our critically ill patients. Education of medical students, residents (both junior and senior), and fellows remains an integral part of our practice. Multidisciplinary critical care rounds are scheduled weekly under the direction of Dr. Young and Dr. Alison Clay. Duke University School of Medicine, Office of Continuing Medical Education (CME) has granted these conferences CME accreditation. They provide the opportunity for health care professionals from various backgrounds to meet and discuss critical care topics of mutual interest while earning needed educational credits for re-licensing purposes.

Research Program

Members of the critical care division have successfully completed several studies this past year and have had the results of their studies published in a number of peer-reviewed journals (see the publications section below). Investigations by members of the division continue in both basic sciences and clinical research. Dr. Niklason’s laboratory continues to produce ground-breaking research in the bioengineering of vascular tissue. These results have been presented at a number of international conferences and continue to be published in prominent scientific journals. Dr. Moretti spends three weeks each month in Dr. Schwinn’s laboratory, as he continues to refine the techniques of translational functional human genomics, particularly in the study of sepsis and septic shock in the ICU population. Dr. Podgoreanu has further enhanced our studies in genomics and proteomics of critical illness through his laboratory efforts. In addition, clinical research projects concerning the etiology, proteomics, and treatment of delirium in ICU patients and an investigation of a novel sedative agent are ongoing.

Goals

The goal of the division is to build on recent accomplishments and continue to improve in all aspects of patient care, teaching, and research, with patient care continuing to be the highest priority of the division. Every member of the division deserves credit for the continued enthusiasm and skillful patient care being provided in the face of the growing financial constraints on the practice of critical care medicine. These contributions are recognized by hospital administration, our patients, and their families. All members of the division are involved in the teaching of critical care medicine to medical students, residents, and others.

Current research projects include determining the genetic factors impacting on postoperative bleeding, point-of-care systems for monitoring perioperative coagulation, the use of a novel sedative agent, monitoring and treating delirium in the ICU, and genetics of sepsis and delirium. With the expertise of physicians in the division, and in collaboration with colleagues from other disciplines, new inquires into the role of genomics and proteomics in critical illnesses are under way.

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