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Critical
Care Medicine
At
Medical College of Virginia Hospitals
McGuire Veterans Administration Hospital
Attending Physicians
Faculty members in the Division of Pulmonary and Critical
Care Medicine at Virginia Commonwealth University serve
as attending physicians for the Medical Respiratory Intensive
Care Unit (MRICU) at MCV Hospitals and the Medical ICU (MICU)
at the McGuire Veterans Affairs Medical Center. Further,
off-service critical care consultation is provided by Division
faculty at both hospitals. All faculty members are board
certified in Critical Care Medicine. All fellowship trainees
completing the program in Pulmonary and Critical Care Medicine
have achieved board certification in Critical Care.
Intensive Care Units at MCVH and VAMC
Have Large Patient Censuses
MCV Hospital’s Medical Respiratory ICU is one of the six
adult ICUs which have a combined capacity of sixty-three
beds. The MRICU is a twelve-bed ICU, however, the number
of patients cared for on the MRICU service often exceeds
the ICU capacity, necessitating admission to other MCVH
intensive care units. Approximately 1100 patients are admitted
yearly to the MRICU service. The MICU is an eight-bed unit
with approximately 500 patients admitted annually. Examples
of the diversity of clinical conditions cared for by Critical
Care Division faculty are:
1) respiratory failure (e.g., adult respiratory distress
syndrome, severe exacerbation of chronic obstructive lung
disease, status asthmaticus, and infectious pneumonia);
2) diabetic ketoacidosis;
3) gastrointestinal hemorrhage;
4) sepsis and septic shock with multiple organ failure;
5) acute and chronic liver failure;
6) hypertensive crisis; and
7) drug overdose.
Most patients admitted to the MRICU service
at MCV Hospitals or the MICU at the VA Hospital have respiratory
failure. Fifty percent of total admissions and 75% of patients
on the service at any given time are receiving mechanical
ventilation. Admissions arrive in to medical ICU’s newly
admitted from the Emergency Department, as transfers from
inpatient ward services, and as transfers from outlying
regional hospital ICUs. The MRICU and MICU receives many
such transfers from hospitals throughout central Virginia,
northern Virginia, south central Virginia and northeastern
North Carolina. Dr. Curt Sessler is the MRICU Medical Director
while Dr. Frederick Glauser is the MICU director.
Critical Care Medicine at VCU Is Team-Focused
The MRICU at MCV Hospitals is a "closed" ICU
with all care supervised by one of the 5 full time MCV/VCU
faculty members of the Pulmonary and Critical Care Division.
The MRICU team consists of a Division faculty member, a
Pulmonary/Critical Care fellow, Internal Medicine residents
and interns, and several acting interns. Nursing care is
provided by an excellent dedicated MRICU staff with an average
of 7 nurses for 12 patients. Our excellent clinical outcomes
are achieved through a strong emphasis on multidisciplinary
care and collaboration. Patient care is greatly impacted
by exceptional support from the Respiratory Care Department,
a dedicated Intensive Care Pharmacy, nutritional support
services, social work, occupational and physical therapy.
The McGuire Veterans Administration Medical Center MICU
is an eight bed unit that also has a dedicated ICU team.
One of the 3 full time faculty members of the Pulmonary
and Critical Care Section serve as attending physicians.
The MICU team composition at the VA Hospital is identical
to the MRICU team described above. Additionally, respiratory
care ICU pharmacy, nutrition and physical therapy support
the MICU patient in a multidisciplinary fashion.
Bedside Teaching and Instruction
The MRICU and MICU are rich environments for housestaff
and multidisciplinary education. Educational programs
include active bedside and chalkboard teaching as well
as didactic lectures. All Pulmonary and Critical Care
faculty have been recipients of the "Best Faculty
Teacher Awards" presented annually by the Internal
Medicine housestaff. Many Pulmonary/Critical Care fellows
have been finalists or recipients of the annual Muran
Award presented to the best teaching fellow by the
Internal Medicine housestaff. The ICU rotations are
extremely popular with the Internal Medicine housestaff
and the Acting Intern rotations for fourth-year medical
students are highly sought after.
Critical Care Research
Many clinical and translational research projects are
being conducted in the MRICU and MICU. Active research is
being conducted in a variety of areas including:
1) investigation of novel mechanisms of septic shock,
2) the epidemiology of multiple organ dysfunction syndrome,
3) prevention of ventilator-associated pneumonia,
4) investigation into causative factors for catheter-related
bloodstream infection,
5) factors influencing handwashing practice,
6) development and validation of a new sedation-agitation
scale,
7) two separate sepsis trials supported by the pharmaceutical
industry,
8) an acute lung injury trial supported by industry.
Excellence in Patient Care
Critical Care Medicine at MCV Hospitals and the McGuire
VA Hospital is conducted at a very high level of performance
due to the experience and dedication of its physicians,
nurses and support staff. The resulting outcomes achieved
by the ICU services at both institutions are excellent and
have brought national acclaim.
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