Critical Care Medicine | Fellowship Program | Clinical Experience
The Pediatric Intensive Care Unit at St. Louis Children's Hospital is equipped to provide the highest level of care to critically ill children. The unit has a 40 bed capacity, averaging 2,000 admissions per year. The PICU team provides care for infants and children across the complete spectrum of critical pediatric medical illness and traumatic injury. The PICU is staffed with experienced health professionals, including pharmacists, respiratory therapist, physical and occupational therapists, dieticians, chaplains, and social workers. A total of four pediatric and emergency medicine residents are assigned to the unit during the day, and two residents are on at night. Additionally, each team includes a nurse practitioner. Critical care medicine fellows and faculty lead the teams to provide children optimal management of complex life-threatening disease. PCCM fellows and faculty assist with all pediatric critical care transports, including ECMO transport.
The Cardiac Intensive Care Unit (CICU) in St. Louis Children’s Hospital is specifically geared toward the care of children with congenital and acquired heart disease. This includes patients with heart failure requiring medical or device management. All post-operative lung transplant patients are also cared for in the CICU. The CICU is part of a 30 bed Heart Center and has a census that fluctuates, averaging around 12 patients. The unit has dedicated nursing and physician teams that offer state-of-the-art care for pre- and post-operative cardiac surgery patients and for critically ill cardiology patients, including those with end-stage heart failure. Care is provided by a joint team comprised of faculty and trainees from Critical Care Medicine, Cardiology, and Cardiothoracic Surgery. PCCM fellows rotate in the CICU throughout their three years of fellowship and are actively involved in all aspects of ICU care, including care of patients on ECMO, ventilator management, sedation, use of vasoactive and anti-arrhythmic drugs, and performance of bedside procedures. We have one of the most active pediatric heart failure and transplant programs in the country (20-25 transplant/year). A number of our patients are supported prior to transplant with ventricular assist devices, including the Berlin Heart, Heartmate II and HeartWare. Finally, we offer an additional year of specialized cardiac critical care fellowship training.
Fellows participate in inter-hospital transports for patients requiring admission to our PICU and CICU. Dr. Celeste Brancato is director of the Transport team, in collaboration with Dr. Scott Saunders from the NICU. Fellows are involved in all intake phone calls for transports as well as ongoing medical control for the team. We have a graduated process for fellows to gain complete independence in taking these calls that includes direct feedback from supervising faculty. Additionally, fellows serve as physician members of the transport team for those patients that are extremely unstable. Fellow education in transport medicine includes a full day of orientation didactics and simulations and simulations with the transport team twice/year.