Critical Care Medicine
The mission of the Division of Pediatric Critical Care Medicine is to provide exemplary evidence-based, multidisciplinary critical care to the most medically vulnerable children in the greater New York City area and beyond. Our division is distinctive for cutting-edge extramurally supported research and a commitment to providing the most comprehensive training available to the next generation of leaders in pediatric critical care medicine.
The division has three clinical services, each with a designated medical director and specialized staff. In the 14-bed cardiovascular intensive care unit (CVICU) we care for postoperative congenital heart surgery patients beyond the newborn period as well as heart failure patients peri-transplant. In the general 13-bed pediatric intensive care unit (PICU) we care for a variety of general PICU patients but focus on severe respiratory failure, solid organ transplant recipients, and stem cell transplant recipients. In the 14-bed pediatric neuro-ICU we take care of trauma patients for our level one pediatric trauma program, post-operative spine and brain surgery patients, and patients with complicated epilepsy, stroke, and primary neuromuscular disease. We care for extracorporeal membrane oxygenation (ECMO) cases (approximately 50 per year) in the CVICU and the general PICU. Our ECMO program was recently awarded platinum status by ELSO (Extracorporeal Life Support Organization), and is one of the few pediatric centers in the world with this top designation. PICU admissions currently total about 2,100 per year.
The division currently receives National Institutes of Health (NIH) and other research salary support for seven of its full-time faculty members, and members of the division hold a number of independent and mentored research awards including several R- and K-level NIH awards. The division is also an active participant in national trials associated with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). The majority of research funding comes from the NIH and total funding increased more than ten-fold between 2012 and 2018. Division members have published primary and co-authored papers in many leading critical care and pediatric journals since 2012 including Pediatrics, Intensive Care Medicine, Pediatric Critical Care Medicine, Critical Care Medicine, American Journal of Respiratory Cell and Molecular Biology, and Pediatric Cardiology. In addition, members of the group have co-authored papers in top scientific journals including Nature, Nature Communications, Science Translational Medicine, Science Advances, Lancet Global Health, Journal of Clinical Investigation Insights, Journal of Immunology, PNAS, Development, Neuron, Journal of Neuroscience, and PLOS One. Finally, critical care faculty have published invited editorials, book chapters, letters, and review articles in a wide variety of publications including the New England Journal of Medicine.
Before 2012 residents spent short periods of time on all three PICU services. Since then, the division has consolidated the rotation to a single service (the general 13-bed PICU team), while the other two services are staffed by a mixture of advanced nurse practitioners and hospitalists. The resident rotation has a dedicated PICU education director and a defined curriculum that is taught by all critical care faculty and fellows. The resident ratings for the PICU rotation have been higher than any other inpatient or outpatient resident rotation for the last three years.
Pediatric Critical Care Medicine Fellowship
The mission of the Pediatric Critical Care Medicine (PCCM) Fellowship is to educate and train our fellows to become recognized leaders in the field by providing exemplary, multidisciplinary, evidence-based care for critically ill children who are particularly vulnerable because of the complexity of their underlying illnesses; conducting cutting-edge research; and serving as advocates for children afflicted with life-threatening medical problems.
Our program offers fellows a diverse training in clinical, administrative, educational, and research-based PCCM at a state-of-the-art PICU, in a children’s hospital with the third highest case mix index (CMI) in the nation. The fellowship training program was started in 1999 and is fully accredited by the ACGME. Over 40 fellows have completed the program and are now spread throughout the country primarily in top academic institutions, many with leadership positions and independent investigative programs. In addition to the standard three years of training, the fellowship supports the career advancement needs of its individual fellows. This includes specialized programs such as the Physician Scientist Development Program and T-32 grant positions for research, Masters of Public Health programs, Business Administration, and Healthcare Management. The program also welcomes fellows who are training in two subspecialties; the second might include pediatric neurology, pediatric cardiology, infectious disease, palliative care, and adult critical care medicine.
We have established an academic faculty track within the division whereby fellows doing high level research, and who have good potential to develop independently funded careers, are hired as instructor-level faculty for two years. During this period, they have limited clinical service so they can dedicate most of their time to research to allow them to obtain K-level funding. When that occurs, they are hired as full-time, assistant professor–level faculty.
The critical care division at NewYork-Presbyterian/Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center (CUIMC) is relatively young. Until about 20 years ago the PICU service was an open unit staffed by a combination of intensivists and anesthesiologists. At that time, the service consisted of a 13-bed PICU built in the 1990s with all private rooms and a 14-bed open PICU in the adjacent North building that was primarily for cardiac and other postoperative patients. In 1999 the service was modernized, and a fellowship training program was established.
In 2007 the Babies and Children’s Hospital at Columbia Presbyterian became the Morgan Stanley Children’s Hospital at NewYork-Presbyterian/Columbia University Medical Center. In 2105 the 14-bed North unit closed and a newly renovated 14-bed neuro ICU opened two floors above the general ICU. The unit in the North building was recently renovated as a 17-bed infant cardiac unit, integrating the pediatric and neonatal cardiac units, which until then had been separated by two floors.