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Introduction
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The faculty and fellows of the UNC Division of Pulmonary and
Critical Care Medicine manage and practice in state-of-the-art
combined 16 bed medical (MICU) and respiratory (RICU) intensive
care units. The MICU and RICU are the main foci of the care,
education and research missions of this group. All patients
in the adjacent units receive care from an ICU team that is
comprised of the attending physician, Pulmonary/Critical Care
Medicine Fellows, Internal Medicine residents and 4th year medical
students. All attending physicians are Board Certified in Pulmonary
Diseases and Critical Care Medicine. The MICU and RICU nursing
staffs reflect the subspecialty orientations of the units and
are directed by a single nurse-manager. Standard and advanced
critical care services are available to evaluate and treat complications
of all major organs and multi-system diseases. These include
full hemodynamic and respiratory monitoring, intubated and mask
mechanical ventilation, hemodialysis, and apheresis.
About 120 patients with acute or chronic critical illness are
admitted each month. These patients come through the UNC Hospitals
Emergency Department, from the medical or surgical acute care
units, and as transfers from other hospitals. Common presenting
problems are respiratory failure, sepsis and shock, malignant
hypertension, gastrointestinal hemorrhage, renal failure, liver
failure, neurological illnesses, and multi-system organ failure.
Areas of particular strength are hematological emergencies (e.g.
thrombotic thrombocytopenia purpura), sickle cell disease, hemophilia,
organ transplantation complications, vasculitis, and cystic
fibrosis. The ICU team works closely with the interventional
radiology, renal dialysis, apheresis and other specialized treatment
services to evaluate and effectively manage critically ill patients
with single and multi-system organ failure.
The ICU physician team has hospital-based consultants from all
subspecialties of medicine and surgery available to provide
comprehensive evaluation and treatment of all foreseeable problems,
and combinations thereof. The interventional radiology service
provides directed embolization for bleeding, thrombolytic therapy
for major clots, transvenous intrahepatic portosystemic shunt
(TIPS) and vascular stent placements, and other services as
clinically needed. The dialysis service provides routine hemodialysis,
peritoneal dialysis, ultrafiltration, continuous veno-venous
hemodialysis, and other therapies as needed. The apheresis team
performs plasma exchange (PLEX), RBC exchange transfusion, leukopheresis
and other services. Gastroenterology provides full endoscopy
services and treatments, including variceal banding, sclerosis
of bleeding ulcer and endoscopic retrograde cholecystopancreatography
(ERCP). The trauma and general surgery service provides full-time
in-house consultations. The transplant teams for all major organs
(including kidney, pancreas, liver, heart, lung and bone marrow)
provide detailed records and expert consultative services. UNC
Hospitals has accredited critical care programs in medicine,
surgery, pediatrics and anesthesiology. The directors of these
programs work together regularly to provide excellent care and
training across all age groups, problems and specialties.
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Leadership
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Medical Director: James R. Yankaskas, M.D.
Associate Medical Director: Shannon S. Carson, M.D.
Nursing Manager: Cathy Gage, R.N., B.S.N.
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Clinical
Services
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Number for referrals and transfers: 919-862-6264, ask for MICU
resident on call.
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Critical
Care Research
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The MICU and RICU form the base of a robust clinical research
program. Many projects include subjects from other UNC Hospital
ICUs, including the Coronary Care Unit, the Surgical, Neurosurgical,
Cardiothoracic and Pediatrics ICUs, the Burn Unit and the Critical
Care Step-down Unit. The following original (investigator-initiated)
clinical research studies are currently active in the Medical
and Respiratory ICUs.
Outcomes for patients requiring prolonged mechanical ventilation
after acute illness
Principal Investigator: Shannon S. Carson, MD
Impact of continuous versus intermittent dosing of sedatives
on ventilator days and ICU length of stay in mechanically ventilated
patients
Principal Investigator: Shannon S. Carson, MD
Use of clinical risk predictors for triage of patients with
acute Gastrointestinal Hemorrhage
Principal Investigator: Shannon S. Carson, MD
Trends in timing of tracheostomy for patients with prolonged
mechanical ventilation.
Principal Investigator: Shannon S. Carson, MD
Faculty in the Division of Pulmonary and Critical Care Medicine
are also enrolling patients in the following multicenter ICU-based
clinical trials:
Efficacy and safety of drotrecogin alfa (activated in adult
patients with early stage severe sepsis.
Principal Investigator:
Shannon S. Carson, MD
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Faculty and Staff 
