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What is Critical Care Medicine?
Critical Care Medicine is a recognized medical/surgical subspecialty which completely encompasses the direct application of biochemistry, physiology, and pharmacology to the care of patients with life-threatening illness. Critical Care Medicine integrates medical science with biomedical technology to provide continuous moment-to-moment life support. Critical Care Medicine is the compassionate and ethical application of the leading edge of medical knowledge.The Intensive Care Unit is home to practitioners of Critical Care Medicine. It is the place where the efforts of multidisciplinary medical specialists and support staff bring their knowledge to bear on acute illness. The critical care specialist coordinates these efforts by carefully balancing the available technology and the needs of the patient to provide the highest quality of patient care. The ICU is also home to the teaching of medical students, residents, and fellows; and is a ‘laboratory of the highest order’ where invention and innovation occur continuously and is often the focal point for the future of medicine.

UNC Hospitals developed the nation’s first ICU.

What is the Critical Care Division at UNC comprised of?
The mission of the Critical Care Division is threefold: to provide the highest quality of patient care, to provide academic excellence, and to further knowledge in the field through scholarly research.

The Critical Care Division provides services in the 16-bed Cardiothoracic Intensive Care Unit (CVTICU) to which cardiac, thoracic, and vascular patients are admitted, as well as the 16-bed Surgical Intensive Care Unit to which critically ill general surgery, trauma, and abdominal transplant patients are admitted.  The critical care team manages all aspects of a patient’s care. Both units are true multidisciplinary teams where physicians, residents, medical students, advanced practice providers, nurses, pharmacists, respiratory therapists, physical therapists, occupational therapists and dieticians all come together to take the best care possible of the patients.

Typically, the CVTICU team is comprised of senior anesthesia residents, cardiothoracic surgery residents, advanced practice providers, and medical students.  Students and residents rotating here will have the opportunity to manage heart transplants, lung transplants, LVADs, ECMO, transcatheter valve replacements, open aneurysms and dissections, and other complex cardiac, thoracic, and vascular surgery patients.  This unique and interesting patient population provides great opportunities for learning.

Typically, the SICU team is comprised of a critical care fellow, general surgery residents, anesthesia residents, and interns from various specialties: anesthesia, surgery, surgical subspecialties, emergency, and ob/gyn as well as medical students.  Students and residents rotating here will the opportunity to manage multiple types of transplant patients (kidney, liver, pancreas, autologous islet cell), polytrauma victims, complex surgical oncology patients, HIPEC patients, patients in septic shock and a plethora of other interesting surgical patients.  All surgical services, except the aforementioned vascular and cardiothoracic, admit their patients to the SICU.

Point of care ultrasound has been rapidly growing in both scope and application over the past few years.  Here at UNC we have developed and implemented a point of care curriculum for our anesthesia residents that includes workshops, simulation sessions, lectures, and rotations focused on learning POCUS.  Ultrasound rounds have been incorporated in our ICUs as learning sessions where our faculty teach on actual patients for true bedside learning opportunities.  We have multiple faculty members in our department who are proficient in point of care ultrasound including all of our critical care faculty.  Dr. Acton serves as the assistant director of the SICU fellow ultrasound curriculum.  Our faculty provide workshops for both MICU and SICU fellows at our institution and most of our critical care faculty members are instructors for point of care ultrasound at local, regional, and national conferences.

What is on the horizon for Critical Care at UNC?
UNC Critical Care Medicine continues to expand. Some projects to look forward to include the establishment of anesthesiology critical care medicine fellowship, the creation of post-cardiothoracic surgery enhanced recovery pathways, and the offering of ICU telemedicine services to rural North Carolina. Involvement in medical education is growing as well with the addition of more ultrasound workshops, journal clubs, and interdisciplinary M&M conferences. In order to meet the demands of the increasing volume and complexity of cardiothoracic and vascular surgery patients at UNC, the CVTICU recently moved to a new state-of-the-art 16 bed unit on the fourth floor. Eventually the SICU and CVTICU again move its operations to the new UNC Surgical Tower which began construction in 2018.

The members of the Critical Care team include:

Duncan McLean, MD (Critical Care Division Chief, Medical Director of Cardiothoracic and Vascular Intensive Care Unit – CVTICU, and Medical Director of Critical Care Advanced Practice Provider Support program CCAPPS), has completed Internal Medicine and Anesthesiology residencies at both at Oxford University Hospitals (2013) and at the University of Rochester Medical Center in Rochester, NY (2018). He sub-specialized in Critical Care Anesthesiology and Advanced Perioperative Transesophageal Echocardiography (TEE) during his fellowship at Duke University (2019). Dr. McLean is board certified in Anesthesiology, Critical Care, and advanced perioperative TEE.  Dr. McLean is a UNC School of Medicine Academy of Educators member and has interests in point-of-care ultrasound (POCUS), lung injury prevention, quality improvement, and critical care education.

Jacob Acton, MD, Dr. Jacob Acton completed his anesthesiology residency at University Hospitals Case Medical Center in Cleveland, OH. After his residency, he completed a critical care fellowship at the University of Chicago. His interests include critical care ultrasound, medical education, and quality improvement in the critical care setting.

Meena Bhatia, MD, Dr. Meena Bhatia completed her anesthesiology residency at Rush University Medical Center in Chicago, IL. After her residency, she completed a critical care fellowship at the University of Chicago. She then went on to pursue a cardiothoracic fellowship at St. Luke’s Texas Heart Institute in Houston, TX. She serves as the interim division chief of critical care at UNC. Her academic interests include; peri-operative acute kidney injury, lung protective ventilation, blood conservation management, and education.

Mark Henry, MD, Dr. Mark Henry is a Clinical Assistant Professor of Anesthesiology. He completed anesthesia residency at the Medical University of South Carolina in Charleston followed by Critical Care Medicine and Cardiothoracic Anesthesiology fellowships – both at Vanderbilt University Medical Center, Nashville, TN. His primary interest is clinical education: preparing learners to care for patients and educate others. Other interests include: Veno-Arterial Extracorporeal Support (V-A ECMO), ICU Liberation (Sedation, pain control, early extubation and early mobilization), and the Post Intensive Care Syndrome.

Shawn Jia, MD, Dr. Shawn Jia is an anesthesiologist and critical care physician at UNC Hospital. He completed his anesthesiology residency at Duke University Medical Center and critical care fellowship at University of California San Francisco Hospital. His interests include critical care ultrasound, medical education, and peri-operative quality improvement.

Useful Links
Society of Critical Care Medicine
Society of Critical Care Anesthesiologists