Unique Aspects of the PICU Fellowship at CHM
The PICU Fellowship at CHM offers several advantages to future intensivists that are not available at many other programs.
(A) Broad Variation in Pathology
The Children’s Hospital of Michigan is located in an economically and ethnically diverse area that inherently produces a dramatic mix of critical illness. Our fellows get exposure to unique and uncommon disease, novel highly specialized therapies as well as a broad spectrum of general pediatric critical illness. The PICU provides and maintains care to all such patients, regardless of medical insurance availability.
(B) Extensive Training in Cardiovascular Medicine
The fellows have an integral role in the management of post-operative cardiac surgical patients. At CHM, PICU fellows round on these children each day, perform most life-sustaining procedures, and handle most post-operative emergencies. At night, the ICU fellow and attending have primary responsibility for all CV surgery patients. In addition, our fellows have rotations through the cardiac catheterization laboratory and cardiovascular surgery operating room early in their first year of fellowship. A weekly didactic lecture series in cardiovascular medicine is provided that features interactive, audience response board-like questions scattered throughout to maintain enthusiasm for the duration of the presentation and uses adult learning principles. All of the lectures are available to the fellows on-line for further reference if needed during clinical care or self-study.
(C) Expertise in Flexible Bronchoscopy
Virtual Flexible Bronchoscopy Simulator: Owned and maintained by the Division of Pediatric Critical Care, available to fellows at all times
All PICU fellows will be trained in flexible fiberoptic bronchoscopy. Beginning in their first month, PICU fellows will have access to a advanced flexible bronchoscopy simulator (see above). PICU fellows perfect their skills by performing bronchoscopies during their months of clinic care during which they are trained and mentored by the critical care faculty, all of whom are credentialed in pediatric fiberoptic bronchoscopy.
(D) Continuous Veno-Venous Hemodiafiltration (CVVHDF)
The use of CVVHDF is becoming increasingly common for the management of critically-ill children with acute renal failure, fluid overload, and sepsis. At CHM, primary responsibility for CVVHDF in the ICU lies with the intensive care service, in collaboration with our nephrology service. PICU fellows will become experienced in establishing vascular access, determining prescriptions for the dialysate, replacement fluids, anticoagulation and total dose of CVVHDF, as well as proper anticoagulation regimens.
We are currently using the PrismaFlex® by Gambro (below) for all patients requiring CVVHDF, including those on extracorporeal membrane oxygenation.
(E) International Elective
Pediatric critical care electives are encouraged. Faculty and fellows have participated in cardiac surgery missions to various locations including the Dominican Republic, Ecuador, and Ukraine.