Pediatric Critical Care Medicine
PCCM Division Chief: Christian Bauerfeld, MD
Program Director, Critical Care Medicine Fellowship: Ajit Sarnaik, MD
Children’s Hospital of Michigan is a tertiary care center located in the heart of Detroit. The hospital serves a diverse, urban and suburban population with a vast array of pathology. It is the pediatric facility for the Detroit Medical Center complex and serves as the center for critical care pediatric fellowship training for Central Michigan University. The hospital has accreditation as a Level I Pediatric Trauma Center.
The intensive care unit is currently a 48 bed unit. Admissions to the ICU include but are not limited to acute respiratory failure; fulminant infectious disease and sepsis; traumatic head injury; status epilepticus; oncologic complications including care of children following bone marrow or stem cell transplant; inborn errors of metabolism; and poisonings. The ICU also provides post-operative care following high-risk surgical procedures including heart, liver, and kidney transplant, neurosurgery, orthopedic spinal surgery, airway reconstruction and surgery for complex congenital heart disease.
Although our program is sponsored by Children's Hospital of Michigan, our fellows are paid via a 501(c)(3) organization, so they are eligible for public service loan forgiveness (PSLF).
Clinical and Research Experience
Broad variation in Pathology: 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 a wide variety of disease, novel highly specialized therapies as well as a broad spectrum of general pediatric critical illness.
Extensive Training in Cardiovascular Medicine: Having a mixed medical and cardiac unit is advantageous for fellow education as fellows play an integral role in the management of post-operative cardiac surgical patients. At the Children’s Hospital of Michigan, PICU fellows round on these children each day, perform most life-sustaining procedures, and handle most post-operative emergencies alongside the attending. At night, the PICU fellow and attending have primary responsibility for all CV surgery patients. In addition, fellows have rotations through the cardiac catheterization laboratory and cardiovascular surgery operating room during their first year of fellowship.
Expertise in Flexible Bronchoscopy: All PICU fellows will be trained in flexible fiberoptic bronchoscopy. Beginning in their first month, PICU fellows will have access to an advanced flexible bronchoscopy simulator. PICU fellows perfect their skills by performing bronchoscopies during their months of service during which they are trained and mentored by the critical care faculty, who are credentialed in pediatric fiberoptic bronchoscopy.
Intensivists Managed Continuous Veno-Venous Hemodiafiltration: The use of CVVHDF is becoming increasingly common for the management of critically-ill children with acute renal failure, fluid overload, and sepsis. At the Children’s Hospital of Michigan, primary responsibility for CVVHDF in the PICU 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. They also become experienced in troubleshooting problems that arise. We are currently using the PrismaFlex® by Gambro for all patients requiring CVVHDF, including those on extracorporeal membrane oxygenation
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.