Critical Care Medicine at the University of Virginia is a multidisciplinary endeavor by the Departments of Anesthesiology, Surgery, Internal Medicine, Pediatrics, Neurology and Neurosurgery. Faculty from the Department of Anesthesiology are heavily involved in the leadership of each of the surgical ICUs. The Associate Chief Medical Officer (ACMO) for Critical Care Medicine at UVA Health System is Dr. James Michael Jaeger, Associate Professor of Anesthesiology. Additionally, three other anesthesiology faculty are Medical Directors or Co-Directors of the surgical/trauma/burn (STBICU), thoracic cardiovascular postoperative (TCV PO) and neurological (NNICU) ICUs. The department is well represented and respected within the ICUs, having 10 intensivists on faculty, providing care for the most ill patients at UVA.
As a resident in UVA’s Department of Anesthesiology, you may rotate in each of these ICUs, and can request additional elective time during your fourth year as well for ICU experience. The department believes in a well-rounded ICU exposure and experience because at its core, Anesthesiology remains an Intensive Care specialty. Often, the anesthesia residents take a leadership role and the onus of responsibility in these units because they are uniquely skilled, even when more junior, to protect patients and even guide residents from other specialties in the care of critically ill patients. Each specialty brings specific strengths to the ICU and the ICUs are also an excellent opportunity for anesthesia residents to learn from the training of their colleagues in other specialties.
Each ICU is organized in a different format, representing the needs of the unit and the culture of the specialties that practice there. In general, the “medical” units (PICU, NICU) are closed units, meaning the resident on staff in the ICU is responsible for all orders; the non-ICU team becomes designated into a consult-only role, and the intensivist attending becomes the primary attending. With the surgical units, this can vary to some extent depending on the unit.
One of the primary ICUs that the anesthesia department is involved with and the residents will both rotate in and interact with is the TCVICU. This is the destination for all major cardiac, thoracic and vascular surgical patients. This includes patients who have had heart and double-lung transplants. Each of the respective specialties in this unit round on their patients and play an active role in their care and follow-up. This is also the only adult unit that is involved with extra-corporeal membrane oxygenation (ECMO) and thus all ECMO patients board in the TCVICU. A truly open unit, there is a primary intensivist for the TCVICU who is in communication with the surgical attending and team to facilitate emergent care when needed.
The STICU in comparison to the TCVICU, is designated a “semi-closed” ICU where some anesthesia faculty also attend. The unit takes care of patients requiring critical care from general surgery (including liver and sometimes kidney transplant patients), plastic surgery, orthopedic surgery, and ENT. Two teams round in the unit, and about half of the beds are designated for the Trauma service which includes both blunt and penetrating trauma patients. Anesthesia residents who rotate in this unit will learn to treat sepsis and how to coordinate care among multiple specialties on an interdisciplinary team, advising and helping interns in the ICU as well.
The Nerancy Neurological ICU
The Nerancy Neurological ICU is a closed unit with an anesthesiologist co-director. This unit is designated for both post-surgical patients from craniotomies and major spine surgery, as well as neurological patients with ailments from stroke to vasospasm or Guillan-Barre. Intensivists are either Neurology or Anesthesiology trained and thus the residents get exposed to different methods of both teaching and care in the unit. The Neurosurgery team openly communicates and is readily available for their patients in this unit where they round at least twice a day.