Surgical Intensive Care Unit (SICU)
The SICU is a 20 bed ICU that accepts and manages patients who have undergone a variety of general and specialty surgical procedures including all gastrointestinal procedures, some trauma (the majority of trauma is managed in a dedicated trauma ICU), liver, renal and pancreas transplantation, as well as all surgical specialties other than cardiothoracic. The ICU team is comprised of an anesthesiology or surgical intensivist, a senior and junior anesthesiology resident and a multidisciplinary team of allied health care providers.
The overall goals for this rotation are to understand and develop skills in the assessment, initial resuscitation, management and recovery of post-surgical patients from a wide variety of surgical disciplines including general, vascular, transplantation, orthopedic, urologic, head & neck surgery. The critical care fellows spend from 3- 4 months directly managing all aspects of patient care, triage decisions, coordinating transfers into and out of the SICU. The critical care fellow gradually assumes more supervisory responsibilities overseeing the care delivered by multidisciplinary teams of junior and senior residents from anesthesiology and surgical specialties, including procedures. Specific goals of this rotation also include:
- Diagnosis and management of sepsis related to gastrointestinal causes including gastrointestinal radiology such as computerized tomography, ultrasound, and contrast studies.
- Advanced respiratory failure strategies including different modes of conventional mechanical ventilation, oscillatory ventilation, ECMO support.
- Extra-Corporeal Life Support techniques including appropriate selection for and institution of ECMO support, management dilemmas including bleeding, ventilator management during ECMO, trailing patients off support and ethical issues related to appropriate continuation or withdrawal of ECMO support.
- Exposure to the widest variety of antimicrobial therapeutics for primary and nosocomial infections including resistant organisms based on national guidelines, and local empiric ID epidemiology.
- General ICU outcome models (APACHE III), used for both groups of patients and appropriate use of these models for individual patient decision making.
- Evaluation and delivery of appropriate nutrition support especially in highly catabolic patients with limited ability to tolerate conventional nutrition strategies.
- Objective methods to monitor adequacy of nutrition support including resting energy expenditure, mathematical models of calories needed.
- AACN Beacon Award, 2009 - 2014
- Outstanding Achievement and Leadership Award for Eliminating Ventilator-Associated Pneumonia, 2012 - 2013
- Society of Critical Care Medicine Family Centered Care Award, 2011 - 2012
SICU Selected Publications
- Dirkes S, Dickinson S, Havey R, O'Brien D. Prone positioning: is it safe and effective? Critical Care Nurse Quarterly, Jan - Mar 2012
- Dammeyer J, Dickinson, S, Packard D, Baldwin N, Rickelmann C. Building a protocol to guide mobility in the ICU. Critical Care Nurse Quarterly, Jan - Mar 2013
- Dickinson S, Tschannan D, Shever L. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Critical Care Nurse Quarterly, Jan - Mar 2013
- Havey R, Herriman E, O'Brien D. Guarding the gut: early mobility after abdominal surgery. Critical Care Nurse Quarterly, Jan - Mar 2013
- Rukstele C, Gagnon M. Making strides in preventing ICU-acquired weakness: involving family in early progressive mobility. Critical Care Nurse Quarterly, Jan - Mar 2013
- Knoblauch D, Bettis M, Lundy F. Financial implications of starting a mobility protocol in the Surgical Intensive Care Unit. Critical Care Nurse Quarterly, Jan - Mar 2013
- Talley C, Wonnacott R, Schuette J, Jamieson J, Heung M. Extended benefits of early mobility to critically ill patients undergoing continuous renal replacement therapy: the Michigan experience. Critical Care Nurse Quarterly, Jan - Mar 2013