Clinical Program
The heart of the Section of Critical Care is the Pediatric Intensive Care Unit (PICU). The 30 bed unit is housed within the new state-of-the-art University of Chicago Comer Children’s Hospital. Critically ill children are supported by advanced technologies such as: high frequency oscillatory ventilation that causes less trauma than conventional ventilation and can speed healing of lung injuries; open lung/low tidal volume ventilation for respiratory failure and asthma; extracorporeal membrane oxygenation (ECMO), a type of long-term heart-lung bypass; nitric oxide for respiratory failure; helium-oxygen mixtures for acute asthma patients; and complete dialysis services.
Mortality rates in the PICU are significantly lower than the national average. While the mortality rate in most PICUs is between 4 and 7 percent, the mortality rate in the PICU at the University of Chicago is between 2 and 3 percent.
Education
The Section of Critical Care maintains a fully accredited fellowship program designed to prepare young physicians for an independent career in Pediatric Critical Care Medicine. The three year training program is structured to prepare a fellow for a variety of ultimate career choices ranging from an academic clinical or research position to one in a busy private practice. The faculty offers a solid, diverse, and committed mentorship in clinical critical care medicine, and both basic science and clinical research. The University of Chicago Comer Children’s Hospital has a busy 30-bed Pediatric Intensive Care Unit with active medical, surgical, neurosurgical, trauma and cardiac surgical services. We have a full range of pediatric subspecialties as well. Fellows are involved in the care of every patient in the PICU.
The first year in fellowship is primarily clinical, consisting of six months of training in the PICU, one month of anesthesia, one month of vacation, and the remaining time in spent developing a clinical or laboratory research project under the supervision of an established mentor.
The second and third years are primarily dedicated to research with time to complete the remaining service months. The fellows take night and weekend call throughout all three years of fellowship. Fellows may train under the direct mentorship of either section faculty or with faculty from the wider University of Chicago Division of Biological Sciences. The fellowship allows individualized tracks of study in such diverse areas as molecular biology, clinical pharmacology, and biomedical ethics. Recent graduates of the fellowship program have successfully competed for research funding from the National Institutes of Health, American Lung Association and American Heart Association, a reflection of the high quality research training available at the University of Chicago.
Research
The faculty of the Section of Critical Care in the Department of Pediatrics at the University of Chicago are actively involved in research to improve the care of critically ill children. The PICU is one of only a few in the country that receives direct funding from the National Institutes of Health (NIH) for research on improving the care of critically ill children. Other hospitals throughout the country adopt protocols that are developed here at Chicago Comer Children's Hospital
Some ongoing research efforts in the Section of Critical Care include:
Dr. Tracy Koogler, who is focused on medical ethics as it pertains to organ donation. She is nationally recognized as an expert in organ donation after cardiac death and often travels to lecture on the subject. Her most recent work queried the attitude the attitude of families about organ donation discussions and has changed the position of organ procurement organizations at the national level on this subject.
Dr. Jennifer Liedel receives NIH support to study the molecular basis of heat shock protein protection using cultured gastrointestinal cells. She has investigated the effect of heat shock protein 70/72 on mitochondrial and microtubule binding and protection after a variety of insults that stimulate enterocolitis. She has demonstrated that HSP 70/72 does in fact, bind to mitochondria and microtubules using immunoprecipitation and the confocal microscope. She has also demonstrated that the integrity of mitochondria is a key mechanism in the ability of HSP 70/72 to confer protection to the intestinal epithelial cell from oxidant and heat injury. She has preliminary data to suggest that HSP 70/72 preserves mitochondrial ATP production as well. Dr. Liedel is also actively involved in clinical research. Her investigation of heparin induced thrombocytopenia in children and argatroban use for this disorder has resulted in her becoming one of the national authorities in this area. She also maintains active protocols that will define the use of vasopressin in the pediatric and neonatal intensive care units. In fact, she has become a recognized national authority on the use of vasopression in critically ill pediatric patients as the first author of the largest study of this therapeutic approach.
Dr. Melanie Brown is currently examining the relationship between asthma and obesity. Specifically, she is addressing the role of serum response factor (SRF), the insulin receptor (IR), and AKT in maintaining a contractile phenotype in airway smooth muscle in vivo. Dr. Brown also generated a new scheme for construction of a bicistronic transgene that she used to make transgenic mice with smooth muscle-specific, doxycycline-inducible overexpression of an HA-tagged constitutively active mutant of AKT.
Dr. Rachel Wolfson has been studying the role and regulation of a novel pro-inflammatory mediator, HMGB1, which is a molecule that may prove to be pivotal to lethal outcomes in septic shock. She recently was awarded an NIH K12 Child Health Research Award to study the role of the heat shock proteins on the elaboration of HMGB1 from the intestinal epithelium in sepsis.
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web site for more information about out pediatric critical care services.
