CHP has a catchment area of nearly 2 million people, and nearly all critically ill children from the tri-state region of southwestern Pennsylvania, southeastern Ohio, and West Virginia are admitted to this institution. In addition, CHP is the only level 1 pediatric trauma center in western Pennsylvania and is an international center for liver, kidney, heart, and heart-lung transplantation. Consequently, fellows have an opportunity to study the care of children with the full range of life-threatening medical disorders, as well as those recovering from trauma, cardiothoracic, neurosurgical, craniofacial, and other major surgery. Fellows completing this program are well trained in virtually all aspects of pediatric intensive care. Fellows become thoroughly knowledgeable and competent in the management of infants, children and adolescents with single and multiple organ system failure, understanding theoretical and practical aspects of invasive and non-invasive monitoring, and the use of extracorporeal support (including ECMO, continuous renal replacement therapies, plasma exchange, and ventricular assist devices).
Fellowship begins with an intensive, one-month orientation program, “Introduction to Pediatric Critical Care Medicine.” Fellows receive hands-on simulation-based training, lectures, conferences, and detailed training in invasive procedures. This curriculum includes multidisciplinary didactic sessions based on pediatric critical care topics essential to initiating clinical work. These topics are presented by PCCM faculty as well as faculty from other disciplines and include basic and advanced airway management, recognition and management of shock, arrhythmia recognition and management, management of neurological trauma, and resuscitation teamwork skills. Psychomotor skills are also emphasized, and the course includes hands-on practice and mastery utilizing high fidelity simulation manikins. These technical skills include bag-valve-mask ventilation, intubation, laryngeal mask airway placement, central line placement, and chest tube placement. There is also an airway cadaver lab in conjunction with the adult CCM fellows in the Department of CCM. The orientation month also includes a two day, multi-institutional, high-fidelity simulation-based “boot camp” at the Children’s Hospital of Philadelphia with other first year fellows from programs across the Northeast and Mid-Atlantic regions. The month concludes with a week of gradually increasing responsibility in the PICU.
The PICU averages 2500 admissions per year and is staffed during the day by three attendings, 3-5 fellows, PCCM nurse practitioners, and 4-6 residents. The PCCM service has primary responsibility for major life-supporting treatments on all patients in the ICU. The fellows are supervised by PCCM faculty and have extensive interactions with both pediatric medical and surgical subspecialty faculty as well. The PCCM attendings on service are present in the PICU for 16-20 hours per day and as needed during the remaining hours.
Weekday morning work and teaching rounds begin at 7:30 a.m. with a presentation of new admissions, followed by x-ray rounds, and then rounds on each patient in the unit. Fellows present new admissions, and residents have primary responsibility for presenting other patients. Fellows supplement the resident’s presentation with additional information as necessary and supervise the resident in making the plan for the day, which is approved or modified by the attending. Rounds include nurses, respiratory therapists, critical care pharmacists, and case coordinators. Families are also invited and encouraged to participate. Faculty from other medical and surgical services involved with PICU patients commonly join rounds for those patients, providing rich opportunities to add their expertise, enhance communication, and assure that multiple patient goals are addressed and coordinated appropriately.
Fellows actively participate in the emergency transport system administered by the PCCM faculty under the leadership of Dr. Kathryn Felmet, Transport Director. Fellows receive all emergent requests for medical transport to CHP. With supervision by PCCM attendings, fellows are the transport command physicians, providing detailed medical advice to referring physicians for the 1000-1200 children transported annually to CHP. They also serve as transport physicians for extremely unstable infants and children (e.g., patients who have had a cardiac arrest, are in shock without vascular access, or are having respiratory compromise with an anticipated difficult airway) throughout the Northeast and Mid-Atlantic region and as far away as Hawaii.
The CICU is a 12 bed unit and averages 600 admissions annually. The goal of the CICU rotation is to educate fellows in the care of children with life-threatening congenital and acquired heart disease. The PICU fellow has primary responsibility for managing patients in the CICU. Diagnoses managed in this unit range from post-operative atrial septal or ventricular septal defects to complex single ventricle repairs and severe cardiomyopathies treated with extracorporeal support and heart transplantation. In addition to care of complex lesions and transplantation, CHP is a leading center in the NIH-funded development of pediatric ventricular assist devices (lead by cardiothoracic surgeon Dr. Peter Wearden) and in the studying the cardiac effects of dexmedetomidine (lead by Dr. Constantinos Chyrssostomou).