Clinical Program

The Pediatric Intensive Care Unit (PICU) is a multidisciplinary unit that provides a full range of services for critically ill infants and children. The PICU is jointly staffed by four attending physicians from the department and two attending physicians from the Department of Pediatrics. Members of the faculty are responsible for all medical and surgical admissions to the PICU. These physicians also jointly share responsibility for the care of medical and surgical patients in the Pediatric Transitional Care Unit (PTCU).

Infants, children, and adolescents with a wide range of medical and surgical conditions are admitted to the PICU. The patient population served includes infants with congenital heart disease in both the preoperative and postoperative period. Neonatal, cardiac, and pediatric extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO), is provided by the PICU team. The number of ECMO patients at Duke has steadily increased over the past several years.

The average daily census in the PICU increased by 13% over the past year and by 29% over the past two years. This increased census has been accompanied by an increase in overall patient acuity as assessed by the APR DRG index. Medical patients are admitted directly to the pediatric critical care service. Surgical patients are admitted to the primary surgical service with concurrent care from the pediatric critical care service.

Training Program

Physician training at the resident and fellow level is an integral and essential component of the mission of our division. We train two physicians per year in our three-year, fully accredited Pediatric Critical Care Medicine Fellowship program. Dr. Craig Weldon assumed the role of fellowship director in July 2004. Our fellows have the option of an additional year of training to further advance their research experience or to specialize in the care of infants and children with congenital heart disease. Our fourth-year fellow (Dr. Angela Wratney) is a recipient of a T32 NICHD Award.

Pediatric, emergency medicine, and anesthesiology house staff receive clinical and didactic teaching in pediatric intensive care. Additionally, fellows from other disciplines, including pediatric cardiology, neonatology, pulmonology, and anesthesiology have the opportunity to rotate through the PICU. The PICU rotation remains a favorite rotation for Duke medical students.

Research Program

Basic science, translational, and clinical research in our division has been robust. Twenty manuscripts were published or accepted for publication in 2004, and several additional manuscripts have been submitted for review.

Basic Science and Translational Research

In the neuroscience laboratory, Dr. Lisa Faberowski is utilizing a unique neuronal culture model exposed to hypoxic ischemic injury to demonstrate neuroprotective effects of volatile anesthetics in adult and neonatal models. Developmental differences between adult and neonatal brains suggest a different mechanism for cerebral protection. Developmental differences and, thus, the protective effect of volatile anesthetics during hypoxic/ischemic injury, are being studied in a hippocampal slice model. Dr. Faberowski was recently granted a four-year, Scientist Development Award from the American Heart Association for a project entitled “The Effect of Oxygen on Neuronal Degeneration in a Perinatal Hypoxic Rat Brain Model: Modulation by Isoflurane.” Using organotypic hippocampal slices prepared from, both non-cyanotic and cyanotic rat pups, this research project will determine the effect of ontogenetic development in the response of neural tissue to oxygen and anesthetic exposure.

Dr. Jennifer Turi continues to focus her research efforts on iron transport and oxidative lung injury. The presence of excess iron in the lungs can result in toxicity and cellular injury from the generation of oxidative stress and the promotion of bacterial growth. Thus, Dr. Turi is actively investigating the process of detoxification of this iron via the reduction of Fe 3+, its intracellular transport, and its subsequent sequestration within ferritin. Furthermore, she is evaluating the alteration in the function and regulation of these iron transport proteins in pathologic conditions such as cystic fibrosis.

Dr. Ira Cheifetz has focused his laboratory research efforts on cardiac and respiratory physiology with a focus on cardiorespiratory interactions. During the past year, these investigations have included ongoing work to determine the optimal use of heliox gas mixtures during conventional ventilation and the application of external high-frequency chest wall oscillation to optimize gas exchange and cardiorespiratory interactions during lung recruitment maneuvers. Research has recently been initiated to investigate the role of carbon dioxide elimination in optimizing lung recruitment in a model of acute lung injury.

Clinical Research

Dr. Scott Schulman received a $5.1-million, three-year NIH grant to study the efficacy and safety of sodium nitroprusside in children. This is one of the largest grants ever awarded by the National Institutes of Health for evaluating drug safety in children. Funding comes from the 2002 Best Pharmaceuticals for Children Act and was awarded by the National Institute of Child Health and Human Development.

Additional clinical research in the PICU over the past year has been directed by Drs. Scott Schulman, Frank Kern, Lisa Faberowski, and Ira Cheifetz. These projects have focused on predictors of successful extubation, cardiorespiratory monitoring strategies to decrease length of ventilation, and the pharmacodynamic effects of analgesics, anti-inflammatory agents, and inotropes. Our division continues to participate in several multicenter, randomized-controlled trials in the fields of pharmacology and respiratory care.

With the addition of Dr. Craig Weldon to our multidisciplinary group, clinical research interests have been further broadened to include the physiologic effects of intrahospital transport on critically ill children, transfusion practices in the PICU, and new methods to measure work of breathing and the effects of pressure support ventilation for pediatric respiratory failure.

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Ira M. Cheifetz, MD, FCCM, FAARC

Chief, Division of Pediatric Critical Care Medicine
Medical Director, Pediatric Intensive Care Unit (PICU)
Medical Director, Pediatric Respiratory Care Services and ECMO
Associate Professor of Pediatrics

Faculty

Frank H. Kern, MD, FCCM
Scott R. Schulman, MD
Jennifer L. Turi, MD
B. Craig Weldon, MD

Fellows

Andora Bass, MD
Cindy Barrett, MD
Sharad Menon, MD
Sydney Primis, MD
Marie Frazier, MD
David Adams, MD
Saumini Srinivasan, MD

Laboratory Research Coordinator

Michael A. Gentile, RRT, RCP

Support Staff

Shelia Johnson
Myra Stein