Clinical Faculty

Nancy W. Knudsen, MD

Associate Professor of Anesthesiology, Assistant Professor in Surgery

Department:
Anesthesiology

Division:
Anesthesiology

Mailing Address:
DUMC 3094 Durham, NC 27710

Office Telephone:
919-681-6989

Fax:
919-681-7989

Training:
MD, University of Missouri-Kansas City School of Medicine, 1991

Fellowship:
Critical Care, Duke University Medical Center, 1995-1996

Residency:
Medicine, SSM St. Mary's Health Center (Missouri), 1991-1992

Clinical Interests:
Critical care medicine, general anesthesiology

Research Interests:
Healthcare costs in the United States are at an all time high.  In 1997, 13.5% of the Gross Domestic Product was spent on healthcare.  Ten percent or 1.3% was spent in the intensive care unit (ICU).  Over 500,000 patients/year die in an ICU setting.  ICU mortality rates average 10-20%.  Intensivists are now widely recognized as one of the keys to improving outcome in the length of stay and cost/case.  My research interests lie in utilizing our scarce resources for the most appropriate patients, those who will derive the most benefit from ICU care.  Through analyzing the transfers to our ICU, we have found that those patients on a ventilator and with renal failure have a higher mortality than other patients.  Scoring systems have been routinely used as well, but can be difficult to apply in the small hospital setting.  We have also documented that over half of the trauma and floor emergencies appear at night when most institutions do not have attendings available.  The Duke ICU has had in-house attending coverage since 1998 and has a mortality rate of 4% for the year 2001.  It is not enough to just improve care, but to improve the experience for the family during this very stressful time.  We have shown that the presence of intensivists 24/7 has improved family communication and satisfaction as well.  My goals are to continue to improve outcomes for patients and their families by streamlining care yet keeping an eye on the individual patient and their family's emotional needs.
I am also interested in mechanical ventilation and ways to improve morbidity/mortality in this group of patients.  I am a member of the Duke ARDSnet and Duke ARDSnet2 research teams.

Publications:
Knudsen NW, Fulkerson WJ, Vaslef SN, Sebastian MW.  Impact of interhospital intensive care unit transfers. Poster presentation at 21st International Symposium on Intensive Care and Emergency Medicine, Brussels, March 2001. Crit Care Med 2001; 5 (1 suppl):P173.

Knudsen NW, Sebastian MW, Lubarsky DA. Cost Containment in Vascular Surgery. Seminars in Cardiothoracic and Vascular Anesthesia. Nov 2000; 4 (4) 256-64.

Knudsen NW, Fulkerson WJ. Lung injury from mechanical ventilation. In: MacIntyre N, editor. Mechanical Ventilation. 1st ed. Philadelphia: W. B. Saunders; 2000. p. 212-221.

Knudsen NW, Fulkerson WJ, Sebastian MW. Family communication enhanced by 24 hour in house intensivists.  Presented at SCCM in February 2001.  Crit Care Med Dec 2000; 28 (12suppl): A109.