Critical Care Medicine Division

Best Medical Schools for Anesthesiology #4 in the nation.Faculty within the Critical Care Medicine Division provide expert care for patients suffering from a broad range of critical illness and injuries. These faculty provide world-class care to patients in multiple intensive care units at Duke University Hospital, Durham VA Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital. The division has achieved national and international prominence as leaders in critical care, cutting-edge research and innovative education programs.

Vijay Krishnamoorthy, MD, PhD - Chief, Critical Care Medicine Division

The evolution of the Critical Care Medicine Division within Duke Anesthesiology was set in motion in the 1980s with the vision of Dr. Robert Sladen, an international leader in critical care. Under his direction, anesthesiology progressed beyond the walls of the operating room, marking the beginning of anesthesiology intensive care in the Duke University Health System. Under Dr. Sladen’s direction from 1986-1997, anesthesia-trained critical care physicians began caring for patients in the surgical intensive care units. Throughout the next 18 years, Duke Anesthesiology continued to expand its footprint in the care of critically ill patients across Duke Health, with gradual expansion into the medical, neurologic, and cardiac critical care at Duke University Hospital, as well as providing general medical/surgical critical care at Duke Health’s community hospitals: Duke Raleigh Hospital and Duke Regional Hospital. During this period of time, the Critical Care Medicine Fellowship was started by Dr. Christopher Young, with innovative education in critical care medicine and perioperative echocardiography.

Due to this incredible growth, the department officially launched the Critical Care Medicine Division on September 1, 2015, with Dr. Raquel Bartz at the helm. Under Dr. Bartz’s leadership, the division has continued to grow and now represents the largest division in the department, with faculty providing care at six intensive care units across Duke University Health System. Several factors have driven the division’s growth:

  • The ongoing expansion of clinical services at ICUs beyond Duke University Hospital
  • The provision of innovation in mechanical circulatory support to patients with life-threatening cardiac and respiratory dysfunction throughout the health system (Duke University Hospital was designated as an Extracorporeal Life Support Organization Gold Center of Excellence in 2021)
  • The recruitment of a clinically-talented and academically-oriented faculty
  • Continued innovation in education programs to fellows, residents, and medical students
  • The growth of prominent research programs in population health, clinical trials, translational research, and basic science, with funding from federal, foundation and industry sources.

On September 1, 2021, Dr. Vijay Krishnamoorthy assumed the position of Interim division chief. Given this incredible trajectory over the past 35 years, the future of the Critical Care Medicine Division at Duke Anesthesiology is bright!

Critical Care Medicine ICU Coverage ModelThe Critical Care Medicine (CCM) Division provides patient care, teaching and critical care research in six intensive care units across the health system. All units are directed or co-directed by faculty from the CCM Division within Duke Anesthesiology.

Surgical Intensive Care Unit (SICU), Duke University Hospital

The SICU at Duke University Hospital is a 24-bed Level 1 trauma unit. In addition to providing multidisciplinary care for trauma patients, it serves as a site for care of a variety of postoperative general and subspecialty surgical patients, including abdominal transplantation. Attending staff from the Departments of Anesthesiology, Surgery and Medicine lead the multidisciplinary patient care teams. The unit is co-directed by Dr. Nitin Mehdiratta.

Cardiothoracic Critical Care Unit (CTICU), Duke University Hospital

The CTICU at Duke University Hospital is a 32-bed unit providing care for patients undergoing cardiac or thoracic surgical procedures. This includes patients undergoing coronary artery bypass grafting, minimally invasive cardiac surgery, adult congenital heart surgery, valvular heart surgery, electrophysiologic surgery, pulmonary transplantation, cardiac/pulmonary transplantation, implantation of advanced artificial cardiac support devices, and thoracic surgery. Attending staff from the Departments of Anesthesiology, Surgery and Medicine lead the multidisciplinary patient care teams. The unit is co-directed by Dr. Ian Welsby.

Neurological Intensive Care Unit (NICU), Duke University Hospital

The NICU at Duke University Hospital is a 32-bed unit that cares for patients with critical neurologic problems, including stroke, traumatic brain and spinal cord injury, and post-operative neurosurgical patients. Attending staff from the Departments of Anesthesiology and Neurology lead the multidisciplinary patient care teams. The unit is co-directed by Dr. Colleen Naglee.

Surgical Intensive Care Unit (VA SICU), Durham Veteran’s Affairs Medical Center

The VA SICU is a 12-bed unit providing care to a variety of critically ill surgical patients at the Durham VA Medical Center. Approximately 40 percent of the patients are postcardiothoracic surgery patients, with the rest typically being high-risk general, vascular, urology and neurosurgery patients. Attending staff from the Departments of Anesthesiology and Surgery lead the multidisciplinary patient care teams. The unit is directed by Dr. John Lemm. 

Critical Care Unit (DRH ICU), Duke Regional Hospital

The DRH ICU is a 22-bed unit providing care to all critically ill patients at Duke Regional Hospital. The medical conditions treated in this unit are broad, including medical, surgical, cardiac, neurologic, and obstetric critical illness. Attending staff from the Departments of Anesthesiology, Medicine and Surgery lead the multidisciplinary patient care teams. The unit’s associate medical director is Dr. Kathleen Claus.

Intensive Care Unit (DRaH ICU), Duke Raleigh Hospital

The DRaH ICU is a 28-bed unit providing care to all critically ill patients at Duke Raleigh Hospital. Similar to DRH ICU, the conditions treated in this unit are broad, including medical, surgical, cardiac, neurologic, and obstetric critical illness. Attending staff from the Departments of Anesthesiology, Medicine and Surgery lead the multidisciplinary patient care teams. The unit is directed by Dr. Arturo Suarez.

Nazish K. Hashmi, MBBS

Nazish K. Hashmi, MBBS
Fellowship Director

The Critical Care Medicine (CCM) Fellowship is an ACGME-approved program that provides a comprehensive one-year training program in both critical care medicine and transesophageal echocardiography (TEE), leading to board eligibility in both CCM through the American Board of Anesthesiology and in TEE through the National Board of Echocardiography. We offer eight ACGME-accredited positions per year.

Fellows

Duke Anesthesiology has been offering an ACGME-accredited fellowship in critical care medicine since 1994. In addition to retaining full accreditation status, the program was awarded a special commendation recognizing the development and implementation of innovative web-based modules for the education and evaluation of critical care fellows. The fellowship continues to attract a number of strong applicants. Additional training in transesophageal echocardiography (TEE) is now offered to critical care fellows in collaboration with the fellowship program in cardiothoracic anesthesiology.

Residents

First-year residents in anesthesiology are introduced to critical care medicine at the VAMC SICU. Here they have an opportunity to learn the skills needed to care for critically ill post-operative patients and those patients requiring intermediate levels of care.

Additional training in critical care medicine for CA-2 residents in anesthesiology is provided in the 24-bed SICU at DUMC (6WestDMP). Residents gain additional experience in managing complex patients in this busy trauma/post-surgical unit. One of the unique features that distinguish the Duke critical care experience for the residents in 6West DMP is the presence of attendings, staffed by the Departments of Anesthesiology and Surgery. The varied backgrounds and training of the attending physicians allows the residents to gain multiple perspectives in the treatment of critical illness. The clinical and didactic components of this rotation are maintained at high levels with the input of the critical care fellows and attending staff.

CA-3 residents can choose to spend additional time in the DUMC SICU during their final year of training. During this time, senior residents have gained additional experience in managing complex ICU patients while acquiring more responsibility for daily rounds, decision-making, and education of junior members of the SICU team. Opportunities for training in TEE are also offered to senior residents during this elective rotation.

Medical Students

Instruction to medical students in intensive care medicine is offered through the Duke University School of Medicine. A month-long rotation in SICU is available to fourth-year medical students from Duke and other institutions (both national and international). Students enrolled in this course take part in daily rounding in the SICU at Duke University Medical Center. After an initial introduction to critical care medicine, they participate in the care of critically ill patients by evaluating and presenting patients on SICU rounds, and taking in-house call with the residents. The students frequently cite the experience in managing complex medical problems and enthusiastic teaching by residents, fellows and attendings as strong positives of this course.

With the recent re-structuring of the curriculum at the School of Medicine, a new critical care intersession (“Clinical Core”) has been instituted. This course is designed to give medical students a brief introduction to acute, in-hospital care early in their medical education. One-hundred, second-year Duke medical students are instructed by members of the Critical Care Medicine Division in the methods of critical care during the Clinical Core. Day one of this seminar is devoted to the presentation of a case to the students, followed by small group discussion of critical care issues raised by the case presentation. During the next two days, the students are given the opportunity to make rounds in the Duke SICU with Critical Care Medicine attendings and explore related technologies such as invasive hemodynamic monitoring and mechanical ventilation. A month-long elective in critical care medicine is available for those students who wish to further advance their knowledge.

The Critical Care Medicine Division has robust programs in the study of critical illness, spanning from population health to basic science. Our research is funded by institutional, federal, foundation, and industry sources. Please explore the links below to see the diversity of our current research programs.

Population Health

The division houses the Critical Care and Perioperative Population Health Research (CAPER) Unit, with a mission of improving the lives of patients undergoing surgery and critical care globally, through the conduct of large-scale observational research using rigorous population health research methods. Methods used are drawn from the fields of epidemiology, pharamacoepidemiology, causal inference, health services research, health economics, health policy, and implementation science. Studies focus on the following areas: methods, injury epidemiology, resuscitation, analgesia, nutrition, multi-organ dysfunction, and health equity. To learn more, visit the CAPER Unit’s webpage.

Clinical Trials

The division participates in a variety of clinical trials, spanning multiple critical care topical areas. Trials led by members of our faculty are focused in the following areas: hemodynamics, coagulation, nutrition, neurologic injuries, and multi-organ dysfunction. Learn more about the clinical trials infrastructure at Duke Anesthesiology by visiting the Clinical Research Unit’s webpage.

Clinical, Translational and Basic Science Research Programs

The division has nationally-recognized programs in clinical, translational and basic science research in a variety of areas of critical care medicine including: critical care systems, point-of-care ultrasonography, nutrition and metabolism, sleep and delirium, brain injury, coagulation, education, genetics, data science, mechanical circulatory support, and acute kidney injury. Many investigators are members of the department’s Center for Perioperative Organ Protection.

Click on each division faculty’s name (within the faculty tab) to learn more about their work at Scholars@Duke.

View the department’s competitive and non-competitive research grant awards by calendar year.

Please contact the Critical Care Medicine Division’s interim staff assistant, Audrey McGregor, at 919-684-0862 or audrey.mcgregor@duke.edu with inquiries.

Divisional News

Chris KeithCritical Care Medicine Division