Duke Children's Hospital & Health Center

Critical Care Medicine

Delivering around the clock care to infants, children, and adolescents with life-threatening illnesses and injuries.

The Division of Pediatric Critical Care Medicine strives for excellence in patient care, research, and fellowship training. Our division provides comprehensive services for a wide variety of critically ill medical and surgical patients with acute, life-threatening disease and injury. Our division includes the 16-bed Pediatric Intensive Care Unit (PICU), and the 13-bed Pediatric Cardiac Intensive Care Unit (PCICU), which are state-of-the-art critical care units designed to meet the needs of our patients and families. Care is also provided in a nine-bed Pediatric Progressive Care Unit.

Medical and surgical subspecialists from all disciplines are immediately available in the PICU and PCICU. Areas of subspecialty expertise include congenital heart disease, cardiovascular surgery, respiratory failure, neurosurgery, stem cell transplantation, immunodeficiencies, hematologic and oncologic emergencies, sepsis, and multiorgan system dysfunction. Available advanced treatment modalities include Extracorporeal Life Support (neonatal, pediatric, and cardiac ECMO), high frequency ventilation, nitric oxide therapy, non-invasive ventilation, and hyperbaric oxygen therapy. Twenty-four-hour-a-day critical care consultation is available.

Top of Page

Treatments

The Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Instensive Care Unit (PCICU) at Duke Children's Hospital provides comprehensive services for a wide variety of critically ill medical and surgical pediatric patients with acute, life-threatening disease and injury. Duke is a Level I Trauma Center and a regional, national, and international referral facility. Areas of subspecialty expertise include congenital heart disease, cardiovascular surgery, respiratory failure, neurosurgery, stem cell transplantation, immunodeficiencies, hematologic and oncologic emergencies, sepsis, and multiorgan system dysfunction. Available advanced treatment modalities include Extracorporeal Life Support (neonatal, pediatric, and cardiac ECMO), high frequency ventilation, nitric oxide therapy, non-invasive ventilation, ventricular assist devices (VADs), and hyperbaric oxygen therapy.

The 16-bed PICU and 13-bed PCICU are state-of-the-art critical care units designed to meet the needs of our patients, families, and staff team members. Care is also provided in a nine-bed Pediatric Progressive Care Unit. The Pediatric Critical Care Medicine Division and the Pediatric Intensive Care Unit are actively growing to better serve the needs of our patients and our community.

Additional inpatient services at Duke Children's Hospital include 55 intermediate care beds, a 16-bed stem cell transplant unit, and a 48-bed Neonatal Intensive Care Unit and Transitional Care Nursery. The Pediatric Radiology Division offers the highest quality imagery techniques including magnetic resonance imaging, positron emission tomography, ultrasound, and nuclear medicine. The Emergency Department, a Level I Trauma Center, includes a specialized pediatric emergency center staffed by board-certified Emergency Medicine physicians. A new Pediatric Emergency Department facility was completed in 2007. The Duke Hyperbaric Center is a well-established facility involved in both patient care and research which is used for PICU and PCICU patients primarily for the management of carbon monoxide poisoning or air embolism.

The PICU and PCICU attendings coordinate the transport of critically ill infants, children, and adolescents to Duke through the Life Flight / Life Care program which provides air and ground transport by highly-trained pediatric transport nurses. Fellows participate in the coordination of transports during their second and third years of training.

Problems commonly managed in the PICU and PCICU include:

Medical and surgical management of neonatal and pediatric congenital heart disease
Acute respiratory failure from multiple causes including status asthmaticus, pneumonia, bronchiolitis, and airway obstruction
Septic shock
Pre- and post-operative management for all surgical subspecialties (neurosurgery, cardiothoracic surgery, general pediatric surgery, orthopedics, otolaryngology, ophthalmology, and plastic surgery)
Diabetic ketoacidosis and other severe endocrine disorders
Status epilepticus
Brain tumors (pre- and post-operative management)
Trauma including closed head injury
Stem cell and solid organ transplantation
Poisonings including ingestions and carbon monoxide inhalation
Primary immunodeficiencies including DiGeorge Syndrome and Severe Common Immunodeficiency Syndrome (SCIDS)

Specialized services in the PICU and PCICU include:

Advanced respiratory support including conventional mechanical ventilation, high frequency oscillatory ventilation, high frequency jet ventilation, and inhaled nitric oxide
Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric patients with refractory respiratory and/or cardiac failure
Continuous veno-venous hemofiltration, hemodialysis, and peritoneal dialysis
Non-invasive and invasive state-of-the-art cardiovascular and neurological monitoring
Continuous bedside monitoring of respiratory mechanics and capnography
Advance diagnostic imaging support

The PICU and PCICU team is comprised of a broad range of healthcare professionals including board certified / eligible pediatric intensivists and cardiac intensivists, pediatric critical care fellows, highly skilled and specially trained critical care nurses and respiratory care practitioners, residents, medical students, social workers, physical and occupational therapists, chaplains, discharge planners, clinical nutritionists, and clinical pharmacists. All medical and surgical subspecialties are readily available to provide consultation as needed. The PICU and PCICU care delivery model supports this entire team's commitment to utilizing their specialized skills to meet our patients' needs in a family-centered care environment.

Top of Page

Physicians and Staff

Physicians

Name	Areas of Special Interest
Ira Cheifetz, MD	Pediatric critical care medicine, acute lung injury, high-frequency ventilation, cardiopulmonary interactions, cardiopulmonary resuscitation, ECMO, congenital heart disease, mechanical ventilation
Mary E. Hartman, MD, MPH	Pediatric critical care medicine
Jon N. Meliones, MD, MS	Pediatric cardiac critical care, pediatric critical care performance improvement, ECMO, high- frequency ventilation, technology
Kshitij P. Mistry, MD, MSc	Pediatric critical care medicine, patient safety, performance improvement
Caroline P. Ozment, MD	Extracorporeal membrane oxygenation, alternate modes of mechanical ventilation (high frequency, JET), and transfusion medicine
Stacey L. Peterson-Carmichael, MD	Lung pathophysiology as it relates to acute and chronic lung disease in children; performance of lung-function measures in infants with ventilator-associated lung injury; respiratory syncytial virus (RSV), congenital diaphragmatic hernia
Scott R. Schulman, MD	Pediatric cardiac anesthesiology
Jennifer Turi, MD	Pediatric critical care medicine and acute lung injury
David A. Turner, MD	Pediatric critical care medicine, medical simulation, education
B. Craig Weldon, MD	Blood management, mechanical ventilation, postoperative delirium

Staff

Name	Areas of Special Interest
Michael A. Gentile, RRT, RCP, FAARC	Research Associate
Samantha Tate	Clinical Research Coordinator
Lisa Mamo	Research Analyst
Austin B. Cutler, PharmD	Clinical Pharmacist
Chris Rudd, PharmD	Clinical Pharmacist
Susan Strasser, RN, BSN, MBA	Clinical Operations Director, Neonatal & Pediatric Critical Care
Beth Hutchinson, RN	Nurse Manager of Operations, Pediatric Intensive Care Unit
Beth Hutchinson, RN	Nurse Manager of Operations, Pediatric Cardiac Intensive Care Unit (Interim)
Tammy L. Uhl, RN, MSN, CCRN, CCNS	Clinical Nurse Specialist, PICU/PCICU
Valorie Smith	Division Administrator
Veronica Mills	Program Coordinator, Pediatric Critical Care Fellowship

Pediatric Critical Care Nurse Practitioners

Name	Areas of Special Interest
Debbie Guentensberger, RN, MSN, PNP	Pediatric Critical Care Nurse Practitioner
Remi Hueckel, RN, MSN, FNP	Pediatric Critical Care Nurse Practitioner
Jeannie Koo, RN, MSN, CPNP-AC	Pediatric Critical Care Nurse Practitioner
Keyatta Lackey, RN, MSN, PCCNP, CCRN	Pediatric Critical Care Nurse Practitioner
Kelly Swain, RN, MSN, PNP	Pediatric Critical Care Nurse Practitioner
Mark D. Weber, RN, MSN, PCCNP	Pediatric Critical Care Nurse Practitioner