Overview
The Department of Intensive Care & Resuscitation is a multidisciplinary group of physicians, acute care nurse practitioners, and respiratory therapists within the Anesthesiology Institute. The scope of practice ranges from community hospital medical/surgical ICUs to specialized ICUs for abdominal transplant to others for full spectrum perioperative cardiovascular care including heart/lung transplant and all methods of mechanical and circulatory support.
In total, the department manages over 170 intensive care unit beds across four regional hospitals and 2 ICUs within the main campus – the Surgical ICU (30 beds) and the Cardiovascular ICU (95 beds). Caring for these patients is a diverse and dedicated group of physicians and nurse practitioners. More than 50 physicians with backgrounds and training in Internal Medicine, Cardiology, Anesthesiology, General Surgery, Cardiothoracic Surgery, Emergency Medicine, and Neuro Critical Care work in our ICU’s. Our ICU team is complemented by 91 acute care nurse practitioners and 92 respiratory therapists.
Other areas served or led by the department are the interventional critical care services, the medical emergency response/code teams, the house officer program, and the telemedicine program (eICU). The medical emergency response teams are staffed by physicians, acute care nurse practitioners, nurses, respiratory therapists and paramedics/EMTs. These teams respond to all inpatient and outpatient emergencies and provide advanced patient care and triage.
The procedure team is a subset of intensivists who perform a wide variety of procedures for critically ill patients. Their scope ranges from simple temporary line placement to tunneled catheters, pleural and pericardial drains, and ECMO cannulations. The ability to perform these procedures in the ICU obviates patient transport and facilitates timely completion.
We value our multidisciplinary care-team approach in caring for our critically ill patients and have developed multiple teams and programs to enhance and improve the care of our patients. This is a dynamic and growing group that is always seeking diligent professionals who desire to care for some of the most critically ill patients in the world.
Leadership
Andrew Shaw, MB FRCA FFICM
Chair, Department of Intensive Care and Resuscitation
Christine Lynch, DNP, ACNP
Director, NP/PA Services
Nicole Elegban, BSN, MBA-HCM, RN
Administrator, Department of Intensive Care and Resuscitation
Main Campus
SICU
The Surgical Intensive Care Unit, SICU, serves patients with acute perioperative management needs or with acute post-operative complications. Critical care in the SICU is directed by attending staff physicians, board-certified in critical care medicine. The primary surgical services admitting to the SICU include liver transplant, small bowel transplant, renal transplant, general and colorectal surgery, orthopedics, urology and ENT surgery. The SICU also provides anesthesia and surgery residents and critical care fellows the opportunity to learn and understand the essential fundamentals and advanced principles of monitoring, resuscitation, and support of organ systems.
Leadership
Faith Factora, MD
Medical Director, Surgical ICU
Dana Rubis, ACNP
Manager, Surgical ICU Acute Care Nurse Practitioners
CVICU
The Cardiovascular Intensive Care Unit, CVICU, is the largest cardiovascular surgery intensive care site in the country. Seven units with 95 beds support more than 19,000 patient days per year. These units care for patients that have had cardiac, thoracic, or vascular surgery. Clinical management is shared between board certified intensivists and cardiovascular surgeons. This collaborative structure enables the CVICU staff to manage all aspects of postoperative cardiothoracic and vascular surgery including ventilatory support, sedation, nutrition and hemodynamic monitoring. CVICU staff also play a key role coordinating consulting service recommendations. In addition, intensivists and nurse practitioners perform a variety of bedside and fluoroscopic procedures including tunneled catheters, intra-aortic balloon pump insertion and ECMO placement. Lastly, CVICU staff provide consultation services for ventilator dependent patients on step down nursing units.
Leadership
Steven Insler, DO
Medical Director, Cardiovascular ICU
Kathryn Piccolo, DNP, ACNP
Manager, Cardiovascular ICU Acute Care Nurse Practitioners
Critical Response & Resuscitation
The Critical Response and Resuscitation Committee, CRRC, oversees the Cleveland Clinic critical response teams and collaborates with regional hospitals to share best practices. Tasked with responding to patients experiencing a sudden decline in condition or those who have a cardiopulmonary arrest while on hospital grounds, the CRRC reviews and refines all aspects of emergency response including dispatch and first responder education, review of cardiopulmonary arrest records, and use of technology, e.g., early warning systems, to improve patient outcomes.
Despite caring for some of the most complex and critically ill patients in the country, regional and main campus critical response teams boast Gold and Silver awards from the American Heart Association in recognition of exceeding national “Get With the Guidelines” metrics. These awards are reserved for only a select few hospitals that achieve the highest compliance rate in several categories. Rates of return of spontaneous circulation (ROSC) and survival to discharge far exceed national averages.
Leadership
Donn Marciniak, MD
Chair, Critical Response and Resuscitation Committee
Chair Resuscitation Operations Council (ROC)
Shannon Pengel, RN, BSN, MSN
Co-Chair, Critical Response and Resuscitation Committee
Co-Chair, Resuscitation Operations Council (ROC)
Chief Nursing Officer, Main Campus
Anesthesiology Critical Care Medicine Fellowship
The Cleveland Clinic Anesthesiology Critical Care Medicine fellowship is a one year ACGME accredited fellowship that accepts 10 fellows per academic year. The program is one of the largest and most successful critical care medicine (anesthesiology) programs within the United States.
The goal of the fellowship program is to provide comprehensive training and experience in critical care medicine. Our educational curricula are learner-centered, relevant, interactive, and innovative. Examples of our curricula include: longitudinal curricula in echocardiography, critical care ultrasonography, mechanical ventilation and communication, to enhance clinical performance, learning and education. Our fellows function as an integral part of our care team. They actively participate in the care of patients with complex pathology across the surgical, cardiovascular, neuro and community critical care units. They are trained to provide an exceptional experience to patients and their loved ones through effective communication skills and empathy.
Highlights
- Protected academic time of half a day per week.
- Extensive board relevant didactic series.
- Extensive training in critical care ultrasonography with workshops focused on basic skills in the beginning and advanced skills in the second half of the year.
- Opportunity to participate in the critical care echocardiography board review course conducted at Cleveland Clinic.
- Basic mechanical ventilation workshop at the simulation center early in the year and an advanced ventilation workshop midyear.
- All fellows are certified in fundamentals of critical care support.
- All fellows are ATLS certified by the end of the fellowship year.
- Quality and Patient Safety projects with interprofessional teams.
- Opportunity to obtain TEE and TTE numbers to meet certification requirements.
Program Leadership
Program Director
Roshni Sreedharan, MD, FASA, FCCM
sreedhr@ccf.org
Associate Program Director
Brett Wakefield, MD
WAKEFIB@ccf.org
Advanced Practice Providers
Cleveland Clinic Acute Care Nurse Practitioners (ACNPs) work at Cleveland Clinic main campus and nine of our regional hospitals. At the main campus our NP’s work in the Surgical Intensive Care Unit (SICU) and Cardiovascular Intensive Care Unit (CVICU). Our SICU team also manages patients within the Post-Anesthesia Care Unit (PACU) and leads our Adult Medical Emergency team.
Our house officer program provides another 74 acute care nurse practitioners for “house officer” coverage to nine of our regional hospitals. These regional practice ACNPs serve as critical care house officers working at the top of their license, and have medical authority at Main Campus, South Pointe, Euclid, Avon, Marymount, Lutheran, Hillcrest, Medina and Fairview Hospitals. These nurse practitioners admit patients as part of the ICU team, diagnose and resuscitate critically ill patients, respond to calls in all areas of the hospital, and lead code response teams. They are trained in procedures including intubation and central line placement. The House Officer Team currently consists of two medical directors, two managers, an administrator and thirty-six house officers.
Main Campus SICU, CVICU ACNP and Regional House Officer duties include:
- Routine and urgent/emergent patient evaluations.
- ICU admissions and ICU patient management 24/7.
- Code Blue, stroke, and rapid response team Intubations, central and arterial line placement, and other invasive procedures for critically ill patients.
- Order entry, speaking to patients and communication and education of family.
- On-call care of ICU patients.
All critical care NPs, PAs, and house officers are trained to provide Cleveland Clinic world-class critical care through Cleveland Clinic’s Anesthesiology Institute. Education and preceptorship is tailored to future employment, i.e. main campus SICU or CVICU or regional practice. During the orientation period, training may include but is not limited to:
- Didactic lectures by Cleveland Clinic medical directors and nurse practitioner leadership.
- Rotating with the main campus adult medical emergency response team, cardiology, neurology, and within other ICU’s.
- Participating on a stroke alert team and observe first-line care from neurologists.
- Acute pain and ventilator management.
- Invasive procedures including central line placement, tube thoracostomy, basic and advanced airway management through rotations in the simulation lab, cadaver lab, operating rooms and patient care areas.
Leadership
Mark Zahniser, MD
Medical Director, House Officer Program
Michael Taylor, MD
Medical Director, House Officer Program
Kym Zeroske, DNP, ACNP
Manager, House Officer Program
David Holloway, ACNP
Manager, House Officer Program
Respiratory Therapy
Cleveland Clinic, an exciting work environment for respiratory therapists. Cleveland Clinic’s intensive care and resuscitation respiratory therapists are team-oriented with a practice model that embodies boundary-less collaboration between services. In the Heart and Vascular Institute, intensive care and resuscitation respiratory therapists partner with the critical care staff physicians, cardiovascular surgeons, nurse practitioners, nurses, and other service providers to deliver world-class care and service.
Intensive care and resuscitation respiratory therapists are given a unique opportunity to work in exclusive world-renowned critical care and step-down settings. Our seven cardiovascular intensive care units comprise a total of 95 beds making it one of the largest of its kind in the country. The respiratory therapists in Cleveland Clinic’s Heart Center also serve a 24-bed Coronary Intensive Care Unit, a 10-bed Heart Failure Intensive Care Unit, a 13-bed Cardiac Accelerated Recovery Unit, and a 15-bed Short Stay Unit. Respiratory care is also provided in the Heart Center’s 12 Step-Down areas, which total 288 beds. The CVICU supports more than 20,000 patient-days per year. Additionally, intensive care and resuscitation respiratory therapists care for over 100 lung transplant recipients every year. Our intensivist staff are board-certified critical care physicians who provide all daily clinical management in the CVICUs. Cleveland Clinic's Heart Center is nationally ranked and recognized as the world leader in cardiovascular care.
- Learn more about the Heart, Vascular & Thoracic Institute: view the Heart Center interactive map, learn about our model of care, facts & statistics, details about our treatment outcomes, insights and perspectives from our physician leaders, and the history of innovation in the Heart Center.
Leadership
Lindsey Kreisher, RRT-ACCS, MHA
Manager, Respiratory Care
Innovative therapies
Intensive Care and Resuscitation Therapists work with state-of-the-art equipment, use advanced clinical techniques, participate in research and help develop and utilize patient-driven protocols.
- Variety of innovative respiratory care modalities:
- Airway Clearance.
- Indirect Calorimetry.
- Nitric Oxide Therapy.
- Inhaled Epoprostenol Therapy.
- Mini bronchoalveolar Lavage.
- Advanced mechanical ventilation modalities with fast-track weaning.
- Assistance with mechanical ventilation management in the operating room.
- Assistance with product development for ground-breaking equipment.
- Test site for new medical products.
- Utilization of capnography to promote fast-track weaning.
- Protocols specific to the lung transplant population.
Teamwork
Respiratory therapists in the Department of Intensive Care and Resuscitation pride themselves on teamwork. They work closely with the nurses and physicians to function as a critical care team and provide the best care for their patients. In this constructive work environment, respiratory therapists collaborate with the cardiovascular intensive care unit intensivists on the plan of care for each patient. The therapists function independently, using patient-driven, evidence-based protocols and care plans in the treatment of these critical patients.
The Intensive Care and Resuscitation Respiratory Therapy Team has established committees to discuss issues that are important within the department. Everyone has a voice and can be actively engaged in decisions that are made within the department.
Some committees include:
- Equipment Committee: Technology in respiratory care is continuously changing. The purpose and goal of this committee is to evaluate the technology and equipment which will best suit the patient population and the department. The members of this committee strive to meet Cleveland Clinic’s mission of putting “Patients First” by trialing new and innovative therapies in respiratory care.
- Engagement and Recognition Committee: The engagement and recognition committees provide a great base for our teamwork in the department. They organize social events as well as quarterly meals within the group. They encourage and stimulate cohesiveness between therapists. This teamwork and relationship building carries through into our patient care areas where our therapists help each other and work toward the common goal of world class care.
- Career Development and Education Committees: The career development and educational committees are responsible for seeking out and providing opportunities for education and professional development, both inside and outside the hospital setting. These committees help facilitate talks given by our own respiratory therapists as well as physicians and other support staff. These talks keep the department up to date with current and advanced concepts in the field of respiratory care. It is their mission to bring and keep all of our therapists on the same education and skill level.
- Lung Transplant Committee: The vision of the Lung Transplant Respiratory Therapy Team is to provide current best practice models and individualized evidence-based therapeutic options to the lung transplant recipient. The Intensive Care and Resuscitation Respiratory Therapy Lung Transplant Team maintains compliance with existing patient care protocols. The Team continually coordinates evolving evidence based care to the lung transplant recipient in a patient-centric, context driven fashion. This team continuously refines and develops new protocols to enhance both patient care and the patient experience. Our Lung Team is committed to the prevention of all forms of Ventilator Associated Lung Injury, the enhancement and protection of graft function as well as the restoration of optimal lung function for our patients.
- Research Committee: The research committee participates in studies within the department as well as collaborates with physicians and other departments to produce quality studies to further the advancements in respiratory care. Our department strives to be the leader in evidenced based practice.
Resources
Respiratory therapists in the Cleveland Clinic Cardiothoracic Anesthesia Department are encouraged to be active members in their professional organizations.
