Overview

Overview

The Center for Critical Care 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 Center 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. Almost 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 40 acute care nurse practitioners and 90 respiratory therapists.

Other areas served or led by the Center are the procedure team, the medical emergency response/code teams, the house officer program, and the telemedicine program. 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. The ability to perform these procedures in the ICU obviates patient transport and facilitates timely completion.

We value our 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

Eric Kaiser, MD, MMM
Chief, Center for Critical Care

Mark Zahniser, MD
Vice-Chief, Center for Critical Care

Aaron Douglas, DO
Vice-Chief, Center for Critical Care Operations

Steve Hata, MD, FCCM
Vice-Chief, Center for Critical Care Research

William Phillips, MD
Director, House Officer Program

Christine Lynch, DNP, ACNP
Director, Anesthesiology Institute APRN/PAs

Nicole Elegban, BSN, MBA-HCM, RN
Administrator

Main Campus

Main Campus

SICU

The Surgical Intensive Care Unit, SICU, serves patients with acute peri-operative management needs or with acute post-operative complications. Critical care in the SICU is directed by attending staff anesthesiologists and surgeons 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 of principles monitoring, resuscitation, and support of organ systems.

Leadership

Faith Factora, MD
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

Steve Insler, DO
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 main campus 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
Co-Chair, Critical Response and Resusciation Committee

Shannon Pengel, RN, MSN
Co-Chair, Critical Response and Resusciation Committee
Associate CNO, Main Campus

Advanced Practice Providers

Advanced Practice Providers

Cleveland Clinic Acute Care Nurse Practitioners (ACNP’s) and Physicians Assistants (PA’s) work at the Cleveland Clinic main campus and seven 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 lead our Adult Medical Emergency team

Our house officer program provides another 40 acute care nurse practitioners for “house officer” coverage to seven of our regional hospitals. These regional practice ACNP’s and PA’s serve as critical care house officers working at the top of their license, and have medical authority at South Pointe, Euclid, Avon, and Marymount Hospitals, with plans for expansion into Lutheran, Hillcrest and Medina 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 and 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 call response as the team leader
  • 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 NP’s, PA’s, 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
  • Rotate with the main campus adult medical emergency response team, cardiology, neurology, and within other critical care ICU’s
  • Participate on a stroke alert team and observe first-line care from neurologists
  • Learn acute pain and ventilator management
  • Train in 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

Kym Zeroske, DNP, ACNP
Manager, House Officer Program

Respiratory Therapy

Respiratory Therapy

Cleveland Clinic, legendary for contributions to medical science, innovative therapeutics and medical education, offers an exciting work environment for Respiratory Therapists. Cleveland Clinic’s Cardiothoracic Anesthesia Respiratory Therapists are team oriented with a practice model that embodies boundary-less collaboration between services. In the Heart and Vascular Institute, Cardiothoracic Anesthesia Respiratory Therapists partner with the Anesthesia Institute's critical care physicians, anesthesiologists, surgeons, nurse practitioners, nurses, and other service providers to deliver world-class care and service.

Cardiothoracic Anesthesia 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, Cardiothoracic Anesthesia 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 has been ranked #1 in the United States by U.S. News & World Report since 1995. Our Heart & Vascular Institute is recognized as the world leader in cardiovascular care.

  • Learn more about the Heart and Vascular 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.

Innovative Therapies

CTA Respiratory 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 Cardiothoracic Anesthesia 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 anesthesiologists 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 Cardiothoracic Anesthesia 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 Cardiothoracic Anesthesia 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.