Surgical Critical Care Service

Saint Louis University offers an accredited one-year program designed to provide the trainee with in-depth knowledge of surgical critical care. Completion of this residency qualifies the individual for the examination offered by the American Board of Surgery for the Certificate of Added Qualifications in Surgical Critical Care.

Fellowship Candidacy

Individuals applying to this program need a minimum of three clinical years in a surgical training program, but preference is given to individuals who have completed or are completing their surgical residency training.

Surgical Critical Care Service Overview

The Surgical Critical Care Service is a division of the Department of Surgery. It is closely aligned with the Division of Trauma and is staffed on a rotating basis with five fellowship-trained attending surgeons. The service consists of a surgical critical care fellow, two junior level surgery residents and an emergency medicine resident. Rotations are available to senior medical students on an elective basis. In addition, we maintain a close relationship with the military C-STARS (Center for Sustainment of Trauma and Readiness Skills) Program and interface with individuals seeking additional training in trauma and ICU care prior to deployment.  This includes personnel from nursing, ancillary services, primary care and the surgical specialties.

The Surgical Critical Care Service provides care for any patient in the ICU, including patients from all surgical subspecialties. The fellow is responsible for the daily operation of the service and plays an important role in the surgical education of the members of the team. The educational schedule includes a programmed lecture series on topics in critical care, joint conferences with medical intensive care fellows and attendings, joint radiology conferences and clinical correlation conferences conducted with the Department of Pathology. The board pass rate has been 100% for the last 10 years.

The primary educational focus is the complex management of the critically ill surgical patient with an emphasis on prioritization of care and multidisciplinary care coordination. Daily work rounds are conducted by the general surgery residents and directed by the surgical critical care resident. These are followed by daily attending rounds with board-certified intensivists, nurses, doctors of pharmacy, nutritionists, social workers, physical and occupational therapists. Decisions for patient care include management of cardiovascular, respiratory, neurological, nutrition and infection control. Additional education is gained in overall intensive care unit management with daily experience in the management of staffing, decisions for transition to other levels of care, infection control practices and allocation of hospital resources.

Fellowship Features

The program is based at SSM Health Saint Louis University Hospital (SLUH), a Level I trauma center and tertiary care referral center. In addition, it is the regional Center for Skull Based Surgery and has an active solid organ transplantation program. The trainee spends ten months in the surgical intensive care units at this institution.

Role of the Surgical Critical Care Fellow

Saint Louis University is in compliance with the directives of the Accreditation Council for Graduate Medical Education (ACGME) and the work hour requirements. The surgical critical care fellow is in house for 72 hours per week and has one day off/weekend. Daily responsibilities include directing the Surgical Critical Care Service, providing 24-hour coverage for all critically ill patients in the Trauma/General Surgery ICU and for selected patients in the Cardiovascular Surgery ICU and Transplant/Neurosurgery ICU. The training program also includes two elective months, which may include rotations in the Medical Surgical ICU at Mercy Hospital St. Louis, the Burn Unit at Mercy Hospital St. Louis, or in the Pediatric ICU at SSM Health Cardinal Glennon Children's Medical Center. The two elective months may also be dedicated to clinical research activities. Other arrangements may be considered on an individual basis.

Didactics

Teaching rounds are supplemented by didactic materials, including lectures and directed reading. The surgical critical care resident is responsible for selecting topics and speakers for the weekly Surgical Critical Care Conference. He or she will present at least once at Surgical Grand Rounds and will attend and provide commentary regarding critical care decision making at the weekly Trauma and General Surgery Morbidity and Mortality conferences.

Administrative Committee and Research

In addition to these educational components, the resident is expected to participate in administrative and research aspects of surgical critical care. The resident is a member of the administrative committee of the Trauma/General Surgery ICU and also attends the monthly meeting of the Special Care Committee of the medical staff. Funding is provided for the resident to attend at least one outside course or symposium on ICU administration, particularly those held in conjunction with the annual meeting of the Society of Critical Care Medicine. Finally, the resident is expected to develop and complete at least one clinical research project during the residency. If desired, more in-depth training in basic or clinical research is available through an optional second year of research training.

It is expected that, at the completion of this fellowship, the resident will be capable of providing care to the critically ill patient and be able to assume an active leadership role as a Medical Director of an Intensive Care Unit.

Conference Schedule

  • Trauma ICU Conference: Monday at 2:30 p.m.
  • Surgical Critical Care Conference: Tuesday at 5 p.m.
  • Surgical Grand Rounds: Wednesday at 7 a.m.
  • General Surgical Morbidity and Mortality: Wednesday at 8 a.m.
  • Trauma Morbidity and Mortality: Second Monday at 1:30 p.m.
  • Trauma Infection Control: Fourth Monday at 1:30 p.m

Surgical Critical Care Research

The Division of Surgical Critical Care supports research endeavors from individual fellows on the topics of their choosing and has sponsored presentations at national meetings. Quality improvement projects conducted by the fellow, such as analysis and implementation of strategies to minimize deep venous thrombosis, have led to changes in systems-based practices in the institution.

Previously Funded Research

1) Protocol No 01-04-TL-242-001: A Pivotal, Multicenter, Multinational, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of TAK-242 in Adults with Severe Sepsis.

2) F7Trauma-1648: A Multi-Center, Randomized, Double-Blind, Parallel Group, Placebo  Controlled Trial to Evaluate the Efficacy and Safety of Activated Recombinant Factor VII (rFVIIa/NovoSeven®/ Niastase®) in the Treatment of Refractory Bleeding in Severely Injured Trauma Patients.  

3) A randomized, double blind, placebo-controlled, phase 2B study to assess the safety and efficacy effects of art-123 on subjects with sepsis and disseminated intravascular coagulation. Artisan Pharma, Inc.

4) A multinational, randomized, double blind study comparing the efficacy and safety of a prolonged AVE5026 prophylaxis with a standard enoxaparin prophylaxis in the prevention of venous thromboembolism in patients undergoing high risk abdominal surgery (PHASE III).

5) Randomized double blind trial of Tigecycline for skin and soft tissue infections. Principal site investigator. Wyeth.

6) Clinical Evaluation of Efficacy and Safety of FS VH s/d 500-APR for Hemostasis in Subjects Undergoing Vascular Surgery.  Baxter.

7) A Randomized, Open label, Efficacy and Safety Study of Octaplex and Fresh Frozen Plasma in Patients Under Vitamin K Antagonist Therapy with the need for Urgent Surgery or Invasive Procedures. Octapharma.

Currently Funded Research

1) Establishing the Ethical Framework for Critical Care Genetics. Catherine Wittgen, M.D.,Principal Investigator. National Institutes of Health.

2) A randomized, double-blind, parallel group, multicenter phase IIIb study to compare ticagrelor with clopidogrel treatment on the risk of cardiovascular death, myocardial infarction and ischemic stroke in patients with established Peripheral Artery Disease EUCLID- Examining Use of tiCagreLor In paD).

Current Quality Improvement Projects

1) Steroid response to sedation in the ICU.

2) Evaluation of venous thromboembolism prophylaxis initiatives in an academic medical center.