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Critical Care, Intensive Care Medicine

About our Practice

We provide comprehensive critical care services for over 1,500 patients each year who suffer from life-threatening illnesses such as pneumonia, Acute Lung Injury, Acute Respiratory Distress Syndrome, liver failure, gastrointestinal bleeding, acute kidney failure, and shock. Our critical care teams are supervised by physicians who specialize in critical care medicine and pulmonary disease. Other physicians on our team include nephrologists, gastroenterologists, psychiatrists, cardiologists, physiatrists, endocrinologists, surgeons, radiologists, and consultants in infectious disease. Members of the physician teams are available continuously in the Medical Intensive Care Unit 365 days/year.

Our Medical Intensive Care Units (MICUs) are equipped with state-of-the-art equipment for managing all medical emergencies. Our Nursing Staff is a highly skilled and motivated group that delivers the best possible bedside care to our patients. They are also very concerned with our patients’ comfort, and they are attentive to our patients’ families, who frequently need information and guidance. Our teams are complemented by strong support from Respiratory Therapists, Pharmacists, Nutritionists, Physical and Occupational Therapists, and Social Workers.

Our areas of special focus include management of Acute Respiratory Distress Syndrome (ARDS). We have conducted research on this condition for over 30 years and have led and collaborated on many multicenter clinical trials of promising new treatments for ARDS. Our therapeutic approaches include conventional lung-protective mechanical ventilation, high frequency oscillatory ventilation (HFOV), Airway Pressure Release Ventilation (APRV), inhaled Nitric Oxide (iNO), and extra-corporeal membrane oxygenation (ECMO). Another of our areas of special focus is Physical Medicine and Rehabilitation in the Intensive Care Unit. We have a specialized program with dedicated physical therapists who use an array of specialized equipment and therapeutic approaches to prevent weakness, depression, and functional loss while our patients remain on life support.

Contact Information:

For physicians
For patients and families
Information for Physicians
Information for Patients and Families
Consultation Services
Research in the MICU
Physicians and Faculty
 

Information for Physicians

Contact Us
Physicians at other hospitals - to speak to a Critical Care physician in our MICU about a patient, please call the Hopkins Access Line (410-955-9444) and ask to speak to the MICU attending physician.
 

SERVICES IN THE MEDICAL INTENSIVE CARE UNIT

Mechanical Ventilation

Conventional mechanical ventilation (CMV, Volume and Pressure Assist Control, SIMV, Pressure Support, Volume Support, and others)
Noninvasive Ventilation
High Frequency Ventilation
Airway Pressure Release Ventilation (APRV)

Extracorporeal Membrane Oxygenation (ECMO) and Extracorporeal Gas Exchange (ECGE)

Blood Banking and Transfusion Medicine


http://pathology.jhu.edu/department/divisions/transfusion/

Plasmapheresis

Hemodialysis (Intermittent and Continuous)

Lung Transplantation

http://www.hopkinsmedicine.org/pulmonary/clinics/lung_transplantation.htm

Nutritional Support (Enteral and Parenteral)

Physical Medicine and Rehabilitation
Physical Therapy
Occupational Therapy
Speech and language pathology; swallowing disorders
Cognitive Behavior Therapy
Social Work

Interventional Pulmonary Service

http://www.hopkinsmedicine.org/pulmonary/clinics/interventional.html

Pleural disease service
http://www.hopkinsmedicine.org/pulmonary/clinics/interventional.html

Interventional Radiology

http://www.hopkinsmedicine.org/vascular/

Consultation Services
Infectious Disease
Nephrology
Gastroenterology
Hepatology
Cardiology
Endocrinology
Rheumatology
Allergy and Immunology
Chemical Dependence
Immunogenetics
Occupational and Environmental Medicine
Palliative Care
Gerontology
Surgery (General, Abdominal, Thoracic, Otolaryngology, Head and Neck/Ear-Nose-Throat, Vascular, Transplant (kidney, liver, lung, pancreas, heart), Neurosurgery, Orthopedic, Plastic)
Psychiatry
Obstetrics and Gynecology

Information for Patients and Families

SERVICES IN THE MEDICAL INTENSIVE CARE UNIT

Mechanical Ventilation
The main purposes of breathing are to get oxygen into the blood and to remove carbon dioxide from the blood.� Some diseases prevent patients from maintaining safe levels of oxygen and carbon dioxide in the blood. This is known as respiratory (breathing) failure, which can be caused by many different conditions, including pneumonia, asthma, COPD, drug overdose, and neurologic disorders such as Myasthenia Gravis. Mechanical ventilation is a form of life support for patients with respiratory failure. Many patients with respiratory failure recover and resume independent breathing after a period of treatment for the underlying disease. The time required for recovery varies considerably depending on the nature of the disease or condition. However, occasional patients cannot recover to independent breathing. In these instances, we work towards comfort and stability with chronic mechanical ventilation support and then explore opportunities for continued care outside the intensive care environment.

We utilize several different approaches to mechanical ventilation, depending on each patient’s needs.

Conventional mechanical ventilation (CMV)
With CMV, a plastic tube is inserted through the mouth into the trachea (windpipe) and connected to a machine that provides breaths of air with an oxygen-enriched mixture of gases. The size of the breath of air delivered with CMV is similar to the size of a normal breath.

High Frequency Ventilation, High Frequency Oscillatory Ventilation
This is a form of mechanical ventilation that utilizes very small breaths of air at very rapid breathing rates. It is designed to reduce excessive forces in the lungs that may occur when conventional mechanical ventilation is used in patients with severe pneumonia, acute respiratory distress syndrome, and other diseases in which the lungs are very inflamed. As with conventional ventilation, a tube is inserted through the mouth into the trachea (windpipe) and connected to the high frequency ventilator.

Noninvasive Ventilation
This is a form of mechanical ventilation for patients who require modest levels of support from a ventilator. This approach does not require a tube in the trachea (windpipe). Instead, ventilation assistance is provided through a tight-fitting facemask. This approach allows some patients to speak and eat normally.

Airway Pressure Release Ventilation (APRV)
This approach resembles conventional ventilation in that it requires a tube in the trachea (windpipe). It is used in occasional patients whose breathing on conventional ventilation is uncomfortable. It may also be useful for patients with very inflamed lungs, as in pneumonia and other causes of the acute respiratory distress syndrome.

Extracorporeal Membrane Oxygenation (ECMO) and Extracorporeal Gas Exchange (ECGE)
In severe cases of respiratory (breathing) failure, it may not be possible to maintain adequate oxygen and carbon dioxide levels in the blood, even when the lungs are supported by mechanical ventilation.� When the disease is severe but potentially reversible, we may use ECCMO or ECGE as a substitute for the lungs while we treat the disease and wait for recovery.� During ECMO or ECGE, blood is pumped from a tube in a large vein into a machine (ECMO or ECGE machine) that adds oxygen to the blood and removes carbon dioxide. The blood is then returned to the patient through a tube placed in a vein or artery. This machine replaces most of the function of the lungs. Studies are ongoing to assess the benefit of this approach, which is not routinely available at smaller hospitals.

Lung Transplantation

http://www.hopkinsmedicine.org/pulmonary/clinics/lung_transplantation.html


Occasional patients recover from respiratory failure, but they cannot breathe independently and comfortably because their lung disease has become too advanced. In some of these instances we explore the possibility of lung transplantation with physicians in the Johns Hopkins Lung Transplantation Program. Cystic fibrosis, COPD, and pulmonary fibrosis are the most common diseases that lead to lung transplantation.

Nutritional Support
Most patients in the Medical Intensive Care Unit cannot eat normally because they are too weak or receive treatments (such as mechanical ventilation) that interfere with normal eating. When patients are seriously ill for days and sometimes weeks, they become malnourished, which weakens the body’s ability to recover from illness. For most of our patients, we provide nutritional support with a small tube inserted through the mouth or nose that continues down the esophagus (swallowing tube) into the stomach or small intestine. A liquid nutrition formula is pumped through this tube at a slow rate into the digestive system. In a few patients, the digestive tract is unable to absorb the liquid nutrition. In these instances we may provide nutrition intravenously. Nutritional support is customized to meet each patient’s needs and is guided by a team of nutrition experts.

Physical Medicine and Rahabilitation

In most intensive care units, patients receive little or no physical activity. It is assumed that they must lie in bed to conserve energy. Some patients are very weak after recovery from a critical illness and have difficulty returning to work and regular activities. The Johns Hopkins Critical Care Physical Medicine & Rehabilitation program provides specialized treatment individually tailored to improve each patient’s recovery. Physical therapists, occupational therapists, and speech and swallowing specialists have expertise in treating patients in the intensive care unit and provide dedicated support. This multifaceted team uses safe and innovative treatments to improve recovery, including in-bed cycling, interactive video games, and a tilt table bed. Our patients enjoy participating in these activities which help them maintain strength and speeds their recovery.

Cognitive Behavior Therapy is another approach utilized by our Physical Medicine team. It is difficult for patients to experience a sense of control and calm in a stressful setting such as an intensive care unit. Anxiety is a common and distressing symptom for some ICU patients. Medications for anxiety often have unfavorable side effects. Our Critical Care Physical Medicine & Rehabilitation team includes a rehabilitation psychologist with expertise in treating anxiety symptoms in ICU patients using non-medication, cognitive-behavioral approaches. This treatment can help improve critically ill patients’ psychological and physical rehabilitation throughout hospitalization and ensure a better recovery after they are discharged from the hospital.
This article about our Critical Care Physical Medicine Program appeared in the New York Times: http://www.nytimes.com/2009/01/12/health/12icu.html


Social Work

Medical social workers assist with communications between families and the health care team. They provide information and assistance to patients and families for advanced directive planning. They may work with patients, family, physicians, nurses, and therapists to match a patient’s needs after discharge to a rehabilitation center or skilled nursing facility.

Interventional Pulmonary Service

http://www.hopkinsmedicine.org/pulmonary/clinics/interventional.html
Our Interventional Pulmonary team conducts procedures that require specialized training and experience. These include rigid and flexible bronchoscopy, foreign body removal, tracheal and bronchial stents, endobronchial ultrasound, and bronchoscopic laser, thermal, cryotherapy, and photodynamic therapy. Our pleural disease service performs thoracoscopy for diagnosis and management of pleural effusions, empyema, and pleural abscess, chest tube placement including PleurRx® and pigtail catheters.
Interventional Radiology
Our Interventional Radiology team performs transvenous intrahepatic porto-systemic shunts (TIPS, for gastrointestinal bleeding from cirrhosis), catheter directed embolization for gastrointestinal and for pulmonary bleeding, vena cava filters for deep vein thrombosis and pulmonary embolism, percutaneous drainage of intra-abdominal and intra-thoracic abscesses and closed space infections, and percutaneous biopsies of suspected tumors or infected mass lesions.

Blood Banking
Our Blood Bank provides patient-specific matched packed red blood cells, platelets, fresh-frozen plasma, and factor concentrates including Factors VII.

Hemodialysis (artificial kidney; intermittent and continuous)

Consultation Services

How to Contact Us
If you are in an Intensive Care Unit at another hospital and are considering a transfer to Johns Hopkins Hospital, we encourage you to discuss your thoughts with your attending physician at your current hospital. Sometimes it is best to stay in your home hospital because it has the same diagnostic equipment and can perform the same treatments as at Johns Hopkins. Also, transferring a critically ill patient connected to tubes and machines can be risky and costly. If you and your attending physician are interested in transferring, your attending physician can call us through the Hopkins Access Line (410-955-9444) and ask to speak to the MICU attending physician.

RESEARCH IN THE MEDICAL INTENSIVE CARE UNIT

We are committed to improving the health of today’s patients and of our patients in the future. One of the ways we do this is by advancing the state of medical knowledge with cutting edge research. Our faculty’s specific areas of research interest and expertise in Critical Care are listed under the heading “Our Physicians.”.

We have been members of the National Institutes of Health Acute Respiratory Distress Syndrome Network (ARDSnet) since 1995 (http://www.ardsnet.org). This organization conducts large, multicenter clinical trials of promising new treatment strategies for patients with ARDS and related disorders. We have contributed to all 10 of the ARDSnet trials, including the current trial of Rosuvastatin versus Placebo for Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome from Sepsis. Johns Hopkins investigators led two of the previous trials.

Our areas of active investigation include:
Acute Respiratory Distress Syndrome, Acute Lung Injury
Mechanical ventilation
Lung-protective ventilation in Acute Respiratory Distress Syndrome
High Frequency Ventilation; High Frequency Oscillatory Ventilation
Predictive models in Acute Respiratory Distress Syndrome
Epidemiology of critical care and critical illness
Physical Medicine and Rehabilitation in the Intensive Care Environment
Long-term physical, cognitive and mental health outcomes after critical illness
(http://www.hopkinsmedicine.org/pulmonary/research/outcomes_after_critical_illness_surgery/)
Mechanisms of resolution of acute lung injury and ARDS
Oxidant injury in acute lung injury and ARDS
Pulmonary endothelial antioxidant regulation
Endothelial barrier function
Regulational determinants of acute lung inflammation and repair
Regulatory T cells in Lung Injury and its Repair
Modulation of Alveolar Macrophage Innate Immune function during ARDS
Age-dependent lung immune responses in acute lung injury and ARDS
Chronic obstructive lung disease (COPD)
Large airway physiology
Pleural physiology
Critical Care Triage
Sleep and respiratory monitoring in the ICU
Extracorporeal Membrane Oxygenation (ECMO) for Acute Respiratory Failure

Locations

Johns Hopkins Hospital
600 North Broadway
Baltimore, Maryland� 21205

Johns Hopkins Bayview Medical Center
4940 Eastern Ave
Baltimore, MD 21224

Our Physicians

Roy G. Brower, M.D.
Professor of Medicine
Medical Director, MICU at Johns Hopkins Hospital
Acute Respiratory Distress Syndrome
Mechanical ventilation, high frequency ventilation
Lung-protective ventilation
Extra-corporeal membrane oxygenation (ECMO); extra-corporeal gas exchange

David Pearse, M.D.
Professor of Medicine
Medical Director, MICU at Johns Hopkins Bayview Medical Center
Endothelial barrier function regulation, pulmonary thromboembolism

Neil Aggarwal, M.D.
Instructor of Medicine
Acute lung injury, mechanisms of resolution

William Checkley, M.D., Ph.D.
Assistant Professor of Medicine
Acute Respiratory Distress Syndrome
Epidemiology of Critical Care

Franco R. D’Alessio, M.D.
Assistant Professor of Medicine
Immunological determinants of acute lung inflammation and repair
Regulatory T cells in Lung Injury and Repair
Modulation of Alveolar Macrophage Innate Immune response in ARDS
Age-dependent lung immune responses in acute lung injury and ARDS

Mahendra Damarla, M.D.
Assistant Professor of Medicine
ARDS
Ventilator induced lung injury
Sepsis
Molecular regulators of ARDS

Rachel Damico, M.D., Ph.D.
Assistant Professor of Medicine
Pulmonary vascular disease
Molecular determinants of vascular injury in pulmonary disease

Sanjay V. Desai, M.D.
Assistant Professor of Medicine
Long-term outcomes from critical care
Medical education

Gregory B. Diette, M.D., MHS
Asthma, COPD
Environmental Causes of Lung Disease

M. Brad Drummond, M.D.
Assistant Professor of Medicine
Chronic obstructive pulmonary disease (COPD)
HIV-associated lung diseases

David Feller-Kopman, M.D.
Associate Professor of Medicine
Director, Bronchoscopy & Interventional Pulmonology
Complex airway disease
Large airway physiology
Pleural physiology and disease
Percutaneous tracheostomy

David N. Hager, M.D., Ph.D.
Assistant Professor of Medicine
Associate Medical Director, Medical Intensive Care Unit
Acute Respiratory Distress Syndrome
Mechanical Ventilation
Critical Care Triage

Nadia Hansel, M.D., M.P.H.
Associate Professor of Medicine
Environmental and genetic determinants of asthma and COPD

Maureen R. Horton, M.D.
Associate Professor of Medicine
Acute lung injury and interstitial lung diseases

Christian Merlo, M.D., M.P.H.
Assistant Professor of Medicine and Epidemiology
Associate Program Director for Research and Scholarship�

Dale Needham, M.D., Ph.D.
Associate Professor of Medicine and of Physical Medicine and Rehabilitation
Physical Medicine and Rehabilitation in the ICU
Long-term physical, cognitive and mental health outcomes after critical illness

Naresh M. Punjabi, M.D., Ph.D.
Professor of Medicine and Epidemiology
Effect of intermittent hypoxia, sleep fragmentation, and sleep-disordered breathing on cardiovascular and metabolic outcomes

Alan Schwartz, M.D.
Professor of Medicine
Director, Center for Interdisciplinary Sleep Research and Investigation
Sleep and respiratory monitoring in the ICU
Respiratory control during sleep and anesthesia

Venkataramana Sidhaye, M.D.
Assistant Professor of Medicine
Lung epithelia biology
Innate immune responses

R. Scott Stephens, M.D.
Instructor of Medicine
Pulmonary endothelial antioxidant regulation
Acute Lung Injury
Extracorporeal Membrane Oxygenation (ECMO) for Acute Respiratory Failure

 

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