Medical Intensive Care Unit
The Medical Intensive Care Unit (MICU) at Yale-New Haven Hospital (YNHH) is regarded as one of the region's elite ICUs and has developed into a major regional referral center. In March of 2010 the MICU moved into its new state of the art facilities on the 9th and 10th floors of the Smilow Cancer Hospital (North Pavilion) which contains 36 MICU beds alongside 15 step-down beds. The MICU admits 3000 patients per year including 350 patients from regional hospitals. The MICU has an average daily census of 34 critically ill patients with a wide range of life threatening disorders including septic shock, acute respiratory distress syndrome, and acute hepatic failure. Four teams cover the MICU, each led by a Pulmonary Critical Care and Sleep Medicine Faculty member working with a team of fellows, residents, and midlevel practitioners. In addition to PCCSM fellows and Internal Medicine residents, the MICU is a major training site for medical students, as well as residents and fellows from several departments, including Surgery, Emergency Medicine, and Obstetrics-Gynecology. The faculty lead collaborative work rounds seven days per week and conduct morning teaching conferences on weekdays. On noon every Friday there is an academic conference including a critical care journal club and the last week of the resident rotations is devoted to a monthly review of the care provided with an emphasis on augmenting quality and safety in an academic environment. MICU has an advanced ultrasound device for imaging and provides training in bedside echocardiography and use for guidance of procedures (thoracentesis, paracentesis, vascular access).
The MICU employs a variety of protocols to drive a high level of routine practice including low and high PEEP ARDSnet protocols, a spontaneous breathing protocol for ventilator weaning, an insulin infusion protocol for management of hyperglycemia and a novel protocol for management of severe alcohol withdrawal (MINDS). The MICU has several advanced therapies including combined MARS/CVVH (Molecular Adsorbents Recirculating System) for acute hepatic failure, an adult high frequency oscillator for severe hypoxemic respiratory failure, a cooling device for therapeutic hypothermia for both anoxic brain injuries and control of intracranial pressure in acute liver failure, and in conjunction with our cardiothoracic surgical service we offer ECMO therapy for refractory ARDS and cardiogenic shock. The MICU is the center for many avenues of clinical research, with multiple faculty conducting studies in acute lung injury, sepsis, cognitive impairment, diabetes, liver failure, and end-of-life care. The faculty have also collaborated to develop a sophisticated protocol to enroll patients with critical illness and obtain plasma specimens for a growing biorepository. Faculty have published many original research articles, editorials and scholarly reviews in highly respected journals, including The New England Journal of Medicine, The Lancet, Critical Care Medicine, Chest, Intensive Care Medicine, Shock, Respiratory Care and The American Journal of Respiratory and Critical Care Medicine. The MICU welcomes patient transfers at all times of the day or night. For additional information, please contact the MICU Director, Dr. Jonathan Siner at (203) 785-4177.