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Department of Anesthesiology

Day in the Life: CA-2 in the Intensive Care Units

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Alex

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By Alex Bui, M.D. (Baylor St. Luke’s ICU)

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If you want to challenge your knowledge of CV physiology and get used to patients near the end of their rope, this is the month for you! I don't believe you will see a higher level acuity ICU. From post lung and heart transplants, mechanical assist devices (ECMO, VADs, Impellas, balloon pumps), I saw patients pushing to extraordinary limits and live to tell the tale.

Our teams are made up of CV and ICU fellows, residents, and advanced care practitioners. Overall takeaways of the rotation include principals of acute right and left heart failure, weaning from ECMO and VADs, and interpretation of PA catheters. During the day, the team splits the patients, and we work closely with the advanced heart failure team which we can learn a lot from. However, on nights, you will generally cover the ICU floor solo as the attending watches the CV recovery patients fresh from the OR many floors away.

I have had patients code on induction on the floor, doing CPR while crashing on ECMO at the bedside. These are the kinds of wild things you will experience at SLICU where there is no shortage of adrenaline.

Alex

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By Alex Bui, M.D. (MD Anderson Surgical ICU)

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MD Anderson brings a unique patient population to our residency program that will not be seen anywhere else in the world. We are based in the surgical ICU side with typical postoperative ICU care, however what makes this special are the complexities of their medical disease. Nearly every patient is on some type of experimental chemo/therapy such as genetically engineered T-cell therapy, cancer-targeted viral inoculating infusions, therapeutic plasmapheresis, and much more.

Along with these come with rare complications such as chemo induced PRES syndrome, fungal and multi-microbial sepsis, and CART syndrome just to name a few. This is an open unit commonly with general medicine or leukemia/lymphoma folks that definitely leave the critical care medicine to us. From performing POCUS with our anesthesia CCM faculty, intubations, central access, bronchoscopies; we call the shots.

Cancer patients just generally bring a sense of gratitude for our service. These patients come to MD Anderson from around the world and it is an honor to partake in their care.