CVICU: Fellows are assigned to this rotation for 3 blocks in each year of training and can choose additional elective time. The CVICU is a 36-bed unit staffed at all times by Critical Care faculty from the Department of Anesthesiology. This rotation provides exposure to the evaluation and management of a variety of patients with cardiovascular surgery, heart and lung transplant, mechanical assist devices, and other critical illnesses. In addition, the fellow will gain significant experience with ECMO and innovative cardiovascular surgical procedures.  Fellows are involved in presenting at Journal Club and case presentations in addition to didactic lectures based on ICU topics.

MICU: Fellows are assigned to this rotation for 2 months in each year of training and can choose additional elective time. The MICU at Houston Methodist Hospital is a 24-bed unit staffed at all time by Critical Care and Pulmonary/Critical Care faculty and nurse practitioners.  Internal Medicine and prelim-residents and medical students rotate through the unit in addition to fellows. Patients present with a wide variety of conditions including sepsis, respiratory failure, pre- and post- lung transplant illness, acute and chronic renal failure, neuromuscular disease, hyperglycemic crises, malignancies and others. Fellows are responsible for direct patient care as well as supervision of residents and medical students. Procedures include endotracheal intubation, central venous lines (including hemodialysis catheters), arterial lines, bronchoscopy, paracentesis, percutaneous tracheostomy, and others. Multidisciplinary rounds are held each morning with a team that includes pharmacists, respiratory therapists, chaplains, dieticians, nurses and bioethics representatives.

CICU: Fellows are assigned to this rotation for 1 block in each year of training and can choose additional elective time. The CICU is a 32-bed unit staffed by Critical Care and Heart Failure faculty from the Department of Cardiology. This rotation provides exposures to the evaluation and management of a variety of patients with cardiovascular issues such as heart failure, myocardial infarction, atrial and ventricular arrhythmias, pre-heart transplant, mechanical circulatory support, and mixed shock. In addition, fellows will insert pulmonary arterial catheters and perform other crucial critical care related procedures. Fellows will rotate with the "Blue" academic team, and the "Red" non-academic team.

NICU: Fellows are assigned to this rotation for 1 block in each year of training and can choose additional elective time. The NICU is a 36-bed unit staffed by Critical Care faculty from the Department of Anesthesiology. The NICU serves patients with diseases and conditions of the brain, spinal cord, and nerves. Fellows have significant exposure to neurosurgical procedures, neuromonitoring, acute stroke, intracranial hemorrhage, innovative interventional neuroradiology procedures, brain death and organ donation.

SLICU: Fellows are assigned to this rotation for 1 block in each year of training and can choose additional elective time. The SICU is a 34-bed unit staffed by Critical Care faculty from the Department of Surgery and nurse practitioners. The SICU serves a diverse group of patients including critically ill general, vascular, oncologic, transplant, orthopedic, plastic, urologic, and head and neck surgical patients. The rotation includes significant exposure to patients with decompensated liver disease as well as pre- and post- liver transplant patients.

Virtual ICU: Fellows are assigned to this rotation for 1 block in each year of training and can choose additional elective time. The Houston Methodist Virtual ICU supports multiple satellite institutions and provides virtual critical care support. Fellows will work with Virtual ICU attendings to monitor the vitals and activity of multiple ICU's spread across the Houston Methodist Hospital System.

ECMO: Fellows are assigned to this rotation for 1 block in each year of training and can choose additional elective time. The ECMO rotation will familiarize fellows with ECMO management, from patient selection to cannulation at bedside or the OR, day-to-day management and troubleshooting, and de-cannulation. Patients will work directly with an ECMO certified faculty member as well as the Cardiothoracic Surgery service.

Critical Care Recovery Clinic: Fellows are assigned to this rotation for 1 block in each year of training and can choose additional elective time. The CCRC will allow fellows to follow patients that have been discharged from a lengthy ICU stay and support their recovery in an outpatient setting. They will be involved in activities such as tracheostomy management, medication list adjustments, assessment of physical and mental health, and more.

Elective Rotations

Research: Fellows will take this block to work on academic output, including case reports, series, retrospective studies, meta-analysis and systematic reviews. Other options include being involved in CMPI committees and quality improvement projects system wide.

Procedures: Fellows will take this block to rotate around the hospital performing procedures such as hemodialysis catheter placement, central line, arterial line, intubation, bronchoscopy (diagnostic and therapeutic), thoracentesis, chest tube insertion, indwelling pleural catheter placement, percutaneous tracheostomy, ECMO cannulation as appropriate.

Interventional Pulmonology: Fellows will participate in evaluating patients and performing advanced bronchoscopic techniques (EBUS, navigational bronchoscopy, rigid bronchoscopy, central airway obstruction stenting, tumor coring, laser therapy, cryotherapy, APC therapy) under the supervision of a board-certified interventional pulmonologist.

Anesthesia: Fellows will rotate through the OR's and endoscopy suites with the anesthesiologists, performing intubations with direct and video laryngoscopes. 

Other: Throughout the fellowship, fellows are welcome to approach leadership to create new rotations in critical care topics they are interested in.