Critical Care Medicine

In the fall of 2024, the Department of Critical Care Medicine launched the Advanced Support Unit (ASU). The new hospital initiative is designed to provide specialized care for patients with advanced medical needs as they transition to end-of-life care. The eight-bed intermediate care unit supports patients requiring advanced medical interventions, such as mechanical ventilation and vasopressors, in a setting that prioritizes comfort and quality of life. By bridging the gap between intensive treatment and palliative support, the ASU addresses a crucial need for patients whose conditions are irreversible and who may not benefit from aggressive interventions. Karen Chen, M.D., chair ad interim of Critical Care Medicine, highlights that the development of this unit was driven by frontline staff, who recognized the importance of facilitating a compassionate transition to supportive care. Integral to this initiative, the Critical Care team collaborated closely in the design and implementation of the ASU, ensuring it meets the needs of both patients and families during challenging times. The unit is staffed by an interdisciplinary team, including physicians, nurses, social workers, and spiritual care providers, all dedicated to enhancing the overall experience for patients and their loved ones. Admission criteria include a consensus on terminal prognosis, the necessity for advanced monitoring and/or medical interventions, and the family’s acceptance to limiting escalation of care. The ASU's environment promotes peace and tranquility, featuring fewer alarms and ample space for family visits, along with access to counseling and bereavement services.  

Critical Care Medicine hosted its first hybrid World Sepsis Day Conference at MD Anderson, “Navigating Sepsis in Oncology: Innovations, Insights and New Directions.” Led and planned by Imrana Malik, M.D., the conference was organized in correlation with World Sepsis Day 2024 and included 11 engaging sessions focused on diverse and relevant oncological topics. The presentations included didactic lectures and patient stories. Objectives included improving how sepsis is prevented, diagnosed, treated, researched and how these topics impact patients with cancer. Conference sessions featured panel discussions and unique conversations such as using artificial intelligence in sepsis care and what can be done to enhance sepsis education in medical and nursing schools. Speakers presented virtually and in-person. The virtual environment hosted over 80 conference attendees and over 50 in-person attendees throughout the nine hours the event took place.  

Professor Joseph Nates, M.D., has made significant strides in advancing oncologic critical care collaboration within the department and across the globe. As the founder and president of the Global Society of Oncologic Critical Care (G-SOCC), he organized the inaugural congress in Panama City from April 16-20, 2024. This event brought together esteemed speakers, including division faculty members Raja Reddy, M.D., Alexander Reskallah, M.D., and Dilip Thakar, M.D.  Building on this momentum, Nates hosted the Second Global Symposium of the Oncologic Critical Care Research Network (ONCCC-R-NET) on June 13-14, 2024, which successfully engaged 1,500 registrants from 59 countries. This symposium aimed to foster a collaborative infrastructure for oncologic critical care research, featuring additional Anesthesiology, Critical Care and Pain Medicine division faculty Olakunle Idowu, M.D.; Raja Reddy, M.D.; Dilip Thakar, M.D.; Nisha Rathi, M.D.; and Mary Catherine Tolcher, M.D. Nates’ leadership and initiatives are instrumental in enhancing international collaboration on clinical care best practices and research, reflecting our division's commitment to improving outcomes for critically ill cancer patients worldwide. 

The following publications provide valuable insights into the critical care challenges faced by cancer patients and COVID-19 patients. In “Septic Shock in the Immunocompromised Cancer Patient: A Narrative Review,” Nates et al. explore the complexities of managing septic shock in this vulnerable group, highlighting important clinical considerations (Critical Care, 2024). In “Flow-Sizing Critical Care Resources,” Nates et al. also discuss effective resource allocation strategies to optimize care during high-demand situations (Critical Care Medicine, 2023). Cuenca et al. analyze long-term survival outcomes for cancer patients with sepsis and vasopressor requirements, emphasizing the prognostic significance of lactate levels (Critical Care Explorations, 2024). Reddy et al. provide crucial data on the clinical characteristics and mortality causes in hospitalized cancer patients with COVID-19 (Mayo Clinic Proceedings, 2023). Finally, Balasubramanian et al. investigate the impact of plasma volume status on outcomes in COVID-19-related ARDS, offering insights into fluid management (Journal of Critical Care, 2023). Together, these studies enhance our understanding of critical care dynamics for the featured patient populations.  

• Nates, Joseph L et al. “Septic shock in the immunocompromised cancer patient: a narrative review.” Critical care (London, England) vol. 28,1 285. 30 Aug. 2024, doi:10.1186/s13054-024-05073-0 

• Nates, Joseph L et al. “Flow-Sizing Critical Care Resources.” Critical care medicine vol. 51,11 (2023): 1552-1565. doi:10.1097/CCM.0000000000005967 

• Cuenca, John A et al. “Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels.” Critical care explorations vol. 6,4 e1070. 2 Apr. 2024, doi:10.1097/CCE.0000000000001070 

• Reddy, Dereddi Raja et al. “Clinical Characteristics and Cause of Death Among Hospitalized Decedents With Cancer and COVID-19.” Mayo Clinic proceedings vol. 98,3 (2023): 451-457. doi:10.1016/j.mayocp.2022.12.008 

• Balasubramanian, Prasanth et al. “Association of plasma volume status with outcomes in hospitalized Covid-19 ARDS patients: A retrospective multicenter observational study.” Journal of critical care vol. 78 (2023): 154378. doi:10.1016/j.jcrc.2023.154378