Pulmonary and Critical Care Medicine

Medical Intensive Care Unit (MICU)

The Medical Intensive Care Unit (MICU) cares for patients with a wide variety of serious medical illnesses. These patients present complex, comorbid conditions from sepsis to pneumonia, acute respiratory distress syndrome to multiple organ failure.

Each year, Mass General’s Medical Intensive Care Unit (MICU) treats approximately 1,200 severely ill patients using a collaborative, multidisciplinary approach to care. A multidisciplinary team provides the depth and breadth of knowledge and expertise required to care for the wide array of illnesses and complex, multiple conditions seen in the MICU.

The unit is staffed by attending physicians who are triple board certified in internal medicine, pulmonary medicine and critical care. They provide 24/7 coverage with assistance from fellows and residents. Approximately 65 nurses, including a clinical nurse specialist, work in the MICU. MICU nurses have received advanced training in critical care nursing, and many have received additional degrees and certifications including as nurse anesthetists and nurse practitioners.

Joining the pulmonary intensivists and nurses on the multidisciplinary team are:

  • Respiratory therapists
  • Clinical pharmacists
  • Clinical nutritionists
  • Physical, occupational and speech therapists
  • Social workers
  • Case managers
  • Chaplains

The 18-bed MICU, with its broad expertise caring for a variety of medical conditions, also admits patients from other ICUs when units such as cardiology or neurology are full. Standards of care established by the Critical Care Center help ensure that patients receive optimum, coordinated care regardless of which ICU they are assigned to.

What to Expect

The MICU is a Patient-Centered ICU and as such, families are always welcome at their loved one's bedside. After a 2005 in-house study, the MICU eliminated visiting hours so the ICU is open to families 24/7. The MICU also began a practice called “family presencing.” This enables family members to stay in the patient’s room at all times, even during a serious emergency such as a cardiac arrest. In emergencies a MICU nurse stays with the family to provide information and reassurance.

Patients, to the extent they are able, and their families participate in all discussions and decisions about their care. Because of the variety of conditions and illnesses in the MICU, length of stay varies from hours to months.

A Leader During the H1N1 Crisis

Mass General’s MICU was the designated recipient of New England’s most severely ill H1N1 patients during the influenza pandemic of 2009-2010. The MICU offers life-saving extra-corporeal membrane oxygenation (ECMO) therapy and is an expert in the care of acute respiratory distress syndrome (ARDS). Regionally, other hospitals routinely transfer patients to the MICU for specialty care.

Attention to Quality and Safety

Mass General maintains strict standards for quality and safety. The MICU regularly scores at or near 100% compliance with established procedures that are measured on a daily basis. Critical care standards have significantly reduced the number of bloodstream infections caused by central venous catheters and reduced the incidence of ventilator-associated pneumonia.

Sharing Best Practices

At the height of the H1N1 pandemic, the MICU served as a resource for New England community hospitals. MICU staff developed and shared best practices in early care of H1N1 patients and protocols for transfer to Mass General. When a small number of H1N1 cases began to resurface in 2010-2011, MICU leaders reached out again to offer advice and assistance.

Contributing to the Understanding of Critical Illness

MICU physicians, all faculty members at Harvard Medical School, regularly conduct research and enroll their patients in clinical trials. One project of note attempts to understand the basis of critical illness. Specifically, the study aims to identify the genetic differences between, for example, pneumonia patients who recover at home and those whom require hospitalization in intensive care. MICU physicians have participated in research discoveries of genes involved in respiratory illness and septic shock.

Training Critical Care Specialists and Nurses

Assignments in the MICU are an important part of a fellow or resident’s medical training. The MICU is a primary training site for the Harvard Combined Pulmonary and Critical Care Fellowship, where fellows receive excellent exposure to a variety of complex illnesses and comorbid conditions. Nurses receive extensive critical care education through a 12-week MICU orientation program, as well as other training opportunities. For continuing education of the existing staff, MICU physicians and nurses attend conferences, conduct research, and collaborate with colleagues at other major teaching hospitals and organizations like the Centers for Disease Control.

Enhancing the patient and family experience

Local artist donates prints to the MGH Medical Intensive Care Unit (MICU) waiting room.