Demographics of Medical ICU Patients

[howelljolly]

I was wondering about the age range of patients in the ICU. I found info on Surgical ICUs, but not Medical

Im an MS-3 with a strong interest in CCM. I've worked in two CCU's. One was in a community hospital which had almost entirely nursing home resident, vent-dependent patients, and the extremely occasional 20-something y/o OD patient that was d/c once they started breathing on their own. The other was in a university affiliated hospital with a Level-1 Trauma center, a MedICU, CCU, SICU, PICU, and NICU, which saw all sorts of ages in the medical ICU.

Previous posters have said that there are plenty of critically ill middle aged patients, and that its not just old and dying people. I was wondering, what factors make for a wide span of ages in the Medical ICU? Is a wide span of ages the norm? Was my observation in the community hospital demographic not the norm? Is it probably the result of the demographics of the community it served?

The experience I had in the university program was so great that I am very strongly considering going in to PCCM. However, the other experience was a tiny bit discouraging.

Any friendly advice would be appreciated.

---

Members don't see this ad.

 

[Eidolon6]

Your observation that MICU demographics vary with community demographics is correct. If you are not working in a referral center, the variety you may see could be limited...especially if there is a high nursing home referral rate.

Indigent care populations and referral centers probably have the most interesting variety across age lines.

The factors you speak of that make for younger patient populations include things such as degree of social disease (drug/substance abuse, AIDS, poverty,obesity). Tertiary centers often capture the fascinating young patients with rare but potentially fatal diseases (meningitis, rare infections, unexplained organ failures, BMT patients, organ transplant patients, etc)

As for your perception of demographics....you probably shouldn't let it sway your career choice as you will get plenty of variety in training and the current job market is great for Pulm/CCM such that you can find jobs in large tertiary referral centers with multiple ICUs down to smaller community places where a since ICU/CCU is the norm and you are taking care of surgical, medical and neuro patients.

 

[howelljolly]

Thanks for the reply.

At the tertiary centers, is there often a "turf war"? Will a Pulm/CC not generally work with trauma or neuro patients?

Is it advisable to go for a specific Interventional Pulmonology program... either for the sake of bulking up the ol' CV, or for learning interventional procedeures that arent taught in your garden variety Pulm/CC program? I'd venture to guess and a PCCM program trains you well enough to do what you have to.... IABPs, Swans, etc.

 

[Eidolon6]

Interventional Pulmonology is growing and many programs are looking to add this to their training. It it not obligatory and a good percentage of the procedures you would learn you would not use in private practice unless you were to make IP a full-time affair...which requires a significant catchment area with a minimum of competition from other IP guys as interventional pulmonary procedures are not nearly as common as interventional GI or Cards. That being said....the ability to do perc trachs, EBUS, etc is a nice skillset.

As for trauma and surgical patients...most PCCM programs require multidisciplinary ICU exposure meaning you will likely get cross-training in these areas...but agreed...if you are in a tertiary referral center with specialized ICUs...you may get less exposure to these as an attending. That being said, our MICU takes the widest variety of patients in the hospital including massive non-hemorrhagic strokes, surgical overflow, some cardiac and post-transplant patients. Trauma also attempts dumps to the MICU with some frequency...but usually for failure to wean or medical complexity beyond their skillsets.

One thing to note....PCCM programs vary quite a bit from place to place and training is not nearly as standardized as residency...so be sure to look around as many have strengths in some aspects but not others...for example my program is very strong/heavy in critical care and has centers in Pulm HTN, ILD, CF, and transplant...but does very little interventional...which is frustrating but I have been able to garner some training from other sources.