The University of Wisconsin Medical Intensive Care Unit (MICU) is a unique, high-acuity, intensive care unit known for consistently surpassing national leading benchmarks in patient care quality and outcomes. 

The Critical Care Service (CCS) combines residents, fellows, nurse practitioners and faculty from a variety of disciplines. Given the dynamic and challenging nature of the CCS, we created this page as an introduction and learning resource for our rotating students, residents, and fellows. We encourage you to learn from each other and to appreciate the perspective and expertise each of our distinct disciplines bring.

The MICU is proud to be a truly multidisciplinary unit. Our great outcomes are only possible because of the collaborative model among the many disciplines; medicine, anesthesia, infectious disease, surgery, nursing, respiratory care, pharmacy, nutrition, physical and occupational therapy, speech therapy, and social work. We know you will receive excellent guidance and education from working with all.

Faculty and Staff

View list of faculty

Video Series

Educational Resources

Landmark Articles

These are seminal articles in critical care that comprise the most established evidence base that informs our care of the critically ill patient. Every learner should have strong familiarity with these studies upon rotating through the TLC.

Core Articles   |   Key Articles

Core Articles

Sepsis/ Resuscitation

  • The ProCESS Investigators. A Randomized Trial of Protocal-Based Care for Early Septic Shock, NEJM 2014
  • Rivers E Nguyen B, et al. Early Goal Directed Therapy in Severe Sepsis and Septic Shock NEJM 2001:345:1368-1377
  • Dellinger RP, Levy MM et al. Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock 2012 Crit Care Med 2013
  • Kumar A, Roberts D, et al. Duration of Hypotension Before Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Crit Care Med 2006;34:1589-1596
  • Debaker D, Biston P et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock NEJM 2010;362:779-89
  • Russel JA et al Vasopressin Versus Norepinephrine Infusion in Patients with Septic Shock NRJM 2008;358:877-87
  • The Safe Study Investigators A Comparison of Albumin and Saline for Fluid Resuscitation in ICU NEJM 2004;350:2247-56
  • Sprung C, et al Hydrocortisone Therapy for Patients with Septic Shock NEJM 2008;358:111-24
  • Annane D, et al Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock JAMA 2002;288:862-871

ARDS / Ventilator Strategies / Weaning

  • The National Heart, Lung and Blood Institute ARDS Clinical Trails Network. Comparison of Two Fluid-Management Strategies in Acute Lung Injury. NEJM 2006
  • Claude Guerin, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. NEJM 2013
  • Laurent Papazian, et al. Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome. NEJM 2010
  • McIntyre NR, er al. Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support: A Collective Taskforce facilitated by ACCP, AARC, ACCCM Chest 2001;120:375S-396S
  • Ware LB, Matthay MA The Acute Respiratory Distress Syndrome NEJM 2000;342:1334-1350
  • ARDSNET Group Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury NEJM 2001;342:1301-8
  • Kress, et al Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation NEJM 2000;342:1471-1477
  • E. Wesley Ely, et al. Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously. NEJM 1996
  • Karl Yang, et al. A Prospective Study of Indexes Predicting the Outcome of Trials of Weaning from Mechanical Bentilation. NEJM 1991
  • Timothy Girard, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. The Lancet 2008

General ICU

  • Lawrence KL, Kollef MH Antimicrobial Stewardship in the ICU Am J Resp Crit Care Med 2009;179:434-438
  • Ogrady NP, Barie PS et al. Guidlines for the Evaluation of Fever in the ICU Crit Care Med 2008;36:1330-1349
  • NICE-SUGAR Study Investigators Intensive Versus Conventional Glucose Control in Criticaly Ill Patients NEJM 2009;360:1283-1297
  • Martindale RG et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: SCCM and ASPEN: Executive Summary CCM 2009;37:1757-1761

Transfusions

  • Napolitano J, et al. Clinical Practice Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care CCM 2009;37:3124-3157
  • Candid Villanueva, et al. Transfusion Strategies for Acute Upper Gastrointestinal Bleeding. NEJM 2013
  • Paul Hebert et al. A multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care. NEJM 1999.

Acute Kidney Injury

  • Uchino S, et al Acute Renal Failure in Critically Ill patients: A Multinational, Multicenter Study JAMA 2005;294:813-818
  • Stefan J, Eckart K Renal replacement strategies in the ICU Chest 2007;132:1379-1388

Brain Injury / Death and Therapeutic Hypothermia

  • The Hypothermia after Cardiac Arrest Study Group. Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. NEJM 2002
  • Christopher Booth, et al. Is this Patient Dead, Vegetative, or Severely Neurologically Impaired? Assessing Outcome for Comatose Survivors of Cardiac Arrest. The Rational Clinical Examination, 2004.

Key Articles

Glucose

  • Weiner RS, Weiner DC, Larsen RJ Benefits and Risks of Tight Glucose Control in Critically Ill Patients: a Meta-Analysis JAMA 2008;300:933-944
  • Van den Berghe, P et al Intensive Insulin Therapy in Critically Ill Patients NEJM 2001;345:1359-1367
  • Fahy BG, Sheehy A, Coursin DB Glucose control in the ICU CCM 2009;37:1769-1776
  • NICE-SUGAR Study Investigators Intensive Versus Conventional Glucose Control in Criticaly Ill Patients NEJM 2009;360:1283-1297
  • Inzucchi SE, Siegal MD Glucose Control in ICU - How Tight is Too Tight (Editorial to NICE-SUGAR) NEJM 2009;360:1346-1349

Sepsis

  • Rivers E et al. Early Goal Directed Therapy in Severe Sepsis and Septic Shock NEJM 2001:345:1368-1377
  • Dellinger RP et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock N Eng J Med 2008;36:296-327
  • Efficacy and Safety of Recombinant Activated Protein C for Severe Sepsis NEJM 2001:344:699-708
  • Kumar A, Roberts D et al. Duration of Hypotension Before Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Septic Shock CCM 2008;36:1937-1949
  • Hotchkiss RS, Karl IE The Pathophysiology and Treatment of Sepsis NEJM 2003; 348:138-150
  • Hotchkiss RS, Opal S Immunotherapy for Sepsis - A New Approach against an Ancient Foe NEJM 2010;363:87-89
  • Marik, PE Pastores SM Recommendations for the Diagnosis and Management of CSI in Critically Ill Adult Patients: Consensus Statement from ACCCM CCM 2008;36:1937-1949
  • Annane D, Bellisasant, et al Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in Adults: a Systematic Review JAMA 2009;301:2388-2390
  • Kolleff MH et al Inadequate Antimicrobial Treatment of Infections Chest 1999;115:462-474
  • Bernard GR et al Efficacy and safety of recombinant human activated protein C for severe sepsis NEJM 2001:344:699-709
  • Abraham R et al Drotrecogin Alfa for Adults with Severe Sepsis and a Low Risk of Death (ADDRESS) NEJM 2005;353:1332-41

Acute Cardiac Issues / Hemodynamic Monitoring

  • Rennyson SL, Hunt J, et al. Electrocardiographic ST-Segment elevation myocardial infarction in critically ill patients: An observational cohort analysis CCM 2010 38:2304-2309
  • Kanji S, et al Treatment of new-onset atrial fibrillation in noncardiac intensive care unit patients" A systematic review of randomized control trials Crit Care Med 2008:1620-1624
  • Madger, S Central venous pressure: A useful but not so simple measurement Crit Care Med 2006;34:2224-2227
  • Pinsky MR Hemodynamic evaluation and monitoring in the ICU Chest 2007;132:2020-2029
  • Shah MR et al. Impact of the Pulmonary Artery Catheter in Critically Ill Patients JAMA 2005;294:1664-1670

Vasopressors

  • Debaker Comparison of Dopamine and Norepinephrine in the Treatment of Shock NEJM 2010;362:779-89
  • Morelli A et al, Phenylephrine versus norepinepnrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial Crit Care 2008, available online
  • Russel JA et al Vasopressin Versus Norepinephrine Infusion in Patients with Septic Shock NRJM 2008;358:877-87
  • AZNICS Group Low dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial Lancet 2000;356:2139-43
  • Annane D, et al Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock a randomised trial Lancet 2007;370:676-84

GI Bleeding

  • Garcia-Tsao G, Bosch J Current Concepts in Management of Variceal Bleeding and Variceal Hemorrhage in Cirrhosis N Eng J Med 2010;362:823-32

ARDS / Hypoxemic Salvage Therapies

  • Sud, S Sud, M et al High Frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systemic review and meta-analysis BMJ 2010;340:c2327
  • Diaz JV, Brower R, et al Therapeutic Strategies for severe acute lung injury CCM 2010;38:1644-1650
  • Esan et al. Severe Acute Hypoxemic Respiratory Failure: Part 1 - Ventilatory Strategies Chest 2010;137:1203-1216
  • Raoof et al. Severe Acute Hypoxemic Respiratory Failure: Part 2 - Nonventilatory Strategies Chest 2010;137:1437-1448
  • ARDSNET Comparison of Two Fluid Management Strategies in Acute Lung Injury NEJM 2006;354:2564-75
  • Herridge et al. One Year Outcome in Survivors of ARDS NEJM 2003;348:683-693
  • Meade MO et al Ventilation Strategy Using Low Tidal Volumes, Recruitment Maneuvers, and High Positive End-Expiratory Pressure for Acute Lung Injury and Acute Respiratory Distress Syndrome A Randomized Control Trial JAMA 2008;299:637-645
  • ARDSNET Higher verses Lower Positive End-Expiratory Pressures in Patients with Acute Respiratory Distress Syndrome NEJM 2004;351:327-36
  • Griffiths NRCP, Evans TW Inhaled Nitric Oxide Therapy in Adults NEJM 2005;353:2683-2695
  • Gattinoni L et al Effect of Prone Positioning on the Survival of Patients with Acute Respiratory Failure NEJM 2001;345:568-73
  • McIntyre NR, er al. Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support: A Collective Taskforce facilitated by ACCP, AARC, ACCCM Chest 2001;120:375S-396S
  • Ware LB, Matthay MA The Acute Respiratory Distress Syndrome NEJM 2000;342:1334-1350
  • ARDSNET Group Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury NEJM 2001;342:1301-8

Transfusions / HIT / Epo

  • Napolitano J, et al. Clinical Practice Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care CCM 2009;37:3124-3157
  • Hebert PC et al A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care (TRICC Trial) NEJM 1999;340:409-17
  • Koch CG et al Duration of Red Cell Storage and Complications after Cardiac Surgery NEJM 2008;358:1229-39
  • Mater. SA et al Efficacy and Safery of Recombinant Activated Factor VII For Acute Intracerebral Hemorrhage NEJM 2008;358:2127-37
  • Corwin HL et al Efficacy and Safety of Epoetin Alfa in Critically Ill patients NEJM 2007;357:965-76
  • Wartekin TE et al Treatment and Prevention of Heparin-Induced Thrombocytopenia ACCP Evidence Based Clinical Practice Guidelines Chest 2008;133:340S-380S

Steroids in Sepsis

  • Sprung C, et al Hydrocortisone Therapy for Patients with Septic Shock NEJM 2008;358:111-24
  • Annane DJ et al Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in Adults: A Systematic Review JAMA 2009;301:2362-2375
  • Marik, PE Critical Illness-Related Corticosteroid Insufficiency Chest 2009;135:181-193
  • Annane D et al Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock JAMA 2002;288:862-871

Ventilators / VAP

  • Terragani PP, et al Early vs Late Tracheostomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients: A Randomized Controlled Trial JAMA 2010;303:1483-1489
  • Kress, et al Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation NEJM 2000;342:1471-1477
  • Chastre J et al Comparison of 8 vs 15 Days of Antimibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial JAMA 2003;290:2588-2598
  • Muscedere J et al Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Prevention J of Crit Care 2008;23:126-137
  • Muscedere J et al Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Diagonosis and Treatment J of Crit Care 2008;23:138-147
  • Canadian Clinical Trials Group A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia NEJM 2006;355:2619-30
  • Aarts MW et al Empiric antibiotic therapy for suspected ventilator-associated pneumonia: A systematic review and meta-analysis of randomized trials CCM 2008;36:108/117
  • Esteban A et al A Comparison of Four Methods of Weaning Patients from Mechanical Ventilation NEJM 1995;332:345-50
  • Fan E et al Recruitment Maneuvers for Acute Lung Injury Am J Resp Crit Care Med 2008;178:1156-1163
  • McIntyre NR et al Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support: A Collective Taskforce Chest 2001;120:375S-396S

Nutrition

  • Ziegler, TR Parenteral Nutrition in the Critically Ill Patient NEJM 2009;361:1088-97
  • Martindale RG et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: SCCM and ASPEN: Executive Summary CCM 2009;37:1757-1761
Websites

Hemodynamic Monitoring

Presentations / Cases

Journals

Procedure Videos from New England Journal of Medicine