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Pediatric Critical Care Fellowship

The Division of Pediatric Pharmacology and Critical Care

The Division of Pediatric Critical Care at University Hospitals Rainbow Babies & Children’s Hospital/Case Western Reserve University trains nationally recognized specialists in the field who are accomplished clinicians, educators and researchers. Our specialists in the Pediatric Intensive Care Unit (PICU) at UH Rainbow Babies & Children’s Hospital use their expertise in conventional and evolving ventilatory strategies, renal replacement therapies, nitric oxide and ECMO to provide care for our patients. Very active programs in neurosurgery, bone marrow transplantation, trauma, epileptology, craniofacial reconstruction, otolaryngology, sedation, pediatric pain services and palliative care are some examples of the full complement of services we provide for our patients. Our unit design and award-winning nursing staff help us to provide the highest standard of family-centered care to our patients.

Faculty

Our faculty includes twelve Pediatric Intensivists and Pediatric Cardiac Intensivists that mentor our Fellows. Close relationships with faculty from other Divisions provide additional scholarly oversight to our Fellows.

UH Rainbow is one of the most well-funded research institutions in the country (ranked #7 in 2016 among medical school-based pediatrics departments), and our division is active in many areas of research. Research and clinical interests of our faculty include acute respiratory failure, global health, conventional and evolving ventilatory strategies, post-intensive care outcomes, health disparities, head trauma, medical education, infectious disease, disaster management, administration and ECMO.

Selected Publications

Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-346.

Yehya N, Harhay MO, Klein MJ, Shein SL, et al. Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study. Crit Care Med. 2020;48(6):e514-e522.

González-Dambrauskas S, Vásquez-Hoyos P, Camporesi A, et al. Pediatric Critical Care and COVID19 [published online ahead of print, 2020 Jun 9]. Pediatrics. 2020

Rowan CM, Klein MJ, Hsing DD, et al. Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study. Am J Respir Crit Care Med. 2020;201(11):1389-1397

Kudchadkar SR, Nelliot A, Awojoodu R, et al. Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States. Crit Care Med. 2020;48(5):634-644.

Kulkarni M, Slain KN, Rotta AT, Shein SL. The Effects of Furosemide on Oxygenation in Mechanically Ventilated Children with Bronchiolitis. J Pediatr Intensive Care. 2020;9(2):87-91.

Kamat PP, McCracken CE, Simon HK, et al. Trends in Outpatient Procedural Sedation: 2007-2018. Pediatrics. 2020;145(5):e20193559

Abulebda K, Srinivasan S, Maa T, Stormorken A, Chumpitazi CE. Development, Implementation, and Evaluation of a Faculty Development Workshop to Enhance Debriefing Skills Among Novice Facilitators. Cureus. 2020;12(2):e6942. Published 2020 Feb 10.

Rotta AT, Alves PM, Nerwich N, Shein SL. Characterization of In-Flight Medical Events Involving Children on Commercial Airline Flights. Ann Emerg Med. 2020;75(1):66-74.

Carter MR, Khan AH, Salman T, Speicher R, Rotta AT, Shein SL. Emergency room endotracheal intubation in children with bronchiolitis: A cohort study using a multicenter database. Health Sci Rep. 2020;3(3):e169.

Mitchell LJ, Mayer CA, Mayer A, et al. Caffeine prevents prostaglandin E1-induced disturbances in respiratory control in neonatal rats: implications for infants with critical congenital heart disease. Am J Physiol Regul Integr Comp Physiol. 2020;319(2):R233-R242.

Toltzis P. Tight glycemic control in critically ill children. J Pediatr. 2020;218:1-4.

Woods-Hill CZ, Koontz DW, King AF, et al. Practices, Perceptions, and Attitudes in the Evaluation of Critically Ill Children for Bacteremia: A National Survey. Pediatr Crit Care Med. 2020;21(1):e23-e29.

Mount M, Toltzis P. 50 Years Ago in The Journal of Pediatrics: Aspirin and Reye Syndrome. J Pediatr. 2020;222:192

Miller KE, Coleman RD, Eisenberg L, Henriksen J, Lantos JD, Weiss EM. Unilateral Withdrawal of Life-sustaining Therapy in a Severely Impaired Child.Pediatrics. 2018;142(5):e20180131.

Miller KE, Toltzis P. Finding the Right Ethical Framework for PICU Resource Allocation During a Pandemic [published online ahead of print, 2020 May 27]. Pediatr Crit Care Med. 2020

Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020;21(2):e52-e106.

Friedman ML, Barbaro RP, Bembea MM, et al. Mechanical Ventilation in Children on Venovenous ECMO. Respir Care. 2020;65(3):271-280.

Mallory P, Cheifetz I. A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Rev Respir Med. 2020;14(3):307-315.

Moffet JR, Mahadeo KM, McArthur J, et al. Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study. Bone Marrow Transplant. 2020;55(2):341-348.

Kneyber MCJ, Cheifetz IM, Curley MAQ. High-frequency oscillatory ventilation for PARDS: awaiting PROSPect. Crit Care. 2020;24(1):118. Published 2020 Mar 27.

Straube T, Cheifetz IM, Jackson KW. Extracorporeal Membrane Oxygenation for Hemodynamic Support. Clin Perinatol. 2020;47(3):671-684.

Gertz SJ, McArthur J, Hsing DD, et al. Respiratory pathogens associated with intubated pediatric patients following hematopoietic cell transplant Transpl Infect Dis. 2020.

Gehlbach JA, Miller AG, Hornik CP, Cheifetz IM. Dead Space to Tidal Volume Ratio Is Associated With Higher Postextubation Support in Children Respir Care. 2020.

Slain KN, Shein SL. High Flow, High Flow: It's Off to Work We Go. Pediatr Crit Care Med. 2019 Mar;20(3):292-293.

Clayton JA, McKee B, Slain KN, Rotta AT, Shein SL. Outcomes of Children With Bronchiolitis Treated With High-Flow Nasal Cannula or Noninvasive Positive Pressure Ventilation. Pediatr Crit Care Med. 2019 Feb;20(2):128-135.

Slain KN, Rotta AT, Martinez-Schlurmann N, Stormorken AG, Shein SL. Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria. Pediatr Crit Care Med. 2019 Feb;20(2):e70-e76.

McCluskey CK, Allareddy V, Rampa S, Allareddy V, Rotta AT. Characterization of Suicide and Deliberate Self-Harm Among Children in the United States. Clin Pediatr (Phila). 2019 Jan;58(1):66-72.

Slain KN, Shein SL, Stormorken AG, Broberg MCG, Rotta AT. Outcomes of Children With Critical Bronchiolitis Living in Poor Communities. Clin Pediatr (Phila). 2018 Aug;57(9):1027-1032.

Miller KE, Coleman RD, Eisenberg L, Henriksen J, Lantos JD, Weiss EM. Unilateral Withdrawal of Life-Sustaining Therapy in a Severely Impaired Child. Pediatrics. 2018 Nov;142(5

Shein SL, Kong M, McKee B, O'Riordan M, Toltzis P, Randolph AG. Antibiotic Prescription in Young Children With Respiratory Syncytial Virus-Associated Respiratory Failure and Associated Outcomes. Pediatr Crit Care Med. 2019 Feb;20(2):101-109.

O'Connell P, Gaston B, Bonfield T, Grabski T, Fletcher D, Shein SL. Periostin Levels in Children Without Respiratory Disease. Pediatr Pulmonol. 2019 Feb;54(2):200-204.

Shein SL, Hotz J, Khemani RG. Derivation and Validation of an Objective Effort of Breathing Score in Critically Ill Children. Pediatr Crit Care Med. 2019 Jan;20(1):e15-e22.

Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, Yehya N, Willson D, Kneyber MCJ, Lillie J, Fernandez A, Newth CJL, Jouvet P, Thomas NJ; Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Lancet Respir Med. 2019 Feb;7(2):115-128.

Randolph AG, Xu R, Novak T, Newhams MM, Bubeck Wardenburg J, Weiss SL, Sanders RC, Thomas NJ, Hall MW, Tarquinio KM, Cvijanovich N, Gedeit RG, Truemper EJ, Markovitz B, Hartman ME, Ackerman KG, Giuliano JS Jr, Shein SL, Moffitt KL; Pediatric Intensive Care Influenza Investigators from the Pediatric Acute Lung Injury and Sepsis Investigator’s Network .Clin Infect Dis. 2019 Jan 18;68(3):365-372.

Shein SL. Dexmedetomidine During Noninvasive Ventilation: Different Acuity, Different Risks? Pediatr Crit Care Med. 2018 Apr;19(4):373-375.

Shein SL, Farhan O, Morris N, Mahmood N, Alter SJ, Biagini Myers JM, Gunkelman SM, Kercsmar CM, Khurana Hershey GK, Martin LJ, McCoy KS, Ruddy JR, Ross KR. Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository. Hosp Pediatr. 2018 Jan 5.

Clayton JA, Toltzis P. Recent Issues in Pediatric Clostridium difficile Infection. Curr Infect Dis Rep. 2017 Nov 7;19(12):49.

Shein SL, Rotta AT, Speicher R, Slain KN, Gaston B. Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma. Hosp Pediatr. 2017 Jun 15.

Shein SL, Slain K, Martinez Schlurmann N, Speicher R, Rotta AT. Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions. Hosp Pediatr. 2017 May;7(5):263-270

Slain KN, Martinez-Schlurmann N, Shein SL, Stormorken A. Nutrition and High-Flow Nasal Cannula Respiratory Support in Children With Bronchiolitis. Hosp Pediatr. 2017 May;7(5):256-262.

Shein SL, Rotta AT. Sedation and Subglottic Stenosis in Critically ill Children. J Pediatr (Rio J). 2017 Mar 19.

Cocoros NM, Priebe GP, Logan LK, Coffin S, Larsen G, Toltzis P, Sandora TJ, Harper M, Sammons JS, Gray JE, Goldmann D, Horan K, Burton M, Checchia PA, Lakoma M, Sims S, Klompas M, Lee GM. A Pediatric Approach to Ventilator-Associated Events Surveillance. Infect Control Hosp Epidemiol. 2017 Mar;38(3):327-333.

Bradley JS, Armstrong J, Arrieta A, Bishai R, Das S, Delair S, Edeki T, Holmes WC, Li J, Moffett KS, Mukundan D, Perez N, Romero JR, Speicher D, Sullivan JE, Zhou D. Phase I Study Assessing the Pharmacokinetic Profile, Safety, and Tolerability of a Single Dose of Ceftazidime-Avibactam in Hospitalized Pediatric Patients. Antimicrob Agents Chemother. 2016 Sep 23;60(10):6252-9.

Gall C, Wetzel R, Kolker A, Kanter RK, Toltzis P. Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds. Crit Care Med. 2016 Sep;44(9):1762-8.

Shein SL, Speicher RH, Filho JO, Gaston B, Rotta AT. Contemporary Treatment of Children with Critical and Near-Fatal Asthma. Rev Bras Ter Intensiva. 2016 Jun;28(2):167-78.

Shein SL, Gallagher JT, Deakins KM, Weinert DM. Prophylactic Use of Nebulized Hypertonic Saline in Mechanically Ventilated Children: A Randomized Blinded Pilot Study. Respir Care. 2016 May;61(5):586-92.

Miller Ferguson N, Shein SL, Kochanek PM, Luther J, Wisniewski SR, Clark RS, Tyler-Kabara EC, Adelson PD, Bell MJ. Intracranial Hypertension and Cerebral Hypoperfusion in Children With Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults.

Pediatr Crit Care Med. 2016 May;17(5):444-50.

Shein SL, Ferguson NM, Kochanek PM, Bayir H, Clark RS, Fink EL, Tyler-Kabara EC, Wisniewski SR, Tian Y, Balasubramani GK, Bell MJ. Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury--Results From an Automated Data Collection System Time-Synched to Drug Administration. Pediatr Crit Care Med. 2016 Mar;17(3):236-45.

Das A, Anderson IM, Speicher DG, Speicher RH, Shein SL, Rotta AT. Validation of a Pediatric Bedside Tool to Predict Time to Death after Withdrawal of Life Support. World J Clin Pediatr. 2016 Feb 8;5(1):89-94.

Shein SL, Li H, Gaston B. Blood Eosinophilia is Associated with Unfavorable Hospitalization Outcomes in Children with Bronchiolitis. Pediatr Pulmonol. 2016 Jan;51(1):77-83.

Cocoros NM, Kleinman K, Priebe GP, Gray JE, Logan LK, Larsen G, Sammons J, Toltzis P, Miroshnik I, Horan K, Burton M, Sims S, Harper M, Coffin S, Sandora TJ, Hocevar SN, Checchia PA, Klompas M, Lee GM; Pediatric Ventilator-Associated Conditions Study Team. Ventilator-Associated Events in Neonates and Children--A New Paradigm. Crit Care Med. 2016 Jan;44(1):14-22.

Shein SL, Maul TM, Li H, Kurland G. Surfactant Administration During Pediatric Extracorporeal Membrane Oxygenation. ASAIO J. 2015 Nov-Dec;61(6):682-7.

Biber JL, Allareddy V, Allareddy V, Gallagher SM, Couloures KG, Speicher DG, Cravero JP, Stormorken AG. Prevalence and Predictors of Adverse Events during Procedural Sedation Anesthesia-Outside the Operating Room for Esophagogastroduodenoscopy and Colonoscopy in Children: Age Is an Independent Predictor of Outcomes. Pediatr Crit Care Med. 2015 Oct;16(8):e251-9.

Toltzis P, Soto-Campos G, Shelton C, Kuhn EM, Hahn R, Kanter RK, Wetzel RC. Evidence-Based Pediatric Outcome Predictors to Guide the Allocation of Critical Care Resources in a Mass Casualty Event. Pediatr Crit Care Med. 2015 Sep;16(7):e207-16.

Toltzis P, Sprung CL. The Value of Early Administration of Antibiotics in Children with Presumed Severe Sepsis and Septic Shock. Crit Care Med. 2014 Nov;42(11):2455-6.

Toltzis P, O'Riordan M, Cunningham DJ, Ryckman FC, Bracke TM, Olivea J, Lyren A. A Statewide Collaborative to Reduce Pediatric Surgical Site Infections. Pediatrics. 2014 Oct;134(4):e1174-80.

Rotta AT, Alves PM, Mason KE, Nerwich N, Speicher RH, Allareddy V, Allareddy V. Fatalities Above 30,000 Feet: Characterizing Pediatric Deaths on Commercial Airline Flights Worldwide.

Pediatr Crit Care Med. 2014 Oct;15(8):e360-3.

Shein SL, Shellington DK, Exo JL, Jackson TC, Wisniewski SR, Jackson EK, Vagni VA, Bayır H, Clark RS, Dixon CE, Janesko-Feldman KL, Kochanek PM. Hemorrhagic Shock Shifts the Serum Cytokine Profile from Pro- to Anti-Inflammatory after Experimental Traumatic Brain Injury in Mice.

J Neurotrauma. 2014 Aug 15;31(16):1386-95.

Toltzis P, Goldmann D. Rethinking Infection Prevention Research. Lancet. 2013 Mar 30;381(9872):1078-9.

Sammons JS, Toltzis P. Recent Trends in the Epidemiology and Treatment of C. Difficile Infection in Children. Curr Opin Pediatr. 2013 Feb;25(1):116-21.

Shein SL, Bell MJ, Su E, Kochanek PM, Exo J. Intracranial Monitoring and Continuous Data Collection. Crit Care Med. 2012 Nov;40(11):3115-6; author reply 3116.

Shein SL, Bell MJ, Kochanek PM, Tyler-Kabara EC, Wisniewski SR, Feldman K, Makoroff K, Scribano PV, Berger RP. Risk Factors for Mortality in Children with Abusive Head Trauma.

J Pediatr. 2012 Oct;161(4):716-722.e1.

Toltzis P, Nerandzic MM, Saade E, O'Riordan MA, Smathers S, Zaoutis T, Kim J, Donskey CJ. High Proportion of False-Positive Clostridium Difficile Enzyme Immunoassays for Toxin A and B in Pediatric Patients. Infect Control Hosp Epidemiol. 2012 Feb;33(2):175-9.

Pediatric Intensive Care Unit

Our Pediatric Intensive Care Unit provides highly specialized, state-of-the-art-care to approximately 1,700 patients annually. We are located in a nationally ranked pediatric hospital that serves as the quaternary referral center for the region. University Hospitals Rainbow Babies & Children's Hospital also has the only accredited Pediatric Trauma Center in the region.

Our sedation unit is a patient- and family-oriented unit that provides outpatient and inpatient services to over 2,000 patients annually. Our intensivists deliver care to patients needing gastrointestinal services, bronchoscopies, minor surgical procedures, invasive procedures required for management of patients with malignancies, a full range of radiologic studies and more. Utilization and satisfaction ratings are extremely high for this program. Active research programs make the sedation unit a rich source of scholarly activity.

UH Rainbow Babies and Children’s Hospital

University Hospitals Rainbow Babies & Children’s Hospital is a modern 244-bed dedicated children’s hospital with a nationally renowned faculty. UH Rainbow Babies & Children’s Hospital’s eight-story patient care tower, which opened in 1997, is one of the most advanced, family-centered pediatric hospital sites in the nation. Approximately 10,000 newborns, children and adolescents are admitted annually to UH Rainbow Babies & Children’s Hospital, where they receive first-rate care in a warm, supportive environment conducive to healing.

Pediatric Library

The Samuel J. Horwitz, MD Pediatric Learning Center (PLC) is a clinically-oriented library focused on pediatrics and geared to support resident and fellow education as well as assist in continued learning for all UH Rainbow faculty and staff. The facility houses a printed reference collection, a number of computer-equipped work stations, and provides access to printing, scanning and photocopy equipment.

The center is staffed by a full-time librarian and is open 24/7 with a door key code. Along with printed books and journals, the library subscribes to a number of electronic resources, available from the PLC website, and provides a number of specialized research guides and tools. Library services include reference and mediated literature searching, database training and inter-library loan assistance.

Pediatric Learning Center

Tel: 216-844-3265
Fax: 216-844-1724