Programs & Units

Cardiac Surgical Intensive Care Unit

Medical Director, Dr. Bernard McDonald

The Cardiac Surgery Intensive Care Unit (CSICU) is a comprehensive care, multi-disciplinary, Level 1 (CCCS) Intensive Care Unit (alternatively called Level 3 by MOH) which provides care for cardiac surgical patients ranging from routine to the most advanced, complex life support methods available. The CSICU is comprised of a total of nineteen dedicated critical care beds located in three different modules.

All levels of care are provided for cardiac surgical patients recovering from surgery with acute postoperative management needs or with post-operative complications. Five attending critical care medicine physicians from the Division of Cardiac Anesthesia lead our multi-disciplinary team which includes over 100 critical care nurses, respiratory physiotherapists, registered dieticians, physiotherapists, speech-language pathologists, and a pharmacist, all dedicated to the CSICU.

This team structure enables the CSICU staff to expertly deliver all aspects of patient management such as advanced hemodynamic monitoring (including transesophageal echocardiography), advanced hemodynamic support (including intra-aortic balloon pump and temporary and long-term ventricular assist devices), advanced ventilatory support (including high frequency oscillation and extra-corporeal membrane oxygenation) sedation, nutrition and renal replacement therapies. Care is provided in close collaboration with our colleagues from the Division of Cardiac Surgery and with a full range of supporting medical and surgical services readily available for consultation.

CSICU physicians have an active teaching profile within the University of Ottawa’s Critical Care Medicine and University of Ottawa Anesthesiology programs, and the CSICU is a core rotation for critical care medicine fellows and anesthesiology residents. As well the CSICU hosts resident physicians and post-specialty fellows from a variety of post-graduate specialty educational programs including cardiac anesthesiology, cardiology, cardiac surgery, and thoracic surgery. The CSICU also hosts clinical rotations for trainees from all of the health professions working within our team.

Clinical Anesthesiology

Chief, Dr. James Robblee
Deputy Chief, Dr. Jean-Yves Dupuis
The clinical arm of Cardiac Anesthesiology provides all aspects of peri-operative care to cardiac surgical patients. This care is provided by cardiac anesthesiologists who have specialized in anesthesiology and critical care medicine for heart patients.

Anesthesia care starts with pre-operative consultation either as an out-patient in the Pre-Admission Unit (PAU) or as an in-patient in the hospital. Anesthesiology consultation is also available for surgical or medical inpatients.

Intra-operative Anesthesiology Care (the anesthetic itself) is provided for a variety of procedures and in a variety of clinical situations:

• Cardiac surgical procedures
• Electrophysiology ablation procedures to treat arrhythmias
• Implantable cardiac defibrillator (ICD) insertions
• Elective or emergency cardioversion
• Peri-operative pain management, including nerve block procedures
• Transesophageal echocardiography for cardiac surgery and critical care

Complete, comprehensive Critical Care Medicine services are provided by Cardiac Anesthesiology for post-operative cardiac care, and for any additional intensive care needs of the surgical patient. This takes place in the CSICU where all aspects of life support care are administered until patients are ready for mobilization and transfer back to the ward.

Respiratory support and consultative services are also offered to the Coronary Care Unit for critically ill non-surgical patients, especially those requiring ventilatory support.

Technical aspects of monitoring patients for cardiac surgical procedures are tailored to the needs of the patient. They include extensive state-of-the-art hemodynamic monitoring, transesophageal echocardiography, neurophysiological monitoring including electroencephalography and transcranial Doppler, respiratory and anesthesia monitoring, and computerized anesthesia record keeping.
A team of anesthesia technologists also assists in the cardiac operating rooms.

Pre-Admission Unit

Prior to elective surgery, many patients are assessed as out-patients in the Pre-Admission Unit (PAU). Patients meet an anesthesiologist and are provided with information concerning preparation for surgery, the anesthetic itself, and post-operative care.

The visit is a comprehensive one. Additional nursing assessment is done, and educational material regarding the surgical procedure and the entire hospital stay is provided in written and audio/visual formats. Instructions are provided for preparation for admission and timing and location of the admission itself, which will often occur the morning of the scheduled surgery.

Any additional pre-operative tests and consultations that are necessary are also arranged while in the PAU.