UCNS Accredited Neurocritical Care Fellowship

Welcome to the UT Health Science San Antonio Neurocritical Care Fellowship!

We are the first neurocritical care fellowship in the South Texas region accredited by the United Council for Neurological Subspecialties. The goal of our fellowship is to train strong intensivists who are capable of caring for critically ill patients and comprehending the complexities of neurologic injury and disease. Our program is designed with the understanding that fellows who are interested in neurocritical care often come from a wide range of medical backgrounds. We are unique among fellowships in that our program acknowledges this diversity and accommodates it with a highly individualized curriculum.

The fellowship begins with a bootcamp month that is designed differently for each participant according to his or her specific residency background; this is done so that each person starts their formal ICU rotations with a common skill set and knowledge base. For example, fellows with a background in neurology will be allocated time in the ICU or OR to get procedural and airway experience.  Fellows with an emergency medicine background will gain experience in neurology. Additionally, there will be an early emphasis on self-directed didactics.

Procedural experience will be emphasized throughout fellowship. Our fellows will be competent in performing: bedside neurosurgical techniques (EVD, ICP monitor, licox monitor, SEPS drains), and common bedside critical care procedures (central and arterial line placement, chest tube placement, intubation etc). Point of care ultrasound (POCUS) will be an emphasis – there is a longitudinal practicum for all critical care fellows run by our Emergency Medicine colleagues. This provides a fantastic environment for obtaining ultrasound excellence and collegiality amongst all critical care fellows. Our program also offers a series of multidisciplinary, didactic conferences and lectures that create a broad range of learning opportunities for fellows in this specialized field.

University Hospital San Antonio (UHS)  is the only civilian tertiary care level one trauma center in the city of San Antonio, which serves a population of approximately 2 million people and covers a 26,000 square mile area.  UHS recently built a state-of-the-art addition called the Sky Tower where the Neurosciences ICU (NSICU) currently resides. The NSICU is equipped with a portable CT scanner, continuous EEG monitoring, 2 negative pressure air flow rooms, and an 18-bed capacity with the potential to expand to 26. We receive approximately 1100 admissions per year that encompasses all the pathologies common to Neurocritical Care. However, we are unique in that we boast a heavy neurotrauma program. We do multimodal monitoring with the following techniques:

• Continuous EEG
• Continuous jugular bulb cerebral co-oximetry
• Non-invasive near-infrared monitoring (NIRS)
• Automated pupilometers
• Licox monitors (invasive cerebral oxygen tension monitor)
• ICP monitors
• EVD
• Transcranial doppler

Our team consists of: 3 neurointensivists, 5 mid-level providers, a dedicated neurocritical care pharmacist, critical care pharmacy resident, anesthesia and neurosurgery interns, emergency medicine and neurology residents, and medical students. We also have rotating fellows from surgical critical care, pulmonary critical care, and stroke.

We are involved in several research initiatives with NIH, NINDS, DoD, and Private Industry. Each fellow will be expected to participate in research efforts and present their work at national conferences. We are currently enrolling patients in the following prospective clinical trials:

• Severe Neurologic Injury Outcomes during COVID-19 Crisis
• Impact of COVID-19 on the delivery of NCC
• Neurocritical Care Database Registry
• Prospective Observational trial of Normatec Pneumatic Compression Device for the Prevention of Deep Vein Thrombosis in Severe Traumatic Brain Injury
• Prospective Non-Invasive Study of Cerebral Blood Flow Velocity Morphology for Quantification of Intracranial Pressure
• Prospective Observational trial of Use of Normatec Pulse Controlled Device to augment resuscitation in patients in circulatory shock

The NSICU is a closed ICU within the department of Neurosurgery. The neurocritical care team is the primary service that manages them, however, we work very closely with our neurosurgical and neurology colleagues in management. The diverse academic backgrounds of our neurointensivists combined with a close working relationship with the neurology and neurosurgery departments makes this dynamic environment an outstanding one in which our fellows can learn and grow as physicians.

We think this fellowship provides unique and exciting training opportunities and we welcome any inquiries about the program. We are currently taking applications through the SF match website for positions for the 2021-2022 academic year.