When a patient experiences an urgent, life-or-death illness or injury, they often receive highly specialized care on an intensive care unit (ICU). Unity Health Toronto is home to one of the most advanced adult Critical Care programs in the province. There are six adult ICUs across the network – two at St. Joseph’s Health Centre and four at St. Michael’s Hospital.

We sat down with Dr. Andrew Baker, the medical director of Surgery and Critical Care at Unity Health and the chief of the Departments of Critical Care and of Anesthesia at St. Michael’s, to learn more about the world-leading work happening in the Critical Care program.

What is critical care?

I describe critical care as the place where people go when they have life-threatening, time-sensitive illnesses. They come to critical care to survive an otherwise fatal illness episode.

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On a more personal level, I think of it like this:

In the morning critical care is very technical. We think about the latest technology. We think about difficult decisions, medically. We think about the extreme end of many diseases.

In the afternoon, it’s very human. We think about the family, the crisis, the life-and-death nature of some of the illnesses. We think about the decisions and how things are going to evolve.

Dr. Andrew Baker

How does Unity Health’s Critical Care program serve the province?

Unity Health supports highly important programs for the region and the province – and many of those programs need a strong backbone of critical care to do their work.

St. Michael’s Hospital is a regional trauma centre. After initial resuscitation, trauma patients – who are severely injured – come to a critical care unit for ongoing resuscitation and support.

Similarly, there are only so many centres in the province that do brain surgery and St. Michael’s is one of them. All of those patients need critical care to take advantage of our neurosurgical services; they’re inextricable.

Those are just two examples of the many specialty services at St. Michael’s that serve the region and require the backup of critical care.

Beyond that, sometimes there are patients who are receiving critical care elsewhere in the province and they become very ill in a multi-system sort of way. It is recognized that they would benefit from being in a hospital like St. Michael’s, where the Critical Care program is at a very high level and we have a full spectrum of specialized services that can support the most complex, critically ill patients in Ontario.

How is Unity Health contributing to research and innovation in critical care?

We truly lead the world in some of these areas. Pre-eminent among them is our Centre of Excellence for Mechanical Ventilation. Mechanical ventilation is needed to keep us alive in some cases, but it can be threatening to our body. If done poorly, it can be damaging.

The research we have done in mechanical ventilation changed the way we ventilated people between 2010 and 2020. I’m convinced, if the COVID-19 pandemic had happened in 2010 instead of 2020, there would have been many more deaths.

We are also a centre for global collaboration in acute care research. During the pandemic, we led networks doing adaptive trials on how to treat people with COVID and critical illness. Those trials changed the way we treated people and had a positive impact.

There are many other areas including some really innovative work led by Dr. Claudia Dos Santos, a physician and scientist at St. Michael’s who is studying the mechanism of critical illness – or how critical illness works.

We used to think of all illnesses much as we did in high school. We got a chapter on the lungs and then a chapter on the heart and a chapter on the liver. Suddenly, we had COVID-19, which was affecting all of our systems. Then we realized it was about the molecules, for example receptors. What receptors were the COVID-19 protein affecting? Those receptors were distributed across many organs.

Now we are re-organizing the way we think about critical illness and diseases. Dos Santos is doing cutting-edge research on understanding the mechanism of critical illness using molecular markers, such as biomarkers.

What makes the Critical Care team at Unity Health special?

Critical Care is very special at Unity Health is because it is a place where our values are put to action. The stakes are very high and sometimes the decisions are difficult. For these reasons, the recognition of people’s dignity, the celebration of excellence, the requirement for highly functional teamwork and all of our formal values – compassion, community, inclusivity – come into play.

St. Michael’s Hospital and St. Joseph’s Health Centre uphold those values and really bring them to life within the critical care units. I’m exceptionally proud to work with the team of people that I do because they are committed to the patient and family experience, in all aspects.

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