Pediatric Critical Care Fellowship

Nicklaus Children's Hospital's Division of Pediatric Critical Care Medicine offers a fully accredited three-year Pediatric Critical Care Fellowship program. The program is designed to provide comprehensive training with increasing responsibility, complete with the ability to manage all facets of pediatric critical care medicine. Fellows will acquire the skills necessary to assess, stabilize, and transport critically ill patients as well as have the clinical and technical abilities to provide comprehensive intensive care to all medical and surgical patients (including post-operative cardiac and trauma patients).

Understanding the basic sciences, including anatomy, physiology, genetics, biochemistry, and pharmacology as applied to the practice of Pediatric Critical Care Medicine is a part of ongoing dynamic curriculum. Teamwork utilizing other medical/non-medical services, as well as specialty consultants, is stressed. All Fellows are appropriately prepared for the Sub-specialty Board Examination and are capable of undertaking academic/clinical positions as Pediatric Intensivists.

Fellows are expected to demonstrate competence in teaching (including teaching nurses, medical students, pediatric residents, other sub-specialty residents and allied health care students) and to have the ability to produce independent research. Finally, exposure to Ethical issues as related to Pediatric Critical Care and participation in meetings of the Hospital's Bioethics Committee, is mandatory.


Fellows are expected to participate actively in a didactic curriculum offered by the division, which includes core lectures, journal clubs, case discussions, research seminars, and several mini symposia on ventilator management, ECMO, Apheresis, and biostatistics. Regular Board review courses prepare them for the certifying examination.

How to Apply

Applications should be submitted through the ERAS system.

Contact Us

Email the Coordinator

Our Faculty

There are five full-time pediatric intensivists on staff. All faculty members actively participate in teaching and research and are available for mentoring of Fellows.

Bala Totapally MD, DCH, MRCP, FAAP, FCCP, FCCM
Clinical Professor of Pediatrics
Herberth Wertheim College of Medicine
Florida International University
Medical Director of PICU
Program Director, Critical Care Fellowship Program
Medical Director, MCH PALS Program
Andre Raszynski, MD
Medical Director, Division Critical Care Medicine
Clinical Professor of Pediatrics
Herberth Wertheim College of Medicine
Florida International University
Keith Meyer, MD
Medical Director Life-Flight
Neuro Intensive Care Section Director
Michael Leoncio, DO
Pediatric Critical Care Attending
Medical Director Vascular Access
Fernando Beltramo, MD
Pediatric Critical Care Attending


Research training is an integral part of the Fellowship. In addition to the 12 months of dedicated time for research, all Fellows have ample time and opportunity to pursue research activities during several clinical rotations. Fellows are expected to participate in a core curriculum of lectures in the basics of research, including study design, data analysis, and preparation of manuscripts and grants. There are opportunities for translational research (bench and animal laboratory) and/or clinical research. Presentations at national conferences are encouraged and facilitated.

Current Research in the Division

The Division of Critical Care Medicine (CCM) in Nicklaus Children's Hospital has conducted both basic and clinical research in various aspects of pulmonary critical care. Our Fellowship program requires participation of the Fellows in planning, performance, analysis and publication of research projects. To satisfy Board certification requirement, each Fellow also must, at least, publish one article in a Peer Reviewed Journal, as the first author. To facilitate this endeavor, the Division's Faculty, including the Attending Physicians, Scientists (a Ph.D. Physiologist, and a D. Pharm, Pharmacologist) provide mentorship and assistance in planning, execution, analyses and publication of the research data. Our lines of Research in CCM include a variety of interrelated subjects, including:

  1. Animal models on respiratory support modalities for critically ill neonatal or pediatric patients. This includes experimental methods of ventilatory support, such as Intratracheal Pulmonary Ventilation (ITPV) and replacement of lung's gas-exchange functions by Arterio-Venous Extra Corporeal Membrane Oxygenation (AV-ECMO) in rabbits and lambs
  2. Prevention of Barotrauma during mechanical ventilation by maintaining a high level of arterial CO2, at relatively low inspiratory pressures and volumes in small and large animal models (rats and dogs). These studies simulate a well-established pulmonary critical care condition, known as Permissive Hypercapnia
  3. Developmental aspects of Hyperoxia and weaning from Oxygen Therapy in a neonatal rat model. These studies investigate the safety of neonatal oxygen therapy on multiple organ systems, growth rate and brain development
  4. Development of an adult rat model to study pathophysiology and pharmacology during pulmonary critical care conditions. Using this model, we have studied gender differences in anesthesia, oxygenation and ventilatory requirements involving hyperoxia, hypoxia, hypercapnia, and hypothermia. Currently, we are using this rat model to study the effects of various drugs, or treatment modalities during endotoxin-induced sepsis
  5. In vitro studies designed to answer mechanic questions during respiratory support, such as loss of water in ECMO circuit, or pressure changes in closed versus open-bridge ECMO, as well as reduction in airway pressures, and/or humidity during ITPV, by using an artificial lung
  6. Molecular aspects of pulmonary and multiple organ injury in both adult and neonatal rat models. In these studies multiple gene expressions are used as early markers of cell injury, and/or repair
  7. Prospective and retrospective clinical studies involving critically ill neonatal and pediatric patients

Research interests of the Division include intratracheal pulmonary ventilation (ITPV), hypoxic/hyperoxic lung and other organ injury, arterio-venous ECMO, genomics of sepsis and resuscitation. Fellows have the opportunity to work with several animal models, including rat, rabbit and sheep. The use of the Nicklaus Children's Hospital Pediatric Human Patient Simulator is also another option that has been used for ventilation studies at the Hospital.

Transport Program

Nicklaus Children's Hospital's LifeFlight® critical care transport team provides transport of critically ill children from referring hospitals to Nicklaus Children's Hospital pediatric care units. In addition to ground ambulance transports, the LifeFlight program offers air transport via helicopters operated by PHI, Inc., one of the world's most experienced aircraft operators and the holder of a Part 135 Certificate issued by the Federal Aviation Administration, and through contracted fixed-wing aircraft charters.* Fellows gain the experience of Transport Medicine in several ways during the three years of training including: functioning as a medical control physician; transporting patients while on-call as the "Transport Fellow"; and participating in related didactic activities.

* Nicklaus Children's Hospital is not a direct air carrier. Aircraft, both helicopter and fixed wing, are operated pursuant to contract with Nicklaus Children's Hospital, by companies which are FAA certificated.

Clinical Competency Committee (CCC)

In accordance with the ACGME requirements, each training program is expected to form a Clinical Competency Committee (CCC). The program director appoints the CCC. The CCC must have at least three program core faculty (excluding the program director) who have the opportunity to observe and evaluate the residents. The CCC meets at least semi-annually to review and discuss each individual residents' performance data and make a consensus decision on the progress of each resident by applying assessment data to the milestones. The CCC serves as an early warning system/early identification if a resident fails to progress in the educational program and make recommendations to the program director for resident progress including promotion, remediation, and dismissal. The program director meets with each resident semi-annually to review the CCC report and design an individualized learning plan for the resident. To learn more about the CCC click here ->

Below are the faculty memberswho serve onthe CCC committee (in addition to the Program Director)for thePediatricCritical CareFellowship Program:

  • Keith Meyer, MD
  • Andre Raszynski, MD
  • Juan Bolivar, MD
  • Michael Leoncio, DO
  • Ana Paredes, MD

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