Specialized Clinical Programs
An active inpatient and outpatient clinical and investigative program for evaluation and treatment of patients with interstitial lung disease is active at the University of Virginia. Patients are initially evaluated in the Interstitial Lung Disease Clinic by Dr. Borna Mehrad. This program evaluates a wide variety of interstitial lung diseases, and provides not only state of the art therapy, but also investigational protocols to the patients. Patients failing to respond to therapy are referred for evaluation for lung transplantation.
An active Pulmonary Hypertension program directed by Dr. Elizabeth Gay evaluates and treats patients with primary and secondary pulmonary hypertension in the Pulmonary Hypertension Clinic and on the inpatient medical service. Pulmonary fellows gain expertise in the diagnostic workup for pulmonary hypertension, and pharmacologic management of the disorder.
The Pulmonary Division directs the Multidisciplinary Sleep Disorders center, working closely with the pediatric, otolaryngology, neurology and psychiatry departments. The sleep laboratory is state of the art. The 8-bed laboratory performs 150-190 overnight studies per month, evaluating adults and children with sleep-related problems. Although sleep apnea syndromes make up a large part of the caseload, all types of sleep disorders are seen. There is ongoing research in the treatment of obstructive sleep apnea. Pulmonary fellows gain experience in patient evaluation and in the techniques and interpretation of nocturnal polysomnography. With additional elective or research time, fellows can qualify for the Sleep Disorders special competency certification.
The lung transplantation program has been active at the University of Virginia since 1990. Over 330 patients have received lung transplants. The Pulmonary Division provides most of the pre-operative and long term care for these patients. The initial evaluation is done by Dr. Max Weder, the Medical Director of the Pulmonary Transplantation Service, or Dr. Kyle Enfield. The patients are then discussed with the entire transplant team. Patients waiting for lung transplant are followed in the Pulmonary Transplant Clinic. After their immediate post-operative period on the Thoracic Surgery service, patients return to the Pulmonary transplant clinic for lifelong follow-up. The consult fellow assists with inpatient management and diagnostic bronchoscopy. Fellows may also elect to spend time on the transplant service, seeing both patients with acute problems and successful long-term post-transplant patients.
Patients with cystic fibrosis first come to the University as children followed in the pediatric department. In their late teens, they move to the adult CF service under Dr. Robbins, for both inpatient and outpatient follow-up. This is the only clinic for adults with cystic fibrosis in Virginia and also serves patients from West Virginia. For those who chose lung transplantation in the later stages of their disease, the transition to the lung transplant clinic is smooth with no loss in continuity of care.
Pulmonary Consultation Service
Fellows spend 6-9 months of the 3-year fellowship on the consultation service. Patients from the medical, surgical, neurologic, and obstetric units are seen, including critically ill patients in the surgical and neurological ICUs and the cardiac care unit. A sleep disorders consultation service is also provided. The fellows perform bronchoscopies, thoracentesis, pleural biopsies, brachytherapy, EBUS-fine needle aspirations, and chest tube insertions under supervision of the attending physician.
Pulmonary Function Laboratory
Early in the first year, fellows spend a month in the Pulmonary Function Lab, learning the physiologic basis of pulmonary function testing. Fellows learn to perform and interpret pulmonary function tests. Sleep Laboratory: The fellows spend a minimum of one month on the Sleep Laboratory rotation, learning both the techniques and the interpretation of overnight polysomnography. In addition, they see and evaluate patients with sleep disorders with one of the sleep faculty in the outpatient Sleep Clinic.
Transplant / Cystic Fibrosis
The fellows spend one month with Dr. Max Weder or Dr. Kyle Enfield, seeing patients in all stages of the lung transplant process. This includes those waiting for transplant as well as recent and long-term post-operative patients. In addition, the fellows will see adult cystic fibrosis patients both inpatient and in the clinic.
Intensive Care Units
The Pulmonary/Critical Care fellows spend at least six months in the medical intensive care unit, caring for critically-ill patients with complicated medical problems. Admissions come from the medical wards, the Emergency Department Room, and transfers from outside referring other hospitals in the referral area. Fellows evaluate and treat both common and unusual critical care disorders cases under the guidance of the critical care medicine board-certified attending faculty, who are all Critical Care Board Certified. Extensive experience is gained in ventilator management and hemodynamic monitoring techniques, including balloon floatation Swan-Ganz and arterial catheter placement. The fellows also develop skill in intubation, ultrasound guided central venous catheter insertion access, chest tube thoracostomy, and percutaneous thoracotomy and tracheostomy. The critical care experience is broadened by rotations through nonmedical intensive care units including time spent in the Surgical-Trauma Intensive Care Unit, Neurologic Intensive Care Unit, and Coronary Care Unit. In these units, Pulmonary fellows care for patients with trauma, postoperative complications, strokes, and spinal cord injury, as well as cardiovascular diseases.
In the first year, the Pulmonary/Critical Care fellows rotate on the Anesthesiology Service where they achieve proficiency in airway management and intubation.
Outpatient Pulmonary Clinic
The Pulmonary Outpatient Clinic sees 4000 patients annually. Pulmonary fellows have one half-day continuity clinic per week, seeing 2 new patients and several returning patients. Fellows follow their patients throughout the three year fellowship. The fellow’s patients are staffed by one of the Pulmonary/Critical Care attendings available specifically for the fellow’s outpatient clinic.