TexasBoy

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Any advice on what the best pulm/critical care fellowships would be appreciated (preferrably from fellows, attendings, and practicing doctors).

Here's what I'm looking for:
1. Combined pulmonary/critical care (sleep isn't a concern)
2. Great intensivist training with frequent opprotunity for intubations and even chest tubes
3. Aggresive bronch training
4. Exposure to ecmo during training (must be a technique that's available and used at the hospital).
5. Lung Transplant training
6. Pulmonary Hypertension/Cystic Fibrosis clinics/training a plus.
7. Preferrably combined surical/medical ICUs in order to support cross training

Is this program out there? Of course there are the obvious names just as John Hopkins/Harvard/etc, but any gems/outliers out there that will also fit the description above?

Thanks
TB
 

bigtuna

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off the top of my head, programs that would fit your description include:

hopkins
upenn
upitt
michigan
wash u
denver

there are probably many other programs that meet the criteria as will. Hopefully others will chime in. many other traditional academic powerhouses will have most of what you want except the intubations and the emphasis on multidisciplinary crit care. Many, many programs with lesser academic status will give you great general pulm training with a lot of hands on ICU time but may not have the transplant, PH, etc.

What stage of training are you and what are your career goals? The list of programs that has all of the characteristics you mentioned is pretty short and competitive. Nobody (or extremely few) is going to end up doing all of that stuff so if you have some idea of where you're going it may help to pick a program.
 

McLovin

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What is "frequent" ecmo use? We have it, and its an option, though used really as a "last resort". The last patient we put on ecmo was 3 years ago.

Are other places doing this routinely?? Just curious.
 

Tigerz_Fan

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What is "frequent" ecmo use? We have it, and its an option, though used really as a "last resort". The last patient we put on ecmo was 3 years ago.

Are other places doing this routinely?? Just curious.
I've seen 2 in 2 years. And yes, we use it as a "last resort."
 

jdh71

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I've seen 2 in 2 years. And yes, we use it as a "last resort."
Unless something new has come up that I'm not aware of (and this very possible - so much literature, so little time), ECMO has shown no endpoint benefit, as far as mortality is concerned, even if allows you to buff the ABG, in the end, everyone that sick dies anyway. So do we do it because it makes us feel better? As in, "Ok this poor SOB is CTD, but in order to say we did "everything", we'll try something provocative!!"

I don't know . . .
 

souljah1

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I've seen ECMO used 3 times in the last couple months. two died. one survived. the one who survived is a 29yo asthmatic who got H1N1 while pregnant (baby OK) and was transferred to us for refractory hypoxemia. Every mode of ventilation was attempted. PEA arrested from hypexemia. She was on ECMO for 27 days. She was transferred to the floor WALKING AROUND and HOLDING HER BABY and was placed to an acute rehab for aggressive PT. She is trach'd and has been off pressure support for well over one week. NO neurologic deficits.

Sometimes, we don't just treat the numbers.
 

Tigerz_Fan

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I've seen ECMO used 3 times in the last couple months. two died. one survived. the one who survived is a 29yo asthmatic who got H1N1 while pregnant (baby OK) and was transferred to us for refractory hypoxemia. Every mode of ventilation was attempted. PEA arrested from hypexemia. She was on ECMO for 27 days. She was transferred to the floor WALKING AROUND and HOLDING HER BABY and was placed to an acute rehab for aggressive PT. She is trach'd and has been off pressure support for well over one week. NO neurologic deficits.

Sometimes, we don't just treat the numbers.
That is a great success story.

The two ECMO pts we had we both pts with multiple comorbities prior to the illness that put them in the ICU. Likely ECMO would be more sucessful for patients who were healthy prior to the current insult (like you described above).
 

jdh71

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I've seen ECMO used 3 times in the last couple months. two died. one survived. the one who survived is a 29yo asthmatic who got H1N1 while pregnant (baby OK) and was transferred to us for refractory hypoxemia. Every mode of ventilation was attempted. PEA arrested from hypexemia. She was on ECMO for 27 days. She was transferred to the floor WALKING AROUND and HOLDING HER BABY and was placed to an acute rehab for aggressive PT. She is trach'd and has been off pressure support for well over one week. NO neurologic deficits.

Sometimes, we don't just treat the numbers.
asthmatics vs ARDS . . . maybe it has a place for asthmatics - too bad we don't don't use it often enough . . . or should I say, thank god, we don't have to use it more often, but that might be an interesting paper
 

VCMM414

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I've seen ECMO used 3 times in the last couple months. two died. one survived. the one who survived is a 29yo asthmatic who got H1N1 while pregnant (baby OK) and was transferred to us for refractory hypoxemia. Every mode of ventilation was attempted. PEA arrested from hypexemia. She was on ECMO for 27 days. She was transferred to the floor WALKING AROUND and HOLDING HER BABY and was placed to an acute rehab for aggressive PT. She is trach'd and has been off pressure support for well over one week. NO neurologic deficits.

Sometimes, we don't just treat the numbers.
Similar story here, young woman in her 20s who was pregnant and immunocompromised (connective tissue disease), got H1N1. Unable to adequately oxygenate even on oscillator. ECMO x2 weeks. Lived to walk out of the hospital 2 months later.

Also, check out the recently published CESAR trial in Lancet. It seems to support the use of ECMO in adult patients with "potentially reversible" ARDS.

http://tinylink.com/?CtiVMKhWID