UPMC Presbyterian Consultation Service

The consultation service provides comprehensive diagnostic and therapeutic expertise for inpatients at UPMC Presbyterian and Montefiore Hospitals with simple or complex pulmonary disorders and education for the medical house staff and students.  Examples of diseases diagnosed and managed on this service include COPD, asthma, pulmonary embolism, pulmonary hypertension, pulmonary vasculitis, pneumonia, pleural effusion, pneumothorax, interstitial lung disease, occupational lung disease, drug-induced lung disease, thoracic malignancies, and sleep-disordered breathing.  Fellows evaluate all new consults and provide recommendations for the primary care team, follow-up relevant disease management on existing consult patients, perform all relevant diagnostic or therapeutic pulmonary procedures, oversee and manage teams consisting of medical house officers and students, and participate in educational efforts for the team.

Lung Transplant Service

The lung transplant service provides consultative care for advanced lung disease patients who are being evaluated for or are actively listed for transplantation in both the inpatient and outpatient settings. In addition, the transplant team provides primary inpatient and outpatient care for patients who have undergone lung or heart-lung transplantation.

In the pre-transplant setting, fellows learn the criteria for consideration for lung transplantation for a variety of advanced lung diseases, the detailed evaluation required of transplant candidates, and the organ allocation process.  In the post-transplant setting, fellows are trained to manage a variety of immunosuppressive medications and to evaluate and manage various complications of transplantation, including acute and chronic organ rejection, opportunistic infections, post-transplant lymphoproliferative disease, and numerous drug toxicities.

Finally, this service also provides the fellow with extensive experience with both diagnostic and interventional bronchoscopy.

Inpatient Advanced Lung Disease/Medical Step Down

PACCM faculty staff a 36-bed respiratory care unit, which is split between inpatient lung transplant patients and patients with advanced lung disease.  PACCM fellows may elect to round on the advanced lung disease service with PACCM faculty and advanced practice nurses.  On this rotation, fellows gain experience managing patients with advanced lung pathology, including COPD, acute exacerbations of idiopathic pulmonary fibrosis, interstitial lung disease associated with collagen vascular disease, cystic fibrosis, and pulmonary hypertension.  In addition, fellows gain experience implementing and managing non-invasive ventilation for patients with severe sleep disordered breathing or advanced neuromuscular disease.

Comprehensive Lung Center (CLC)

As with many internal medicine subspecialties, pulmonary medicine is primarily an outpatient discipline.  The UPMC Comprehensive Lung Center (CLC) is a recently renovated 20,000 sq ft facility housing 20 individual patient examination rooms, a pulmonary function laboratory, and a pulmonary rehabilitation program.  Specialists in the CLC see over 15,000 patients each year providing general pulmonary and consultative care for patients with all spectra of lung disease, including asthma, COPD, pulmonary hypertension, sleep disordered breathing, pulmonary hypertension, cystic fibrosis, and interstitial lung diseases, including pulmonary fibrosis, sarcoidosis, rheumatologic-associated lung disease, and hypersensitivity-induced lung disease.  In addition, UPMC operates one of the busiest and most aggressive lung transplant programs in the world.  The CLC provides outpatient pre-transplant evaluations and post-transplant care for patients with advanced lung disease from all over the world.

The CLC is the principle venue for the continuity clinic experience through fellowship training.   In addition, fellows spend one month in the CLC during their first year, rotating through the many different subspecialty clinics.  Fellows may also elect for an additional focused outpatient experience in the second year of training.

VAPHS Pulmonary Medicine Clinic

The VAPHS outpatient clinic serves as a referral center not only for the Oakland facility, but also for five other nearby VA Hospitals. The size of the clinic is carefully controlled to provide optimal patient care and teaching. Fellows see patients one-half day every other week throughout the first two years of training.

VA Pittsburgh Health System MICU/Consultation Service

The VAPHS MICU service cares for critically ill medical patients who have been admitted through the Emergency Department or referred from an outlying VA or non-VA facility.  PACCM fellows are primarily responsible for managing the care of critically ill MICU patients and performing or supervising medical house officers with all procedures in conjunction with a PACCM faculty member.  In addition, fellows provide pulmonary consultation services for patients throughout the hospital.  Fellows gain experience evaluating and managing a wide variety of pulmonary and critical care disorders including ARDS, shock, pneumonia, COPD, asthma, bronchogenic carcinoma, pulmonary embolism, pulmonary hypertension, pleural effusion, pneumothorax, interstitial lung disease, occupational lung disease, drug-induced lung disease, and sleep-disordered breathing.

Fellows supervise the care provided to both MICU and consult patients by the medical house staff. They gain experience with critical care ultrasound, airway management, mechanical ventilation, and hemodynamic monitoring and perform all inpatient and outpatient bronchoscopies.  In addition, the VAPHS houses a state-of-the art simulation center to assist with procedural training, including central line placement, bronchoscopy, and endobronchial ultrasound.

Long Term Acute Care

PACCM faculty staff Select Specialty Hospital, which is a 32-bed long-term acute care facility (LTACH) housed within UPMC Montefiore Hospital. Fellows may elect to rotate on this service, where they gain experience with management of chronic critical illness with a specific focus on chronic respiratory failure and tracheostomy management.

Interventional Pulmonology

Senior fellows interested in gaining exposure to advanced bronchoscopic and pleural techniques can elect to rotate on an interventional pulmonology elective.  This includes rotating through the bronchoscopy lab at UPMC Presbyterian where volume exceeds 1700 cases per year with approximately 15% involving advanced techniques, the VA Pittsburgh Bronchoscopy lab and the Hillman Cancer Center.  Fellows will get exposure to advanced diagnostic bronchoscopic techniques including endobronchial ultrasound, navigational bronchoscopy and robotic bronchoscopy as well as therapeutic interventions utilizing flexible and rigid bronchoscopy with balloon dilation,  self-expanding metallic and silicone airway stent deployment, laser and argon plasma ablation, cryotherapy, as well as advanced endoscopic COPD therapies including lung volume reduction using endoscopic valves, bronchial rheoplasty for chronic bronchitic phenotype COPD, and targeted lobar denervation.  Fellows will also get training and exposure to ultrasound guided pleural procedures including thoracentesis, pigtail and surgical chest tube placement, indwelling pleural catheter placement, use of intra-pleural lytic therapy, and medical thoracoscopy.

Multidisciplinary Lung Cancer

The multidisciplinary lung cancer rotation is designed for fellows to gain experience with approaches to diagnosis and management of lung cancer.  Fellows will spend time with lung cancer specialists in pulmonology, pathology, medical oncology, and thoracic surgery.  In addition, fellows will attend tumor board on both the Presbyterian and Shadyside campuses.

Pulmonary Hemodynamics

PACCM Fellows may elect to spend dedicated time in the cardiac catheterization lab with expert pulmonary hypertension specialists to investigate pulmonary vascular hemodynamics at rest and with confrontational exercise testing. With this elective, fellows will obtain procedural experience with arterial line and pulmonary artery catheter placement, as well as interpretation of complex physiology with simultaneous cardiopulmonary exercise testing and invasive measurement of pulmonary vascular and cardiac function in association with upright cycle ergometry (iCPET) via the Advanced Cardiopulmonary Exercise Testing Program (ACPET). Invasive exercise testing helps to delineate disease states related to pulmonary arterial or venous disease, cardiac valvular disease, loading dynamics, and autonomic or skeletal muscle pathophysiology that limit exercise capacity as well as providing multidisciplinary and comprehensive investigation of dyspnea and exercise limitation for clinical and research purposes.

Radiology/Pathology

Fellows may elect to spend two weeks with expert attending chest radiologists and lung pathologists reviewing and interpreting studies and test results.

Critical Care Ultrasound

Fellows may elect to pursue critical care ultrasound certification by focused education and hands-on image training with an expert faculty member.
Dr. Lamberty‘s Ultrasound website: http://paccmus.com/wp/

Thoracic Surgery

Fellows rotating on the Thoracic Surgery service will be exposed to endobronchial ultrasound, CT-guided thoracic procedures, video-assisted thoracic surgery, and open chest surgery including lung transplantation.  Fellows will gain experience with tube thoracostomy and bedside tracheostomy placement.

Mercy Hospital

The Mercy Hospital of Pittsburgh was established in 1847 by the Sisters of Mercy as the first hospital in Pittsburgh and the first Mercy Hospital in the world. It merged with UPMC in 2008. We provide pulmonary consult services for this hospital with opportunities to see basic and complex pulmonary pathophysiology and to care for an underserved portion of Pittsburgh’s population. Mercy also hosts the only thoracic surgery-pulmonary conference in the UPMC system. This conference provides an excellent array of interesting cases and opportunity for collaboration with thoracic surgery.