Pulmonary Critical Care Fellowship

Fellows spend approximately eight months on the medical ICU and an additional three months on non-medical ICU services for training in critical care. Another 12 months are spent on inpatient pulmonary consult services. Approximately four months are spent on various other rotations including palliative care, echocardiography, anesthesia, and pulmonary rehabilitation. Fellows work alongside faculty, internal medicine house staff, advanced practice providers and medical students to manage the full spectrum of critical care and pulmonary disease including, but not limited to, sepsis, cardiogenic shock, respiratory failure, acute kidney and liver failure, acute neurologic disorders, pulmonary infections, thoracic malignancy and complications of cancer therapy, airways disorders and pleural disease.

Fellows are trained to use point-of-care ultrasound, primarily echocardiography and thoracic ultrasound, to supplement their bedside clinical evaluations and assist in performing invasive procedures (such as central venous catheter placement and thoracentesis). Fellows are also trained to become highly proficient in fiberoptic bronchoscopy and related procedures as well as endobronchial ultrasound (EBUS). Simulation training in both fiberoptic bronchoscopy and EBUS is used to accelerate development of procedural competency.

A rigorous ambulatory experience provides a broad exposure to outpatient pulmonary and sleep medicine including dyspnea evaluation, COPD, asthma, lung nodules, thoracic malignancy, sarcoidosis and other interstitial lung diseases, pre-operative respiratory evaluation and sleep disordered breathing.

Research blocks are provided for trainees to have meaningful opportunities for clinical and research scholarship. Fellows are encouraged to attend regional and national meetings to present their work.

The Section of Pulmonary, Critical Care and Sleep Medicine has a robust conference schedule. In the early months of each academic year, faculty provide an introductory core lecture series that covers the most common topics in pulmonary, sleep and critical care. Thereafter the didactic program switches to a weekly journal club, clinical topic and case-based conferences, research conferences and a monthly morbidity and mortality conference. Multidisciplinary conferences with radiology, pathology, oncology, surgery and radiation oncology are also included in the form of a monthly clinical-radiology-pathology conference, a bimonthly thoracic oncology conference and a monthly pulmonary pathology conference.  Fellows are expected to prepare numerous case-based presentations over the course of their training with a focus on utilizing the published medical literature to help guide their approach to clinical care, while laying the foundation for life-long learning beyond fellowship. 

The Section of Pulmonary, Critical Care and Sleep Medicine maintains a full spectrum of related facilities at Bridgeport Hospital.

There is a Pulmonary Physiology lab for pulmonary function testing. This includes the ability to perform advanced cardiopulmonary exercise testing as well as the standard testing of spirometry, lung volumes and diffusion analysis. Our bronchoscopy suite provides for standard bronchoscopic evaluation. We have fluoroscopy for performing transbronchial biopsies and bronchial brush. Endobronchial ultrasound (EBUS) is also performed. Bronchoscopic procedures are assisted by nursing and respiratory therapy staff and anesthesiology services are available if needed. 

The medical intensive care unit is a 16-bed unit capable of the full support of the critically ill patient. We have bedside ultrasonography for line placement, pleural procedures and critical care echocardiography. We have a glide scope for airway management. The fellows have ample opportunity for performing the standard ICU-related procedures including the insertion of central venous catheters, arterial lines, thoracentesis and placement of endotracheal tubes.  

Our Center for Sleep Medicine is a full-service sleep center evaluating and treating a broad spectrum of sleep disorders for adult patients. We provide consultative services and testing including standard polysomnography, home-based sleep apnea testing, multiple sleep latency testing and wrist actigraphy. The Center for Sleep Medicine is staffed by two full-time Clinical Sleep Specialists.

Fellows rotate at Yale New Haven Hospital in the Medical ICU, Neurosciences ICU and inpatient Pulmonary Consult Service under the supervision of the Yale School of Medicine faculty and alongside Yale co-fellows, residents and medical students. Yale New Haven Hospital is a large university referral center and includes a busy 40-bed MICU that has over 4,500 admissions per year. The inpatient consult service at Yale will provide fellows an opportunity to encounter respiratory disorders less commonly seen in the community hospital setting, such as cystic fibrosis and interstitial lung disease, in addition to general pulmonary cases.

The Hospital for Special Care in New Britain, is a large long-term acute care hospital specializing in rehabilitation of children and adults with cardiopulmonary and neurologic disorders. Fellows learn about ventilator weaning, inpatient and outpatient pulmonary rehabilitation and tracheostomy management at this facility. There is also a neuromuscular clinic available for fellows to learn about the respiratory management of patients with neuromuscular disorders such as amyotrophic lateral sclerosis and Duchenne Muscular Dystrophy.

The Section of Pulmonary, Critical Care and Sleep Medicine maintains and encourages fellow participation in an active clinical research and patient care quality improvement effort. Fellows are expected to develop and produce substantive works of clinical scholarship and can take the form of published abstracts, peer-reviewed manuscripts, quality improvement and patient-safety initiatives.  Fellows are expected to attend regional and national meetings, such as the Connecticut Thoracic Society, American Thoracic Society and the American College of Chest Physicians to present their works of scholarship and learn from the broad array of scholarship being performed by others in our field.

Review a sample of publications in the section in the Bridgeport Hospital Medical Library. 

1st Year
Sandra Patrucco Reyes, MD
Anant Shukla, MD

2nd Year
Anna Chang, MD
Ariane Loutoo, MD

3rd Year
Vesna Buntak, MD
Rahul Kapil, MD

View current faculty for Pulmonary Critical Care