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An essential part of critical care and pulmonary medicine is the performance of procedures. Fellows must be able to perform them expeditiously and safely.

The program will provide opportunities for fellows to learn the indications, limitations and complications of the following critical care procedures and the technical skills necessary to perform them.

•Establishment of airway
•Maintenance of open airway in nonintubated and unconscious patients
•Oral and nasotracheal intubation
•Ventilation by bag or mask
•Mechanical ventilation using pressure-cycled, volume-cycled and negative pressure mechanical ventilators
•Noninvasive ventilation
•Use of reservoir and CPAP masks for delivery of supplemental oxygen, nebulizers and incentive spirometry
•Ventilator weaning and respiratory care techniques
•Management of pneumothorax including tube insertion and drainage systems
•Thoracostomy tube insertion and drainage
•Insertion of central venous, arterial and pulmonary artery flotation catheters
•Calibration and operation of hemodynamic recording systems
•Basic and advanced cardiopulmonary resuscitation
•Pulmonary function tests
•Inhalation challenge studies
•Cardiopulmonary exercise testing
•Basal metabolism testing
•Diagnostic and therapeutic procedures, including thoracentesis, flexible fiberoptic bronchoscopy and related procedures
•Examination and interpretation of sputum, bronchopulmonary secretions, and lung tissue for infectious agents, cytology and histopathology
•Utilization, zeroing, calibration of transducers and use of amplifiers and recorders for monitoring
•Ultrasound guided thoracentesis and line placement

Experience will also be provided in the analysis of data pertaining to the following:

•Cardiac output determinations by thermodilution and other techniques
•Evaluation of oliguria
•Management of massive transfusions
•Management of hemostatic defects
•Interpretation of antibiotic levels and sensitivities
•Monitoring and assessment of metabolism and nutrition
•Calculation of oxygen content, intrapulmonary shunt and alveolar arterial gradients

The program will provide opportunities to learn the indications, contraindications, limitations and complications of and when feasible practical experience with the following procedures:

•Transvenous pacemaker insertion
•Peritoneal dialysis
•Peritoneal lavage
•Aspiration of major joints
•Percutaneous needle aspiration and cutting lung biopsy
•Endobronchial cryotherapy, stent placement, and laser ablation
•Intracranial pressure monitoring