Department of Pulmonary Medicine

The Department of pulmonary Medicine is a group of faculty and trained nurses who provide comprehensive consultative evaluation and management for patients with **pulmonary disease associated with cardiac disease**, critically ill post cardiac surgery pulmonary complication patients or the workup of undiagnosed lung abnormalities.

The division's overriding prevention, diagnosis and treatment of respiratory disease focuses on heart disease. We operate as a **Chronic Thromboembolic Pulmonary Hypertension (CTEPH) team** which consists of pulmonologist, echocardiologist, radiologist, peripheral vascular specialist, heart failure specialist and cardiac surgeon for making treatment decisions.

Laboratories and Staffing

**Three faculty members** are working in this ward, which includes **3 separate laboratories**: Sleep lab, CPET (Cardio Pulmonary Exercise Testing) lab, and pulmonary function test lab.

Sleep Laboratory Services:

In the sleep laboratory, 3 nurses and technicians who are trained in sleep medicine are working. The nurses and technicians provide the following services under the supervision of faculty members:

• Consultation and evaluation by specialists
• State-of-the-art **2-bed sleep laboratory**
• Detailed evaluation and treatment of cardiac-related sleep disorder
• Management of **NIV (Non-Invasive Ventilation)** adjustments difficulties
• **Polysomnography (PSG)** and **PAP titration**

Respiratory Physiology and Diagnostics

Respiratory physiology services contain:

• **Preparatory pulmonary evaluation** of high risk patients
• **Pulmonary Function Test (PFT) and CPET:** PFT (Spirometry, Body box, DLCO). **Cardiopulmonary Exercise Testing (CPET)** provides comprehensive testing for heart and lung conditions to determine limiting factors. The CPET laboratory is a national referral center for evaluating symptoms during physical activity. (Physicians involved include respiratory or cardiac physicians. 12 trained nurses work under direct supervision.)

Five trained technicians under supervision of pulmonologist and anesthesiologist are working with **Non-Invasive Ventilation (NIV)** and **Invasive ventilation**. Post cardiac surgery pulmonary complications such as difficult weaning or hypercapnia hypoxic failure are managed by expert physicians.

Consultative and Bronchoscopy Services

Respiration Service / Consultative services include:

• Evaluation and management of pulmonary disease in patients with heart failure, cardiovascular and pulmonary vascular disease
• Preoperative pulmonary evaluation for high risk patients prior to cardiac surgeries (CABG, Valvular surgery, Cardiac transplantation, etc.)
• Evaluation and management of sleep disturbances including sleep apnea, insomnia and other sleep related issues

Diagnostic bronchoscopy services contain:

• Diagnostic flexible Bronchoscopy
• Broncho alveolar Lavage (BAL)
• Endobronchial and Transbronchial lung biopsy
• Bronchoscopy in pulmonary and critically ill cardiac patient in ICU, CCU and bronchoscopy room.