Medical Intensive Care Unit (MICU)
As a large tertiary care hospital, our closed ICU assumes care of patients with several complex and interconnected medical pathology, and is managed by Pulmonary-Critical Care Medicine (PCCM) division with a team consisting of senior resident and intern residents supervised by a PCCM faculty member and fellow. Our comprehensive team is also joined by dedicated critical care pharmacists, respiratory therapists, social workers and bedside nurses. Alongside are rotating medical students, pharmacology students, respiratory therapy students, and nursing students. MICU is predominantly run by fellows. Fellows have a leadership role as they mentor and supervise residents in management of complex medical conditions while they learn to navigate ethical dilemmas as they are exposed to patient populations with a diverse social demographic.
Fellows also have the opportunity to enhance their procedural skills in the ICU under direct supervision. Fellows are responsible for performing and teaching routine ICU procedures such as central venous catheter, temporary non-tunneled HD catheter, Swan-Ganz catheter/pulmonary artery catheters/right heart catheterization, endotracheal intubation, cordis lines, arterial catheters, thoracentesis, paracentesis, thoracic pigtail catheters, and percutaneous tracheostomies.
Critical Care Consults
A dedicated team consisting of fellows and a critical care hospitalist is supervised by a faculty member. The team is also joined by rotating residents that express interest in critical care medicine.
This service provides fellows the opportunity to provide direct patient-related care as they assume primary responsibility of MICU patients with complex medical pathology. Fellows gain independent time with PCCM faculty as they are supervised in their patient care duties, which also includes multi-disciplinary interaction with consultants of medical and surgical specialties. In addition, this service also serves as the pulmonary consult team for specialty ICU services such as CCU, Surgical ICU and Neuro-ICU. Fellows are also responsible for all routine ICU procedures as listed above.
Consult service team is composed of a faculty member and fellow as well as rotating residents for routine pulmonary consults placed in the medical-surgical wards. This rotation provides an opportunity to manage a wide range of complex pulmonary pathology including asthma, COPD, OSA, interstitial lung disease (ILD), pulmonary hypertension (PH), and sarcoidosis. In addition, fellows not only manage complex pleural pathology but perform interventional pleural procedures such as thoracic pigtail catheters, in-dwelling PleurX catheters, and pleuroscopy. Fellows are also exposed to a variety of interventional pulmonary procedures of routine and navigational bronchoscopies, EBUS, rigid bronchoscopies, endobronchial valve, and stent placements as they are supervised in these procedures by an interventional pulmonologist.
Continuity clinic rotation occurs one half-day per week throughout the academic year unless on night-float or vacation. Fellows assume care for an independent panel of patients, supervised by a faculty member. This exposure is intended to provide fellows with the necessary tools to manage common and extremely rare pulmonary conditions as it provides valuable ambulatory clinic experience.
This rotation is five days a week, 12-hour shift. Night float starts on Saturday night and ends on Thursday morning. The focus of the rotation is to encourage independent critical thinking and management.
We have several elective rotations available for senior fellows with in-patient rotations in the cardiothoracic ICU, CCU, neuro-ICU, surgical ICU, and advanced thoracic radiology. We also provide fellows outpatient elective rotations at the sleep, sarcoidosis, and pulmonary hypertension clinics. We have recently been offered an opportunity to rotate at Montefiore Medical Center in New York City for a lung transplant elective.
We have published over 50 publications in the last year in several certified journals including several with high impact factors such CHEST, Annals of ATS , Respiratory Medicine Journals. Fellows remain primary and co-authors on papers. We have two full-time research coordinators and statisticians to help with the research projects. Fellows are given several months of research rotations through the three years of training. It is the expectation that all fellows participate in scholarly activity including publications, abstracts, and oral presentations. Education and mentorship are available for the fellow to develop a hypothesis, study design, statistical method, and data interpretation. Fellows participate in a monthly research meeting with our division chair, Dr. Marc Judson.
On average, graduating fellows have performed several hundred procedures. With that exposure, all fellows will be comfortable performing the procedures required by ACGME.
Albany Stratton VA Medical Center
Medical Intensive Care Unit and Consults
This rotation resembles the description of the MICU at Albany Medical Center. The VA MICU is a typical ICU located in the community and therefore provides a unique experience for the fellow to gain insight and to compare working within different systems. In general, the curriculum, education and expectations are the same. This fellow also covers all inpatient pulmonary consultations and represents similar aspects of the consult service at Albany Medical Center.
Pulmonary Outpatient Clinic
This clinic has a focus on sleep medicine and therefore provides a unique experience. This exposure is intended to provide fellows with the necessary cognitive and technical skills to manage patients with a wide variety of sleep related disorders under supervision of a PCCM faculty.
Tuesday, Wednesday and Thursday: 7:30 to 8:30 a.m. – Dr. Scott Beegle. We discuss board review questions from ACCP-SEEK, and complex/challenging case reviews.
Monday: Noon to 1 p.m. – Dr. Amit Chopra. One of the most recent additions to our curriculum where fellows learn the theoretical and practical aspects of basic and advanced echocardiography. Three former fellows have successfully passed the Critical Care Echocardiography Examination.
Tuesday: Noon to 1 p.m. – Dr. Marc Judson. We discuss interesting cases of the week with clinical/radiological integration. This is often the fellows' favorite conference, where they learn how to approach a case and integrate clinical and radiographic knowledge and generate differential diagnosis.
Wednesday: Noon to 1 p.m. – Fellows present new articles, landmark studies. Dr. Paul Feustel is available as a dedicated statistician and physiologist.
Thursday: Noon to 1 p.m. Didactic sessions by faculty from our division and specialists from other divisions and departments such as neurology, hematology, oncology, gastroenterology, and trauma surgery.
Every third Friday: Noon to 1 p.m. We discuss research in progress.
Every first Monday: Noon to 1 p.m. This is a multidisciplinary conference involving radiology, Pulmonology, and pathology. We discuss three to four cases with interesting radiological and pathological findings.
Second and fourth Thursday of the month.
Many other lectures are given on campus and are available at different intervals. In the past they have included genetics, biostatistics, bioethics, legal and financial aspects of medical practice, and financial planning.
National & Regional Meeting Opportunities
During the three years of fellowship there is opportunity to attend and participate in national conferences such as the American Thoracic Society, American College of Chest Physicians, and the Cystic Fibrosis Conference.
This a joint conference that rotates between Albany Medical Center, Maine Medical Center, Dartmouth Hitchcock Medical Center, University of Vermont Medical Center, and Baystate Medical Center. This is a fellow-driven conference where research and clinical cases are presented. Faculty and fellows from each institution are in attendance.
This is an annual conference where faculty and senior fellows present important developments and cases in pulmonary and critical care medicine.
Starting in 2023, there will be a boot camp for three days that will include basic ultrasound training, introduction to common pulmonary critical care procedures, and basics of PFTs and radiology.
Research & Scholarly Activities
- Powassan virus encephalitis: Single center experience from capital district of New York. Al-Tarbsheh AH, Jain E, Austin A, Ramani A, Giampa J, Dawani O, Robeldo FMS, Chopra A. Am J Med Sci. 2022 Jul 22:S0002-9629(22)00288-9. doi: 10.1016/j.amjms.2022.06.011. Online ahead of print. PMID: 35878736 No abstract available.
- A 28-Year-Old Man With Diffuse Bilateral Pulmonary Nodules. Pokhrel K, Barry S, Ibrahim A, Smith T, Chopra A. Chest. 2022 Jul;162(1):e9-e13. doi: 10.1016/j.chest.2022.02.022. PMID: 35809963
- A 24-Year-Old Man With Dyspnea and a Broken Left Femur. Chieng H, Saha B, Foulke L, Wu GP, Chopra A. Chest. 2022 Apr;161(4):e225-e231. doi: 10.1016/j.chest.2021.10.026. PMID: 35396056
- Comparison of clinical characteristics and outcomes of Covid-19 patients undergoing early versus late intubation from initial hospital admission: A systematic review and meta-analysis. Chong WH, Saha BK, Murphy DJ, Chopra A. Respir Investig. 2022 May;60(3):327-336. doi: 10.1016/j.resinv.2022.02.007. Epub 2022 Mar 31. PMID: 35367154 Free PMC article. Review.
- Pericardial effusion in Covid-19 patients. Al-Tarbsheh AH, Leamon A, Chong WH, Chung JK, Oweis J, Vamshek S, Dawani O, Chopra A. Am J Med Sci. 2022 Jul;364(1):129-130. doi: 10.1016/j.amjms.2022.01.024. Epub 2022 Mar 8. PMID: 35276074 Free PMC article. No abstract available.
- Clinical Outcomes of Early Versus Late Intubation in Covid-19 Patients. Al-Tarbsheh A, Chong W, Oweis J, Saha B, Feustel P, Leamon A, Chopra A. Cureus. 2022 Jan 27;14(1):e21669. doi: 10.7759/cureus.21669. eCollection 2022 Jan. PMID: 35237472 Free PMC article.
- Lipoid Pneumonia. Chieng HC, Ibrahim A, Chong WH, Freed H, Fabian T, Saha B, Foulke L, Chopra A. Am J Med Sci. 2022 May;363(5):452-455. doi: 10.1016/j.amjms.2022.01.019. Epub 2022 Feb 5. PMID: 35134372 Review.
- A 26-year old young male with severe anemia. Salick M, Chaudhary R, Robledo FM, Datar PB, Htoo A, Shkolnik B, Chong WH, Chopra A, Saha BK. Respir Med Case Rep. 2022 Jan 5;36:101575. doi: 10.1016/j.rmcr.2021.101575. eCollection 2022. PMID: 35036305 Free PMC article.
- Sarcoidosis associated pleural effusion: Clinical aspects. Chopra A, Foulke L, Judson MA. Respir Med. 2022 Jan;191:106723. doi: 10.1016/j.rmed.2021.106723. Epub 2021 Dec 20. PMID: 34954636 Review.
- Association between Drainage-Dependent Prolonged Air Leak after Partial Lung Resection and Clinical Outcomes: A Prospective Cohort Study. Chopra A, Hu K, Judson MA, Fabian T, Nabagiez JP, Feustel PJ, Fantauzzi J, Chieng H, Austin A, Vancavage R, Maldonado F, Rahman N, Huggins JT, Doelken P. Ann Am Thorac Soc. 2022 Mar;19(3):389-398. doi: 10.1513/AnnalsATS.202103-235OC. PMID: 34715010
- Comparing the outcomes of intrapleural fibrinolytic and DNase therapy versus intrapleural fibrinolytic or DNase therapy: A systematic review and meta-analysis. Chong WH, Hu K, Saha BK, Chopra A. Pulm Pharmacol Ther. 2021 Dec;71:102081. doi: 10.1016/j.pupt.2021.102081. Epub 2021 Sep 24. PMID: 34571093 Review.
- Management of complex pleural disease in the critically ill patient. Hu K, Chopra A, Kurman J, Huggins JT. J Thorac Dis. 2021 Aug;13(8):5205-5222. doi: 10.21037/jtd-2021-31. PMID: 34527360 Free PMC article. Review.
- Pleural abnormalities in Covid-19: a narrative review. Saha BK, Chong WH, Austin A, Kathuria R, Datar P, Shkolnik B, Beegle S, Chopra A. J Thorac Dis. 2021 Jul;13(7):4484-4499. doi: 10.21037/jtd-21-542. PMID: 34422375 Free PMC article. Review.
- A Young Woman With Recurrent Episodes of Fever and Cough. Ghalib S, Chopra A, Fantauzzi JP, Nabagiez JP, Tiwari A. Chest. 2021 Jul;160(1):e25-e28. doi: 10.1016/j.chest.2021.01.042. PMID: 34246384
- 62-year-old woman with PET-positive solitary pulmonary nodule. Saha B, Chong WH, Chieng H, Chopra A. BMJ Case Rep. 2021 Jun 24;14(6):e243695. doi: 10.1136/bcr-2021-243695. PMID: 34167994 No abstract available.
- Does Covid-19 pneumonia signify secondary organizing pneumonia?: A narrative review comparing the similarities between these two distinct entities. Chong WH, Saha BK, Chopra A. Heart Lung. 2021 Sep-Oct;50(5):667-674. doi: 10.1016/j.hrtlng.2021.04.009. Epub 2021 May 29. PMID: 34098237 Free PMC article. Review.
- The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized Covid-19 patients: A systematic review. Chong WH, Saha BK, Hu K, Chopra A. Heart Lung. 2021 Sep-Oct;50(5):599-608. doi: 10.1016/j.hrtlng.2021.04.005. Epub 2021 May 1. PMID: 34087677 Free PMC article.
- Narrative review of the relationship between Covid-19 and PJP: does it represent coinfection or colonization? Chong WH, Saha BK, Chopra A. Infection. 2021 Dec;49(6):1079-1090. doi: 10.1007/s15010-021-01630-9. Epub 2021 May 31. PMID: 34059997 Free PMC article. Review.
- Pneumothorax in critically ill patients with Covid-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study. Chopra A, Al-Tarbsheh AH, Shah NJ, Yaqoob H, Hu K, Feustel PJ, Ortiz-Pacheco R, Patel KM, Oweis J, Kozlova N, Zouridis S, Ahmad S, Epelbaum O, Chong WH, Huggins JT, Saha BK, Conuel E, Chieng H, Mullins J, Bajaj D, Shkolnik B, Vancavage R, Madisi N, Judson MA. Respir Med. 2021 Aug;184:106464. doi: 10.1016/j.rmed.2021.106464. Epub 2021 May 13. PMID: 34044224 Free PMC article.
- Blood DNA methylation and Covid-19 outcomes. Balnis J, Madrid A, Hogan KJ, Drake LA, Chieng HC, Tiwari A, Vincent CE, Chopra A, Vincent PA, Robek MD, Singer HA, Alisch RS, Jaitovich A. Clin Epigenetics. 2021 May 25;13(1):118. doi: 10.1186/s13148-021-01102-9. PMID: 34034806 Free PMC article.
- The Relationship of Pleural and Pericardial Effusion With Pulmonary Hemodynamics in Patients With Pulmonary Hypertension. Chopra A, Highland KB, Kilb E, Huggins JT. Am J Med Sci. 2021 Jun;361(6):731-735. doi: 10.1016/j.amjms.2021.01.003. Epub 2021 Jan 9. PMID: 33947586
- Incidence and risk factors for secondary pulmonary infections in patients hospitalized with coronavirus disease 2019 pneumonia. Chong WH, Chieng H, Tiwari A, Beegle S, Feustel PJ, Ghalib S, Al-Tarbsheh AH, Jain E, Mullins J, Keenan M, Chopra A. Am J Med Sci. 2022 Jun;363(6):476-483. doi: 10.1016/j.amjms.2021.04.007. Epub 2021 Apr 21. PMID: 33894182 Free PMC article.
- The incidence of pleural effusion in Covid-19 pneumonia: State-of-the-art review. Chong WH, Saha BK, Conuel E, Chopra A. Heart Lung. 2021 Jul-Aug;50(4):481-490. doi: 10.1016/j.hrtlng.2021.02.015. Epub 2021 Feb 27. PMID: 33831700 Free PMC article.
- The association of ABO blood type with the risk and severity of Covid-19 infection. Mullins J, Al-Tarbsheh AH, Chieng H, Chaukiyal P, Ghalib S, Jain E, Dawani O, Santelises Robledo FM, Chong WH, Feustel PJ, Subik K, Chopra A. Am J Blood Res. 2021 Feb 15;11(1):53-58. eCollection 2021. PMID: 33796389 Free PMC article.
- State-of-the-art review of secondary pulmonary infections in patients with Covid-19 pneumonia. Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. Infection. 2021 Aug;49(4):591-605. doi: 10.1007/s15010-021-01602-z. Epub 2021 Mar 11. PMID: 33709380 Free PMC article. Review.
- Correlation of Respiratory Physiologic Parameters in Mechanically Ventilated Coronavirus Disease 2019 Patients. Saha BK, Ghalib S, Chieng H, Pezzano C, Lydon D, Feustel P, Smith TC, Chopra A. Crit Care Explor. 2021 Jan 13;3(1):e0328. doi: 10.1097/CCE.0000000000000328. eCollection 2021 Jan. PMID: 33490956 Free PMC article.
- The Significance of Subpleural Sparing in CT Chest: A State-of-the-Art Review. Chong WH, Saha BK, Austin A, Chopra A. Am J Med Sci. 2021 Apr;361(4):427-435. doi: 10.1016/j.amjms.2021.01.008. Epub 2021 Jan 9. PMID: 33487401 Review.
- Dyspnoea from a rapidly growing intrathoracic mass. Itty R, Chieng H, Ibrahim A, Nabagiez JP, Fantauzzi J, Chopra A. Thorax. 2020 Dec 3:thoraxjnl-2020-216193. doi: 10.1136/thoraxjnl-2020-216193. Online ahead of print. PMID: 33273027 No abstract available.
- Large-Scale Multi-omic Analysis of Covid-19 Severity. Overmyer KA, Shishkova E, Miller IJ, Balnis J, Bernstein MN, Peters-Clarke TM, Meyer JG, Quan Q, Muehlbauer LK, Trujillo EA, He Y, Chopra A, Chieng HC, Tiwari A, Judson MA, Paulson B, Brademan DR, Zhu Y, Serrano LR, Linke V, Drake LA, Adam AP, Schwartz BS, Singer HA, Swanson S, Mosher DF, Stewart R, Coon JJ, Jaitovich A. Cell Syst. 2021 Jan 20;12(1):23-40.e7. doi: 10.1016/j.cels.2020.10.003. Epub 2020 Oct 8. PMID: 33096026 Free PMC article.
- Blastomycosis in the Capital District of New York State: A Newly Identified Emerging Endemic Area. Austin A, Tobin E, Judson MA, Hage CA, Hu K, Epelbaum O, Fantauzzi J, Jones DM, Gilroy S, Chopra A. Am J Med. 2021 Feb;134(2):e101-e108. doi: 10.1016/j.amjmed.2020.09.017. Epub 2020 Oct 20. PMID: 33091391
- Response. Shkolnik B, Judson MA, Austin A, Hu K, D'souza M, Zumbrunn A, Huggins JT, Yucel R, Chopra A. Chest. 2020 Oct;158(4):1783-1784. doi: 10.1016/j.chest.2020.06.076. PMID: 33036094 No abstract available.
- Characteristics of Pleural Effusion in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pneumonia. Chong WH, Huggins JT, Chopra A. Am J Med Sci. 2021 Feb;361(2):281-284. doi: 10.1016/j.amjms.2020.09.008. Epub 2020 Sep 11. PMID: 32951846 Free PMC article. No abstract available.
- Corticosteroid Administration Is Associated With Improved Outcome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2-Related Acute Respiratory Distress Syndrome. Chopra A, Chieng HC, Austin A, Tiwari A, Mehta S, Nautiyal A, Al-Tarbsheh AH, Jain E, Feustel PJ, Shkolnik B, Jaitovich A. Crit Care Explor. 2020 Jun 15;2(6):e0143. doi: 10.1097/CCE.0000000000000143. eCollection 2020 Jun. PMID: 32696006 Free PMC article.
- Granulomatous lung disease: clinical aspects. Chopra A, Avadhani V, Tiwari A, Riemer EC, Sica G, Judson MA. Expert Rev Respir Med. 2020 Oct;14(10):1045-1063. doi: 10.1080/17476348.2020.1794827. Epub 2020 Sep 2. PMID: 32662705 Review.
- Pleural manometry: techniques, applications, and pitfalls. Hu K, Chopra A, Huggins JT, Nanchal R. J Thorac Dis. 2020 May;12(5):2759-2770. doi: 10.21037/jtd.2020.04.04. PMID: 32642184 Free PMC article. Review.
- The Reply. Conuel EJ, Chieng HC, Fantauzzi J, Pokhrel K, Goldman C, Smith TC, Tiwari A, Chopra A, Judson MA. Am J Med. 2020 May;133(5):e206-e207. doi: 10.1016/j.amjmed.2019.12.049. PMID: 32450951 No abstract available.
- Predictive value of hospital discharge neurological outcome scores for long-term neurological status following out-of-hospital cardiac arrest: A systematic review. Wu W, Chopra A, Ziegler C, McLeod SL, Lin S. Resuscitation. 2020 Jun;151:139-144. doi: 10.1016/j.resuscitation.2020.04.013. Epub 2020 Apr 15. PMID: 32304801 Review.
- Diagnostic Accuracy of Thoracic Ultrasonography to Differentiate Transudative From Exudative Pleural Effusion. Shkolnik B, Judson MA, Austin A, Hu K, D'Souza M, Zumbrunn A, Huggins JT, Yucel R, Chopra A. Chest. 2020 Aug;158(2):692-697. doi: 10.1016/j.chest.2020.02.051. Epub 2020 Mar 17. PMID: 32194059
- Cannabinoid Oil Vaping-Associated Lung Injury and its Radiographic Appearance. Conuel EJ, Chieng HC, Fantauzzi J, Pokhrel K, Goldman C, Smith TC, Tiwari A, Chopra A, Judson MA. Am J Med. 2020 Jul;133(7):865-867. doi: 10.1016/j.amjmed.2019.10.032. Epub 2019 Nov 18. PMID: 31751528
- The Relationship of Pleural Manometry With Postthoracentesis Chest Radiographic Findings in Malignant Pleural Effusion. Chopra A, Judson MA, Doelken P, Maldonado F, Rahman NM, Huggins JT. Chest. 2020 Feb;157(2):421-426. doi: 10.1016/j.chest.2019.08.1920. Epub 2019 Aug 28. PMID: 31472154