Surveys are being used increasingly in health-care research to answer questions that may be diffi... more Surveys are being used increasingly in health-care research to answer questions that may be difficult to answer using other methods. While surveys depend on data that may be influenced by self-report bias, they can be powerful tools as physicians seek to enhance the quality of care delivered or the health care systems they work in. The purpose of this article is to provide readers with a basic framework for understanding survey research, with a goal of creating well-informed consumers. The importance of validation, including pretesting surveys before launch, will be discussed. Highlights from published surveys are offered as supplementary material.
Background. There are modes of mechanical ventilation that can select ventilator settings with co... more Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario's respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.
Chronic obstructive lung disease (COPD) is one of the most prevalent health conditions, and a maj... more Chronic obstructive lung disease (COPD) is one of the most prevalent health conditions, and a major cause of morbidity and mortality around the globe. Once thought of primarily as a disease of men, COPD is now known to be increasingly prevalent among women. Although increasing tobacco consumption among women during the past several decades might explain some of this increase, the relationship may be more complex, including factors such as differential susceptibility to tobacco, anatomic and hormonal differences, behavioral differences, and differences in response to available therapeutic modalities. Moreover, women with COPD may present differently, may have a different pattern of comorbidities, and may have a better survival after acute exacerbations. Care providers continue to have a gender bias that may affect both diagnosis and treatment. Future work should focus on factors that lead to gender differences in COPD as well as gender-specific treatment strategies.
Lung transplantation is an evolving specialty with the number of transplants growing annually. A ... more Lung transplantation is an evolving specialty with the number of transplants growing annually. A structured lung transplant curriculum was developed for Pulmonary/Critical Care (Pulm/CC) fellows. Scores on pulmonary in-training examinations (ITE) 2 years prior to and 3 years after implementation were reviewed as well as completion of satisfaction surveys. The mean pulmonary ITE score of 1st-year fellows increased from 54.2 ± 2.5 to 63.6 ± 1.2 (M ± SD), p = .002, whereas mean pulmonary ITE score for 2nd-year fellows increased from 63.0 ± 3.0 to 70.7 ± 1.2, p = .019. The combined mean pulmonary ITE score increased from 58.6 ± 2.3 to 67.1 ± 1.2, p = .001. Satisfaction surveys revealed that fellow perception of the curriculum was that the experience contributed to an overall improvement in their knowledge base and clinical skills while opportunity to perform transbronchial biopsies was available. A structured educational lung transplant curriculum was associated with improved performance on the pulmonary ITE and was perceived by fellows to be beneficial in their education and training while providing opportunities for fellows to perform transbronchial biopsies.
Background: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basi... more Background: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of postbronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality.
Background: Long-term follow-up after transition to oral agents from parenteral prostanoid therap... more Background: Long-term follow-up after transition to oral agents from parenteral prostanoid therapy has not been well characterized. Methods: We reviewed our long-term experience after oral transitioning in patients with pulmonary hypertension. Patients were weaned off parenteral therapy based on a predetermined outpatient protocol. Data were collected retrospectively after transition had taken place.
Rhodococcus equi is an emerging opportunistic pathogen in immunocompromised patients. A lung-tran... more Rhodococcus equi is an emerging opportunistic pathogen in immunocompromised patients. A lung-transplant recipient developed weight loss, nonproductive cough, dyspnea, and somnolence. Computed tomogram showed a pulmonary nodule and pleural changes in the right allograft that was due to R. equi infection. Alteration of cell-mediated immunity is a predisposing risk factor for R. equi infection in humans. Our patient developed R. equi infection soon after a course of high-dose corticosteroids for acute allograft infection and animal exposure. A course of intravenous vancomycin followed by single-agent long-term therapy with oral ciprofloxacin was successful.
Patients with pulmonary hypertension (PH) are considered to be at risk for complications associat... more Patients with pulmonary hypertension (PH) are considered to be at risk for complications associated with flexible bronchoscopy (FB). Although previous reports suggest that transbronchial biopsies increase the risk for hemorrhage in this population, data are limited to survey analyses and isolated reports. It was the aim of this study to describe our experience with FB and to determine if bronchoscopic procedures are associated with adverse events in this population. We conducted a retrospective review of patients with diagnosis of PH who underwent FB at the Cleveland Clinic between 2002 and 2005. Patients without PH who underwent FB by the same pulmonary physician were used as controls. A total of 90 patients, PH (n = 45) versus controls (n = 45), were included. The mean systolic pulmonary artery pressure in patients with PH was 58 +/- 7 mm Hg. Patients with PH had higher oxygen requirements at baseline (FiO(2) 0.42 vs. 0.3%; p = 0.01). The total number of procedures was similar between the groups (95 vs. 102). Procedures performed were bronchoalveolar lavage (21 vs. 13), transbronchial biopsies (24 vs. 32) and transbronchial needle aspiration (7 vs. 6). There were no hemodynamic complications or episodes of respiratory failure associated with the procedures. None of the patients had significant hemorrhage and only 2 developed mild bleeding which resolved spontaneously. Similarly, none required hospitalization or transfer to an intensive care unit. FB can be performed safely in patients with mild to moderate PH. Transbronchial biopsies are not associated with worsening hypoxemia or an increased risk of hemorrhage. Prospective studies with hemodynamic measurements are necessary to confirm these findings.
The Journal of Heart and Lung Transplantation, 2008
Atrial fibrillation occurs frequently after lung transplantation and is commonly treated with ami... more Atrial fibrillation occurs frequently after lung transplantation and is commonly treated with amiodarone. Pulmonary toxicity may result from amiodarone exposure and is characterized by non-specific respiratory manifestations. To our knowledge, there are no reports of this complication occurring after lung transplantation. We present a patient who developed radiologic evidence of amiodarone deposition in the lungs after bilateral lung transplantation.
Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adult... more Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adults. Smoking, air pollution, and bronchial hyperresponsiveness are the main risk factors. The treatment of these diseases in older adults does not differ from the available guidelines but may be complicated by the presence of comorbidities. Smoking cessation is essential for smokers, and pulmonary rehabilitation must be considered regardless of the age of the patient. (J Allergy Clin Immunol 2010;126:702-9.)
Pulmonary hypertension is an uncommon complication of sarcoidosis, but in severe pulmonary diseas... more Pulmonary hypertension is an uncommon complication of sarcoidosis, but in severe pulmonary disease it occurs frequently. It is an important cause of cryptogenic dyspnea in sarcoidosis patients, and can occur despite the absence of pulmonary fibrosis. The true prevalence is unknown. With the advent of specific therapies for pulmonary hypertension, there has been a resurgence of interest in the pathophysiology, diagnosis, and treatment of sarcoidosis-associated pulmonary hypertension. This article reviews the status of the current epidemiologic, pathophysiologic and therapeutic knowledge regarding this entity.
In Italy, occupational diseases are required by law to be listed (however, any occupational disea... more In Italy, occupational diseases are required by law to be listed (however, any occupational diseases not included in the list may be compensated if workers demonstrate causation in court). The list is periodically updated in order to incorporate new findings from medical research. Decree no. 336/94 uses a less inclusive term (chronic obstructive bronchitis) than that used in the earlier decree, no. 482/75 (chronic obstructive pulmonary disease, COPD). Moreover, it includes fewer occupations that involve a risk of developing COPD. In order to find an epidemiological basis that might justify the above changes to Italian law, risk of COPD was investigated in relation to occupation and time, using a case-referent design. The same definition for COPD (clinical history of >2 years with shortness of breath and/or winter phlegm and an FEV1 less than 80% of the predicted value, only minimally reversible with bronchodilators and without marked change during the hospital observation period) was used in two case-referent studies. The first study was carried out from 1972 to 1980 (202 cases of COPD and 202 referents matched for age and sex) and the second from 1990 to 1997 (131 cases of COPD and 298 referents, every fourth eligible patient in each calendar year of observation). In both studies cases and referents were classified into 16 occupational categories, and office workers were the reference. All subjects were selected from male patients admitted to the Occupational Health Clinic in Padua. Smoking-adjusted (Mantel-Haenszel analysis, first study), or age-smoking-adjusted (logistic regression analysis, second study) Odds Ratio (OR) and 95% confidence interval (CI) for COPD were estimated in each occupational category and in two main groups: workers employed in occupations at either high or low risk for COPD. The latter OR and the fraction of exposed cases (pc) were used to estimate the population attributable risk (PAR) through: pc(OR-1)/OR. Significantly high risks for COPD in miners and chemical workers were observed in the first period, but not in the second time window. On the other hand, an increased time trend for OR estimates was found in welders, wood carpenters, construction and foundry workers. Among farmers, painters, cotton textile and refractory brick workers, the OR for COPD was significantly above unity in both time periods. PAR was 37% in the first and 52% in the second study. The restrictive definition of occupational COPD, which was introduced by Decree no. 336/94, contrasts with the epidemiological evidence showing that the risk of occupational COPD has increased over time: up to 50% of COPD cases referred to an occupational medicine physician might have an occupational origin.
Patients with coal workers&am... more Patients with coal workers' pneumoconiosis (CWP) can develop chronic respiratory failure and require lung transplantation. A retrospective review was performed of the 712 referrals and 143 patients undergoing unilateral or bilateral lung transplantation at the University of Kentucky Medical Center between January 1999 and July 2009. Twenty-one of the 712 referrals (3%) had a diagnosis of CWP with eight patients eventually undergoing lung transplant (six single, two bilateral). The mean age of the cohort was 53 ± 5 (mean ± SD) yr (range 45-59). There was no increased risk of perioperative or postoperative complications. Six patients (75%) remain alive after a mean follow-up of 1013 ± 857 d with the two deaths attributable to sepsis 683 and 145 d after transplant, respectively. There were no pulmonary complications because of the native lung in patients after a single lung transplant, with otherwise good clinical outcomes seen after lung transplantation.
A 65-year-old man with pulmonary fibrosis presented 6 months after single left-lung transplantati... more A 65-year-old man with pulmonary fibrosis presented 6 months after single left-lung transplantation complaining of odynophagia. Initial evaluation at an outside institution included direct laryngoscopy, which revealed the presence of a mass at the base of the ...
The objectives of this study were to determine the current staffing models of practice and the fr... more The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models. A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers. We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P < .001). Advanced nurse practitioners with critical care training were reported available by 27% of the PDs. The majority of respondents believed that 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees' autonomy. Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows' autonomy.
Surveys are being used increasingly in health-care research to answer questions that may be diffi... more Surveys are being used increasingly in health-care research to answer questions that may be difficult to answer using other methods. While surveys depend on data that may be influenced by self-report bias, they can be powerful tools as physicians seek to enhance the quality of care delivered or the health care systems they work in. The purpose of this article is to provide readers with a basic framework for understanding survey research, with a goal of creating well-informed consumers. The importance of validation, including pretesting surveys before launch, will be discussed. Highlights from published surveys are offered as supplementary material.
Background. There are modes of mechanical ventilation that can select ventilator settings with co... more Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario's respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.
Chronic obstructive lung disease (COPD) is one of the most prevalent health conditions, and a maj... more Chronic obstructive lung disease (COPD) is one of the most prevalent health conditions, and a major cause of morbidity and mortality around the globe. Once thought of primarily as a disease of men, COPD is now known to be increasingly prevalent among women. Although increasing tobacco consumption among women during the past several decades might explain some of this increase, the relationship may be more complex, including factors such as differential susceptibility to tobacco, anatomic and hormonal differences, behavioral differences, and differences in response to available therapeutic modalities. Moreover, women with COPD may present differently, may have a different pattern of comorbidities, and may have a better survival after acute exacerbations. Care providers continue to have a gender bias that may affect both diagnosis and treatment. Future work should focus on factors that lead to gender differences in COPD as well as gender-specific treatment strategies.
Lung transplantation is an evolving specialty with the number of transplants growing annually. A ... more Lung transplantation is an evolving specialty with the number of transplants growing annually. A structured lung transplant curriculum was developed for Pulmonary/Critical Care (Pulm/CC) fellows. Scores on pulmonary in-training examinations (ITE) 2 years prior to and 3 years after implementation were reviewed as well as completion of satisfaction surveys. The mean pulmonary ITE score of 1st-year fellows increased from 54.2 ± 2.5 to 63.6 ± 1.2 (M ± SD), p = .002, whereas mean pulmonary ITE score for 2nd-year fellows increased from 63.0 ± 3.0 to 70.7 ± 1.2, p = .019. The combined mean pulmonary ITE score increased from 58.6 ± 2.3 to 67.1 ± 1.2, p = .001. Satisfaction surveys revealed that fellow perception of the curriculum was that the experience contributed to an overall improvement in their knowledge base and clinical skills while opportunity to perform transbronchial biopsies was available. A structured educational lung transplant curriculum was associated with improved performance on the pulmonary ITE and was perceived by fellows to be beneficial in their education and training while providing opportunities for fellows to perform transbronchial biopsies.
Background: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basi... more Background: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of postbronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality.
Background: Long-term follow-up after transition to oral agents from parenteral prostanoid therap... more Background: Long-term follow-up after transition to oral agents from parenteral prostanoid therapy has not been well characterized. Methods: We reviewed our long-term experience after oral transitioning in patients with pulmonary hypertension. Patients were weaned off parenteral therapy based on a predetermined outpatient protocol. Data were collected retrospectively after transition had taken place.
Rhodococcus equi is an emerging opportunistic pathogen in immunocompromised patients. A lung-tran... more Rhodococcus equi is an emerging opportunistic pathogen in immunocompromised patients. A lung-transplant recipient developed weight loss, nonproductive cough, dyspnea, and somnolence. Computed tomogram showed a pulmonary nodule and pleural changes in the right allograft that was due to R. equi infection. Alteration of cell-mediated immunity is a predisposing risk factor for R. equi infection in humans. Our patient developed R. equi infection soon after a course of high-dose corticosteroids for acute allograft infection and animal exposure. A course of intravenous vancomycin followed by single-agent long-term therapy with oral ciprofloxacin was successful.
Patients with pulmonary hypertension (PH) are considered to be at risk for complications associat... more Patients with pulmonary hypertension (PH) are considered to be at risk for complications associated with flexible bronchoscopy (FB). Although previous reports suggest that transbronchial biopsies increase the risk for hemorrhage in this population, data are limited to survey analyses and isolated reports. It was the aim of this study to describe our experience with FB and to determine if bronchoscopic procedures are associated with adverse events in this population. We conducted a retrospective review of patients with diagnosis of PH who underwent FB at the Cleveland Clinic between 2002 and 2005. Patients without PH who underwent FB by the same pulmonary physician were used as controls. A total of 90 patients, PH (n = 45) versus controls (n = 45), were included. The mean systolic pulmonary artery pressure in patients with PH was 58 +/- 7 mm Hg. Patients with PH had higher oxygen requirements at baseline (FiO(2) 0.42 vs. 0.3%; p = 0.01). The total number of procedures was similar between the groups (95 vs. 102). Procedures performed were bronchoalveolar lavage (21 vs. 13), transbronchial biopsies (24 vs. 32) and transbronchial needle aspiration (7 vs. 6). There were no hemodynamic complications or episodes of respiratory failure associated with the procedures. None of the patients had significant hemorrhage and only 2 developed mild bleeding which resolved spontaneously. Similarly, none required hospitalization or transfer to an intensive care unit. FB can be performed safely in patients with mild to moderate PH. Transbronchial biopsies are not associated with worsening hypoxemia or an increased risk of hemorrhage. Prospective studies with hemodynamic measurements are necessary to confirm these findings.
The Journal of Heart and Lung Transplantation, 2008
Atrial fibrillation occurs frequently after lung transplantation and is commonly treated with ami... more Atrial fibrillation occurs frequently after lung transplantation and is commonly treated with amiodarone. Pulmonary toxicity may result from amiodarone exposure and is characterized by non-specific respiratory manifestations. To our knowledge, there are no reports of this complication occurring after lung transplantation. We present a patient who developed radiologic evidence of amiodarone deposition in the lungs after bilateral lung transplantation.
Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adult... more Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adults. Smoking, air pollution, and bronchial hyperresponsiveness are the main risk factors. The treatment of these diseases in older adults does not differ from the available guidelines but may be complicated by the presence of comorbidities. Smoking cessation is essential for smokers, and pulmonary rehabilitation must be considered regardless of the age of the patient. (J Allergy Clin Immunol 2010;126:702-9.)
Pulmonary hypertension is an uncommon complication of sarcoidosis, but in severe pulmonary diseas... more Pulmonary hypertension is an uncommon complication of sarcoidosis, but in severe pulmonary disease it occurs frequently. It is an important cause of cryptogenic dyspnea in sarcoidosis patients, and can occur despite the absence of pulmonary fibrosis. The true prevalence is unknown. With the advent of specific therapies for pulmonary hypertension, there has been a resurgence of interest in the pathophysiology, diagnosis, and treatment of sarcoidosis-associated pulmonary hypertension. This article reviews the status of the current epidemiologic, pathophysiologic and therapeutic knowledge regarding this entity.
In Italy, occupational diseases are required by law to be listed (however, any occupational disea... more In Italy, occupational diseases are required by law to be listed (however, any occupational diseases not included in the list may be compensated if workers demonstrate causation in court). The list is periodically updated in order to incorporate new findings from medical research. Decree no. 336/94 uses a less inclusive term (chronic obstructive bronchitis) than that used in the earlier decree, no. 482/75 (chronic obstructive pulmonary disease, COPD). Moreover, it includes fewer occupations that involve a risk of developing COPD. In order to find an epidemiological basis that might justify the above changes to Italian law, risk of COPD was investigated in relation to occupation and time, using a case-referent design. The same definition for COPD (clinical history of >2 years with shortness of breath and/or winter phlegm and an FEV1 less than 80% of the predicted value, only minimally reversible with bronchodilators and without marked change during the hospital observation period) was used in two case-referent studies. The first study was carried out from 1972 to 1980 (202 cases of COPD and 202 referents matched for age and sex) and the second from 1990 to 1997 (131 cases of COPD and 298 referents, every fourth eligible patient in each calendar year of observation). In both studies cases and referents were classified into 16 occupational categories, and office workers were the reference. All subjects were selected from male patients admitted to the Occupational Health Clinic in Padua. Smoking-adjusted (Mantel-Haenszel analysis, first study), or age-smoking-adjusted (logistic regression analysis, second study) Odds Ratio (OR) and 95% confidence interval (CI) for COPD were estimated in each occupational category and in two main groups: workers employed in occupations at either high or low risk for COPD. The latter OR and the fraction of exposed cases (pc) were used to estimate the population attributable risk (PAR) through: pc(OR-1)/OR. Significantly high risks for COPD in miners and chemical workers were observed in the first period, but not in the second time window. On the other hand, an increased time trend for OR estimates was found in welders, wood carpenters, construction and foundry workers. Among farmers, painters, cotton textile and refractory brick workers, the OR for COPD was significantly above unity in both time periods. PAR was 37% in the first and 52% in the second study. The restrictive definition of occupational COPD, which was introduced by Decree no. 336/94, contrasts with the epidemiological evidence showing that the risk of occupational COPD has increased over time: up to 50% of COPD cases referred to an occupational medicine physician might have an occupational origin.
Patients with coal workers&am... more Patients with coal workers' pneumoconiosis (CWP) can develop chronic respiratory failure and require lung transplantation. A retrospective review was performed of the 712 referrals and 143 patients undergoing unilateral or bilateral lung transplantation at the University of Kentucky Medical Center between January 1999 and July 2009. Twenty-one of the 712 referrals (3%) had a diagnosis of CWP with eight patients eventually undergoing lung transplant (six single, two bilateral). The mean age of the cohort was 53 ± 5 (mean ± SD) yr (range 45-59). There was no increased risk of perioperative or postoperative complications. Six patients (75%) remain alive after a mean follow-up of 1013 ± 857 d with the two deaths attributable to sepsis 683 and 145 d after transplant, respectively. There were no pulmonary complications because of the native lung in patients after a single lung transplant, with otherwise good clinical outcomes seen after lung transplantation.
A 65-year-old man with pulmonary fibrosis presented 6 months after single left-lung transplantati... more A 65-year-old man with pulmonary fibrosis presented 6 months after single left-lung transplantation complaining of odynophagia. Initial evaluation at an outside institution included direct laryngoscopy, which revealed the presence of a mass at the base of the ...
The objectives of this study were to determine the current staffing models of practice and the fr... more The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models. A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers. We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P < .001). Advanced nurse practitioners with critical care training were reported available by 27% of the PDs. The majority of respondents believed that 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees' autonomy. Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows' autonomy.
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