Pulmonology, Allergy and Critical Care Medicine Division On Front Lines of Pandemic Caring for Patients, Battling COVID-19

Tuesday, September 28, 2021
An update from Interim Division Chief, Dr. Loretta Que. 
 
The Duke Division of Pulmonary, Allergy and Critical Care Medicine includes 73 faculty (70 MD/DO, 3 PhD), and six Advanced Practice Providers (PA, NP) practicing at five ambulatory locations and all three Duke Health System hospitals.

During the past 18 months, COVID-19 has posed many challenges for our division, reinforcing the importance of teamwork and resilience to battle this new challenge. We have come together to support each other, and in doing so, are taking the lead in coronavirus-related research and innovative clinical care.

As the numbers of patients hospitalized with COVID-19 reached daily record highs in North Carolina, the Duke Pulmonary, Allergy and Critical Care Medicine Division united to provide extraordinary care for patients presenting with critical illness and for those recovering from infection from the SARS CoV2 virus.

To better accommodate the numbers of patients admitted to Duke Health with critical illness, the Duke University Hospital Medical Intensive Care Unit (MICU) expeditiously relocated from Duke Medical Pavilion 6 East to 8 West enabling growth from 24 to 32 beds. The Duke Raleigh ICU is expanding from 15 to 24 beds. The ICU expansion allowed us to care for greater numbers of critically ill COVID-19 patients providing the opportunity to utilize our advanced ARDS care and COVID-19 treatment protocols. Of the 485 patients cared for in the DUH MICU up to August 2021, extraordinary measures were used to treat 68 patients with severe cardiopulmonary failure from COVID-19, including 66 that received extracorporeal membrane oxygenation (ECMO) and two patients who underwent lung transplantation. In our sister ICUs, an additional 230 COVID-19 patients were hospitalized at Duke Regional Hospital and 134 at Duke Raleigh. 

To study the long-term impact of COVID-19 infection on respiratory health, COVID-19 Long Hauler clinics were established at the Duke Asthma, Allergy and Airway Center (DAAAC) and Duke Raleigh Pulmonary clinic to care for patients infected with SARS-CoV2 who developed persistent respiratory symptoms. Greater than 200 patients have been seen in the Long Hauler Clinic and in our pulmonary outpatient clinics. 

All COVID-19 patients admitted to the Duke Health ICUs and seen in the post-COVID Pulmonary Long Hauler clinics are invited to enroll in the Division’s ICU and Post-COVID Pulmonary Biorepositories and databases and are able to participate in a number of the COVID-related clinical trials sponsored by the National Institutes of Health, pharmaceutical companies and foundations giving them access to state-of-the-art therapies and novel devices that are not readily available to the general public. 

As a result of these efforts, we are a Division that has not only met the challenges of the last 18 months but has taken the lead on research and innovative clinical care.

Despite the challenges and stress COVID-19 has placed on our Division, we continue to build and to grow our presence within the Raleigh-Durham community. In July 2020, the Duke Raleigh Pulmonary group formally transitioned from a CPDC to Division of Pulmonary, Allergy, and Critical Care practice.  Elsewhere in our Division, we have expanded our Allergy program at DAAAC and Southpoint and are continuing to enhance focused programs in Sleep Medicine and Thoracic Oncology. We have also taken advantage of telehealth technology to provide virtual care for our outpatient population. Our outpatient leadership has created a system by which patients unwilling or unable to be seen in-person have the option of tele-video visits allowing us to increase access to patient care.

Education

Capitalizing on the opportunity to care for more critical care patients, we have expanded our training program to add a Critical Care Fellowship program. In addition to existing 6 Pulmonary/Critical Care fellows, 1 Interventional Pulmonary fellow and 2 Lung Transplantation fellows, we have started a new Accreditation Council for Graduate Medical Education (ACGME)-accredited Critical Care Fellowship program, which will accept 2 new fellows per year. Our training programs have been a source of excellent faculty members and our Division prides itself on recruiting outstanding applicants. 

Research

In addition to COVID research, overall research in our Division continues to grow and covers a wide range of topics ranging from basic studies on red blood cells to translational research on airway diseases, clinical trials in pulmonary hypertension, lung transplantation, and interstitial lung diseases, and large database investigations. Members of the Division are also active in the study of health disparities in asthma and ICU outcomes, increasingly recognized research imperatives with a substantial impact on public health. Moreover, Duke remains an active member of the American Lung Association-Airways Clinical Research Centers (ALA-ACRC), Chronic Obstructive Pulmonary Disease Gene study (COPDgene), Cardiothoracic Surgery Network (CTSN), Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV 3), Prevention and Early Treatment of Acute Lung Injury (PETAL), Pulmonary Fibrosis Foundation’s clinical care network, Lung Transplant Outcomes Group (LTOG) and Clinical Trials in Organ Transplant (CTOT). Indeed, members of our division were recently awarded a National Institute of Allergy and Infectious Disease (NIAID) $20M grant to conduct an interventional multicenter clinical trial of a novel immunosuppressive strategy in lung transplant providing a critical and much needed opportunity to advance patient care and improve lung transplant outcomes. The award is a testament to our outstanding clinical lung transplant program, research staff and faculty collaborators and to the potential for innovative programmatic research we perform in our Division. 

As a Division, we continue to excel, advancing high quality clinical care for those in need, educating the next generation, and advancing science that will lead to future treatments for those with allergy, respiratory and critical care diseases. This has only been possible in these extraordinary times due to our incredible Division staff, fellows, and faculty.  

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