In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation.
Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it's becoming impossible to master both (everything reaching from the outpatient pulmonary clinics to the interventional suite to the ICU).
But I don't make the rules. Among most hospitals in the United States, the intensivist may be expected to field inpatient pulmonary consultations (at least during nights and weekends). Additionally, the intensivist will usually be expected to bring a high level of pulmonary expertise to any ICU patients (thus obviating the need to obtain an additional pulmonology consultation).
The IBHP will expand the pulmonary section of the IBCC with the addition of about fifty chapters. The goal will be to cover hospital pulmonology: issues that commonly arise in the emergency department, inpatient wards, and ICU. The IBHP will not cover issues that are predominantly of outpatient concern (e.g., chronic cough, cardiopulmonary stress testing, lung cancer screening, latent tuberculosis infection).
Thoracic CT scan imaging will be emphasized, since this is a workhorse test for acute care of complex pulmonary patients that provides actionable information in real time. A primary cause of misdiagnosis in pulmonology is information loss between the interpreting radiologist and the bedside clinician (e.g., the radiology read is entirely correct, yet it fails to fully convey the nuances of the scan). Additionally, radiologists may not be available to interpret scans during off-hours, or to re-interpret scans performed at outside facilities prior to inter-hospital transfers. Thus, it's incumbent on pulmonologists to maintain a high-level proficiency in thoracic radiology.
For all my ultrasound aficionados out there, homage will be paid to point-of-care ultrasonography (especially for pleural disease). POCUS is terrific for simple problems. However, especially for patients with complex parenchymal or vascular disease, the CT scan still reigns as the definitive study.
(Histopathology is largely overlooked, since pathology is a time-delayed test that is uncommonly utilized and will invariably be interpreted with the assistance of a pathologist. My apologies to all the trainees who memorized every aspect of pathology, but on a day-to-day basis this is minimally useful.)
So, if you're confused about why non-ICU pulmonary topics are suddenly popping up, that's why. The chapters will hopefully roll out over ~1 year. Some links won't work until the target chapters are posted.
As always, I'd encourage you to post comments and corrections to the text. Comments should be publicly posted under the section labeled “questions & discussion” (which links to a separate page designed for comments). Please don't e-mail me with corrections (my e-mail box is a flaming disaster). Publicly posting comments also allows for ongoing transparent dialogue and debate.
Following completion of these chapters, I'll circle back and further update the other chapters. The ultimate goal will be to create a modern, integrated text covering general critical care, neurocritical care, and hospital pulmonology.
cheers, josh
- PulmCrit Hot Take: Aggressive glycemic control is dead (TGC-Fast Trial) - September 28, 2023
- PulmCrit – Introducing the IBPH (Internet Book of Hospital Pulmonology) - September 3, 2023
- PulmCrit: “ARDS” is not a real thing - May 27, 2023
Incredible! Super excited for this.
Love Josh (and Adam)
Thank you, Josh. IBCC is already a fantastic resource, this will make it even better. All this takes a lot of time and energy; huge appreciation from all of us (and our patients who benefit)
Exceptionally useful reference. Superb efforts and I miss your podcast with Adam!
You, sir, are a hero of modern medical teaching
Couldn’t agree more with the thought behind this undertaking . Excellent idea . Looking forward to it .
Fantastic news! THANK YOU very much indeed
You are amazing!!!