American University of Beirut

Pulmonary Critical Care Services

Clinical Subdivisions

Medical Intensive Care unit

The intensive care unit (ICU) consists of nine combined surgical and medical beds. There are plans to increase the capacity to twelve combined surgical and medical beds. The unit is staffed with five medical intensive care unit physicians trained in the United States and four of them are American Board certified in Critical Care. The yearly average admission is in excess of 300 with an occupancy rate in excess of 90%. The unit is capable of performing all standard ICU procedures and therapeutic interventions. 
In 2013 we have introduced several clinical practice protocols such as spontaneous weaning trial protocol, sedation and analgesia protocol, sepsis protocol…As well as monthly multidisciplinary education sessions designed to orient incoming house staff physicians to the policies and procedures pertinent to the ICU.  These educational sessions are associated with significant improvement in adherence to established protocols and policies adopted in the ICU as well as reduction in the rates of nosocomial infections.
Major limitation of the ICU remains the small size compared to the needs of our University Hospital. In fact every month several ICU patients are treated in the Emergency Department due to this problem.

Respiratory Care unit

The Respiratory Care Unit was created in 2010. It is currently an eight bed inpatient unit specialized in the care of patients with respiratory failure or advanced lung disease needing specialized care and weaning from ventilators. It has an occupancy rate that is about 80%. We are planning on acquiring monitors because the acuity in the unit is increasing since it is used as a step-down unit because there is no intermediate care unit in the hospital. The unit is staffed by all 6 pulmonologists, and is used for fellows and resident training in chronic ventilator management and weaning.

Pulmonary physiology laboratory

The pulmonary physiology laboratory is the first such laboratory established in Lebanon in the mid 1960’s.  The equipment of the Laboratory was renovated in 2005.
The lab performs a variety of pulmonary testing: Spirometry, Ventilatory Studies (Spirometry, Lung Volumes, and Diffusion Capacity), Respiratory Mechanics (Max. Voluntary Ventilation, Max. Inspiratory Pressure, Max. Expiratory Pressure), Body Plethysmography, 6 Minutes walk Test and Cardio-Pulmonary Stress Test. Also offered are: Methacholine Provocation Test and Impedance by Impulse Oscillometry.

Sleep laboratory

The sleep laboratory was the first such laboratory established in Lebanon in 2002. It consists of 2 separate rooms and testing units, with a central station. Equipment is planned for an upgrade in early 2014. The laboratory services are used by all 4 sleep board certified pulmonary physicians as well as a sleep board certified psychiatrist and neurologist. The lab performs full night polysomnography, split night polysomnography, and MSLT.  Total number of procedures per year exceeds 200. 
The sleep laboratory will be merged with the epilepsy laboratory to for a full neurophysiology unit.

Smoking cessation program

The smoking cessation program (SCP) was established in Nov 2004 with the multidisciplinary efforts of the pulmonary division, Psychiatry department, Dietary department, Nursing department, Pharmacy, and the financial advice of the Internal Medicine Department. It initially targeted the AUB personnel in an effort to improve the staff wellbeing and the patients with respiratory diseases and cardiovascular risk factors. Close to 400 patients were seen in the first years after its launching with fair success rates. Due to several factors as funding, personnel availability and logistics the program suffered from some drawbacks, but remained available to whoever needs consultation and at no charges.
Recently there was a strong revival of the program with the availability of specialized clinic, professional behavioral therapist, dietary advice, and a physician to patients who want to quit, for a reduced fee. 
Briefly the SCP includes:

  • Nursing assessment
  • Behavioral therapy 
  • Measuring exhaled CO
  • Measuring vital capacity
  • Dietary advice
  • Physician assessment and prescription
  • Close follow-up for 3 months with reevaluation for relapse, and withdrawal symptoms 

Furthermore it is expected that the SCP is going to be boosted further by its incorporation into the AUB wellness program, where it is going to offer help to all the community and patients seeking its help.

Initiatives and Programs

Endobronchial ultrasound

We were the first in Lebanon to introduce Endobronchial ultrasound (EBUS) to the practice of pulmonary medicine in early 2010. EBUS is a procedure that allows non-surgical sampling of mediastinal lymph nodes. It uses ultrasound along with bronchoscope to visualize airway wall and structures adjacent to it. The clinical application and diagnostic benefit of EBUS have been established in many studies. EBUS has been incorporated into routine practice in many centers because of its high diagnostic informative value and low risk.  We perform about 50 such procedures per year but expect the number to increase as EBUS is moving to become mainstream.
To date only one other center offers this modality in Lebanon. 

Pulmonary rehabilitation

The pulmonary rehabilitation program was established in November 2011. It is the first and only center in Lebanon (and probably in the Middle East) that provides respiratory disease patients with this state-of-the-art, multidisciplinary and evidence based intervention. The program includes a thorough assessment, exercise training, skills education as well as nutrition and psychological assessment for patients with COPD and other chronic respiratory illnesses such as bronchiectasis interstitial lung disease. The program offer participants a course consisting of 20 sessions over a period of 10 weeks. Each session includes a 30-minutes educational class followed by 60 minutes of monitored exercise training.

The Hamdi Al Zaim Interstitial Lung Disease (ILD) Program 

The Hamdi Al Zaim Interstitial Lung Disease (ILD) Program establishe in 2019 is dedicated to improving the lives of patients with interstitial lung disease, or ILD. We provide state-of-the -art diagnosis and treatment recommendations, by working as a multidisciplinary team to review each case thoroughly and to optimize disease and symptom management. The program delivers a comprehensive and holistic care for patients with all types of ILD. This is done by focusing on patient care, education and research, and community building. ILD team communicate directly with patients and their referring doctors to assure continuity of care and appropriate follow-up. 

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