Unique Pulmonary Fellowship Provides Training in Chronic Ventilation

The Ventilator Care Program (VCP) at Children’s Hospital Colorado is a multidisciplinary program that provides care to infants with chronic respiratory failure. The program, one of the largest in the country, has a significant impact on patients, families and providers. For the first time in its history, that impact is going global through a one-of-a-kind specialty fellowship.  

The Chronic Ventilation Fellowship, which is approved by the Accreditation Council for Graduate Medical Education, is designed for physicians who have and want to care for children with complex respiratory needs.  

Audrey Tilly-Gratton, MD, is the program’s inaugural fellow and a respirologist at Centre Hospitalier Universitaire Sainte-Justine, a peer institution in Montreal, Quebec, Canada. Under the mentorship of Christopher Baker, MD, Medical Director of the Ventilator Care Program, Dr. Tilly-Gratton sees patients in the clinic and conducts clinical and translational research. So far, she’s making a big impact.  

“People love her here,” Dr. Baker says. “They ask me, ‘Can we convince her to stay?’”  

Dr. Tilly-Gratton's first day at Children’s Colorado was on a Friday — the day the care team visits patients with tracheostomies and ventilators in the neonatal intensive care unit.  

“To see them all in a row and to see the collaboration between all those teams was awesome,” Dr. Tilly-Gratton says.  

That experience helped ground her and lay the foundation for her future success. When Dr. Tilly-Gratton's not seeing patients, she’s working on various research projects. 

Groundbreaking research in respiratory care 

During the fellowship, Dr. Tilly-Gratton worked with VCP team members to develop a new set of classes. These classes are based on the well-established VCP program for parents and families with children with tracheostomies and home ventilators. Choosing whether to proceed with a tracheostomy is a significant and often difficult decision for families. Dr. Tilly-Gratton wanted to be able to better prepare families for life at home, particularly for those whose children will require long-term support.  

The classes are working. Families and caregivers have reported an increase in confidence, comfort and knowledge of tracheostomy skills. The class aims to train two caregivers for each patient.  

Dr. Tilly-Gratton is also conducting a retrospective review of patients who have been treated with volume-targeted pressure support through a trach. This is a newer mode of ventilation that’s oftentimes more comfortable for patients. While other centers have published short case series on this topic, this study will be the biggest yet.  

“We’re getting some good data. It shows that patients are doing well, and it’s feasible. As a sub-project, we’re going to look more specifically at the ventilator settings for the premature infants with severe bronchopulmonary dysplasia,” Dr. Tilly-Gratton says.  

Dr. Tilly Gratton’s ongoing research with Children's Colorado is establishing her as an expert in the field. With Dr. Baker’s help, Dr. Tilly-Gratton is completing groundbreaking research on pediatric respiratory care, improved treatment protocols, patient education and more.  

“I view her as a colleague even though I’m mentoring her this year,” Dr. Baker says. “As soon as she’s done with this fellowship, she’ll be a peer in our field helping move chronic ventilation forward. I am excited for that.” 

This specialty training fellowship isn’t just about training one fellow. It’s about growing a community of experts. Academic medicine focuses on training future trainers and leaders in the field. When the fellowship concludes, Dr. Tilly-Gratton will return to her home hospital in Montreal to support the local chronic ventilation program, and the cycle will begin again.  

“Our goal is to be a global leader in pediatric healthcare. We want to share that, not hoard that,” Dr. Baker says. “Medicine is global. It always will be.”