Pulmonary rehabilitation protocols in urgent lung transplantation patients

doi:10.5847/wjem.j.1920-8642.2024.015

Abstract

Abstract:

BACKGROUND: Prolonged invasive respiratory support and extracorporeal membrane oxygenation (ECMO) in patients requiring urgent lung transplantation (ULTx) present significant challenges to clinical practice due to severe underlying diseases and complex conditions. The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.
METHODS: A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation (IMV) and ECMO between January 2018 and January 2023. Data were retrieved from electronic medical records at our lung transplant center.
RESULTS: Fourteen patients (mean age 57.43±10.97 years; 12 males, 2 females) underwent ULTx with bridging ECMO and IMV. The mean body mass index was 23.94±3.33 kg/m², and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.50±3.96. The Nutritional Risk Screening 2002 (NRS 2002) scores were ≥3. ULTx was performed after an 8.5-day waiting period (interquartile interval [IQR] 5.0-26.5 d). Following the surgeries, the average lengths of ECMO and IMV were 1.0 (IQR 1.0-2.0) d and 5.0 (IQR 3.0-7.3) d, respectively. The total length of hospital stay was 60.1±30.8 d, with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d. Two patients died within 30 d after ULTx, with a 30-day survival rate of 85.71%.
CONCLUSION: Patients receiving ULTx showed an acceptable short-term survival rate, validating the practicality and safety of the treatment protocols implemented in our center.

Key words: Urgent lung transplantation, End-stage lung disease, Extracorporeal membrane oxygenation, Invasive respiratory support, Pulmonary rehabilitation.

Fei Zeng, Lingyun Cai, Luyao Guo, Meijuan Lan, Jiangshuyuan Liang, Peipei Gu. Pulmonary rehabilitation protocols in urgent lung transplantation patients[J]. World Journal of Emergency Medicine, 2024, 15(1): 47-51.

References 17

1	Valapour M, Lehr CJ, Skeans MA, Smith JM, Miller E, Goff R, et al. OPTN/SRTR 2020 annual data report: lung. Am J Transplant. 2022; 22(Suppl 2):438-518.
2	Huang M, Xu YS, Yan S, Shi YJ, Pan SB, Chen YB, et al.Use of veno-arterial extracorporeal membrane oxygenation ian the first successful combined lung-liver transplantation patient in China. World J Emerg Med. 2022; 13(5):412-4. doi: 10.5847/wjem.j.1920-8642.2022.090 pmid: 36119762
3	Boffini M, Venuta F, Rea F, Colledan M, Santambrogio L, D’Armini AM, et al. Urgent lung transplant programme in Italy: analysis of the first 14 months. Interact Cardiovasc Thorac Surg. 2014; 19(5): 795-800. doi: 10.1093/icvts/ivu257
4	Roux A, Beaumont-Azuar L, Hamid AM, de Miranda S, Grenet D, Briend G, et al. High emergency lung transplantation: dramatic decrease of waiting list death rate without relevant higher post-transplant mortality. Transpl Int. 2015; 28(9):1092-101. doi: 10.1111/tri.12604 pmid: 25959679
5	Holm AM, Gottlieb J. Saving those who can’t wait. Eur Respir J. 2019; 54(5):1901668. doi: 10.1183/13993003.01668-2019
6	Branch of Organ Transplantation of Chinese Medical Association, National Quality Management and Control Center for Lung Transplantation. Guideline on the application of extracorporeal membrane oxygenation during the perioperative period of lung transplantation (2019 edition). Organ Transplant, 2019; 10 (4):402-9.
7	Zeng F, Lan MJ, Liang JSY, Wu WY. Nursing care for preoperative prerehabilitation of 25 lung transplant patients. Chin J Nurs. 2022; 57 (17):2080-4.
8	Lan MJ, Zeng F, Liang JSY. Construction and application of a pulmonary rehabilitation program in patients with double lung transplantation. Chin J Nurs. 2022; 57(6):659-65. doi: 10.3761/j.issn.0254-1769.2022.06.003
9	Respiratory Therapy Group of Chinese Society of Critical Care Medicine. Expert consensus of airway clearance in critically ill patients. Chin J Crit Care Med. 2020; 6(3):272-82.
10	Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, et al. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders: revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). Anaesthesist. 2015; 64(Suppl 1):1-26. doi: 10.1007/s00101-015-0071-1
11	Hämmäinen P, Schersten H, Lemström K, Riise GC, Kukkonen S, Swärd K, et al. Usefulness of extracorporeal membrane oxygenation as a bridge to lung transplantation: a descriptive study. J Heart Lung Transplant. 2011; 30(1):103-7. doi: 10.1016/j.healun.2010.08.017
12	Critical Care Medicine Professional Committee of Respiratory Physicians Branch of Chinese Medical Doctor Association, Critical Care Medicine Group of Respiratory Medicine Branch of Chinese Medical Association. Recommendations for clinical application of extracorporeal membrane oxygenation in adults severe acute respiratory failure. Chinese Journal of Tuberculosis and Breath. 2019; 42 (9):660-84.
13	Hoetzenecker K, Donahoe L, Yeung JC, Azad S, Fan E, Ferguson ND, et al. Extracorporeal life support as a bridge to lung transplantation-experience of a high-volume transplant center. J Thorac Cardiovasc Surg. 2018; 155(3):1316-28.e1. doi: S0022-5223(17)32720-4 pmid: 29248282
14	Schiavon M, Faggi G, di Gregorio G, Calabrese F, Lunardi F, Marulli G, et al.Single-center experience in urgent lung transplantation program in a country with a shortage of donors: does the end justify the means? Clin Transplant. 2017; 31(12):e13129. doi: 10.1111/ctr.2017.31.issue-12
15	Auråen H, Schultz HHL, Hämmäinen P, Riise GC, Larsson H, Hansson L, et al. Urgent lung allocation system in the Scandia transplant countries. J Heart Lung Transplant. 2018; 37(12):1403-9. doi: 10.1016/j.healun.2018.08.002
16	Schechter MA, Ganapathi AM, Englum BR, Speicher PJ, Daneshmand MA, Davis RD, et al. Spontaneously breathing extracorporeal membrane oxygenation support provides the optimal bridge to lung transplantation. Transplantation. 2016; 100(12):2699-704. pmid: 26910331
17	Gottlieb J, Smits J, Schramm R, Langer F, Buhl R, Witt C, et al. Lung transplantation in Germany since the introduction of the lung allocation score. Dtsch Arztebl Int. 2017; 114(11):179-85. doi: 10.3238/arztebl.2017.0179 pmid: 28382903

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