Acute Crit Care.  2018 Aug;33(3):146-153. 10.4266/acc.2018.00129.

Feasibility of Immediate in-Intensive Care Unit Pulmonary Rehabilitation after Lung Transplantation: A Single Center Experience

Affiliations
  • 1Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. pms70@yuhs.ac
  • 2Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Division of Nursing, Pediatric Intensive Care Unit, Severance Hospital, Seoul, Korea.
  • 4Division of Nursing, Neurointensive Care Unit, Severance Hospital, Seoul, Korea.
  • 5Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation.
METHODS
We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4).
RESULTS
The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4.
CONCLUSIONS
Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation.

Keyword

intensive care units; lung transplantation; rehabilitation

MeSH Terms

Follow-Up Studies
Gait
Humans
Intensive Care Units
Lung Transplantation*
Lung*
Male
Postoperative Period
Rehabilitation*
Retrospective Studies

Figure

  • Figure 1. Assessment of eligibility for pulmonary rehabilitation. ICU: intensive care unit; RASS: Richmond Agitation-Sedation Scale; FiO2: fraction of inspired oxygen; PEEP: positive end-expiratory pressure; SpO2: peripheral oxygen saturation; MAP: mean arterial pressure; DVT: deep vein thrombosis; INR: international normalized ratio.

  • Figure 2. Pulmonary rehabilitation program based on the functional grade. ROM: range of motion; tid: ter in die, three times a day; PTx: physical therapy.


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