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DeFreitas MR, McAdams HP, Azfar Ali H, Iranmanesh AM, Chalian H. Complications of Lung Transplantation: Update on Imaging Manifestations and Management. Radiol Cardiothorac Imaging 2021; 3:e190252. [PMID: 34505059 DOI: 10.1148/ryct.2021190252] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/02/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
As lung transplantation has become the most effective definitive treatment option for end-stage chronic respiratory diseases, yearly rates of this surgery have been steadily increasing. Despite improvement in surgical techniques and medical management of transplant recipients, complications from lung transplantation are a major cause of morbidity and mortality. Some of these complications can be classified on the basis of the time they typically occur after lung transplantation, while others may occur at any time. Imaging studies, in conjunction with clinical and laboratory evaluation, are key components in diagnosing and monitoring these conditions. Therefore, radiologists play a critical role in recognizing and communicating findings suggestive of lung transplantation complications. A description of imaging features of the most common lung transplantation complications, including surgical, medical, immunologic, and infectious complications, as well as an update on their management, will be reviewed here. Keywords: Pulmonary, Thorax, Surgery, Transplantation Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Mariana R DeFreitas
- Department of Radiology, Division of Cardiothoracic Imaging (M.R.D., H.P.M., A.M.I., H.C.), and Department of Medicine, Division of Pulmonary, Allergy and Critical Care (H.A.A.), Duke University Medical Center, Durham, NC
| | - Holman Page McAdams
- Department of Radiology, Division of Cardiothoracic Imaging (M.R.D., H.P.M., A.M.I., H.C.), and Department of Medicine, Division of Pulmonary, Allergy and Critical Care (H.A.A.), Duke University Medical Center, Durham, NC
| | - Hakim Azfar Ali
- Department of Radiology, Division of Cardiothoracic Imaging (M.R.D., H.P.M., A.M.I., H.C.), and Department of Medicine, Division of Pulmonary, Allergy and Critical Care (H.A.A.), Duke University Medical Center, Durham, NC
| | - Arya M Iranmanesh
- Department of Radiology, Division of Cardiothoracic Imaging (M.R.D., H.P.M., A.M.I., H.C.), and Department of Medicine, Division of Pulmonary, Allergy and Critical Care (H.A.A.), Duke University Medical Center, Durham, NC
| | - Hamid Chalian
- Department of Radiology, Division of Cardiothoracic Imaging (M.R.D., H.P.M., A.M.I., H.C.), and Department of Medicine, Division of Pulmonary, Allergy and Critical Care (H.A.A.), Duke University Medical Center, Durham, NC
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What Is the Best Pulmonary Physiotherapy Method in ICU? Can Respir J 2016; 2016:4752467. [PMID: 27445542 PMCID: PMC4904520 DOI: 10.1155/2016/4752467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 12/29/2022] Open
Abstract
Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p < 0.001). The PO2 levels increased in the study group at 72nd hour (p = 0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.
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Esguerra-Gonzalez A, Ilagan-Honorio M, Fraschilla S, Kehoe P, Lee AJ, Marcarian T, Mayol-Ngo K, Miller PS, Onga J, Rodman B, Ross D, Sommer S, Takayanagi S, Toyama J, Villamor F, Weigt SS, Gawlinski A. CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy. Am J Crit Care 2013; 22:115-24. [PMID: 23455861 DOI: 10.4037/ajcc2013869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).
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Affiliation(s)
- Angeli Esguerra-Gonzalez
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Monina Ilagan-Honorio
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Stephanie Fraschilla
- Stephanie Fraschilla and Jay Onga are transplant coordinators for the heart and lung transplant program at Ronald Reagan University of California Los Angeles Medical Center
| | - Priscilla Kehoe
- Priscilla Kehoe is the director of research and Sumiko Takayanagi is a senior statistician in the School of Nursing at the University of California Los Angeles
| | - Ai Jin Lee
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Taline Marcarian
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Kristina Mayol-Ngo
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Pamela S. Miller
- Pamela S. Miller is a postdoctoral scholar in the School of Nursing at the University of California San Francisco
| | - Jay Onga
- Stephanie Fraschilla and Jay Onga are transplant coordinators for the heart and lung transplant program at Ronald Reagan University of California Los Angeles Medical Center
| | - Betty Rodman
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - David Ross
- David Ross is a physician, professor, and medical director of the lung and heart-lung transplant program and S. Samuel Weigt is a physician and assistant professor in the Division of Pulmonary and Critical Care Medicine at David Geffen School of Medicine at University of California Los Angeles Medical Center
| | - Susan Sommer
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Sumiko Takayanagi
- Priscilla Kehoe is the director of research and Sumiko Takayanagi is a senior statistician in the School of Nursing at the University of California Los Angeles
| | - Joy Toyama
- Joy Toyama is a DrPH student in the Department of Biostatistics and a graduate student researcher in the School of Nursing at the University of California Los Angeles
| | - Filma Villamor
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - S. Samuel Weigt
- David Ross is a physician, professor, and medical director of the lung and heart-lung transplant program and S. Samuel Weigt is a physician and assistant professor in the Division of Pulmonary and Critical Care Medicine at David Geffen School of Medicine at University of California Los Angeles Medical Center
| | - Anna Gawlinski
- Anna Gawlinski is the director of research and evidence-based practice at Ronald Reagan University of California Los Angeles Medical Center and adjunct professor in the School of Nursing at the University of California Los Angeles
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