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Cucchi M, Mariani S, Kawczynski MJ, Shkurka E, Ius F, Comentale G, Hoskote A, Lorusso R. Individual patient data meta-analysis on awake pediatric extracorporeal life support: Feasibility and safety of analgesia, sedation and respiratory support weaning, and physiotherapy. Perfusion 2024:2676591241240377. [PMID: 38652693 DOI: 10.1177/02676591241240377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Awake Extracorporeal Life Support (aECLS) with active mobilization has gained consensus over time, also within the pediatric community. This individual patient data (IPD) meta-analysis summarizes available evidence on pediatric aECLS, its feasibility, and safety regarding sedation weaning, extubation, and physiotherapy. METHODS PubMed/Medline and Cochrane Database were screened until February 2022. Articles reporting on children (≤18 years) undergoing aECLS were selected. IPD were requested, pooled in a single database, and analyzed using descriptive statistics. Primary outcome was survival to hospital discharge. Secondary outcomes included extubation during ECLS, physiotherapy performed, tracheostomy, and complications. RESULTS Nineteen articles and 65 patients (males:n = 30/59,50.8%) were included. Age ranged from 2 days to 17 years. ECLS configurations included veno-venous (n = 42/65, 64.6%), veno-arterial (n = 18/65, 27.7%) and other ECLS settings (n = 5/65, 7.7%). Exclusive neck cannulation was performed in 51/65 (78.5%) patients. Extubation or tracheostomy during ECLS was reported in 66.2% (n = 43/65) and 27.7% (n = 18/65) of patients, respectively. Physiotherapy was reported as unspecified physical activity (n = 34/63, 54%), mobilization in bed (n = 15/63, 23.8%), ambulation (n = 14/63, 22.2%). Complications were reported in 60.3% (n = 35/58) of patients, including hemorrhagic (36.2%), mechanical (17.2%), or pulmonary (17.2%) issues, and need for reintubation (15.5%). Survival at discharge was 81.5% (n = 53/65). CONCLUSION Awake ECLS strategy with active physiotherapy can be applied in children from neonatal age. Ambulation is also possible in selected cases. Complications related to such management were limited. Further studies on aECLS are needed to evaluate safety and efficacy of early physiotherapy and define patient selection.
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Affiliation(s)
- Marta Cucchi
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Pediatric Intensive Care Unit, Queensland Children Hospital, Brisbane, QLD, Australia
| | - Silvia Mariani
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Michal J Kawczynski
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Emma Shkurka
- Pediatric Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Fabio Ius
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Giuseppe Comentale
- IRCCS Policlinico Universitario Sant'Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Aparna Hoskote
- Pediatric Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Muelas-Gómez L, Martínez-Gimeno L, Escudero-Gómez C, Atin Arratibel MÁ, Cebrià i Iranzo MA, Solís-Muñoz M. [Efficacy of Physiotherapy Interventions on the Respiratory Musculature Through Respiratory Training Techniques in Post-operative Lung Transplant Recipients: Systematic Review]. OPEN RESPIRATORY ARCHIVES 2024; 6:100288. [PMID: 38274199 PMCID: PMC10809207 DOI: 10.1016/j.opresp.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/09/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Respiratory muscles are a limiter of exercise capacity in lung transplant patients. It is necessary to know the effectiveness of specific respiratory muscle training techniques carried out in the management of adult lung transplant patients in the postoperative period. Methodology A systematic review of clinical trials was carried out, which included adult lung transplant patients undergoing post-transplant respiratory training. A search was carried out in the databases PubMed/Medline, EMBASE, Scopus, Web of Science, Cochrane Library between January 2012 and September 2023, using the terms: "breathing exercise", "respiratory muscle training", "inspiratory muscle training", "respiratory exercise", "pulmonary rehabilitation", "lung rehabilitation"; in combination with "lung transplantation", "lung transplant", "posttransplant lung". No language limit. Results Eleven trials were included with a total of 639 patients analyzed. Most training programs begin upon hospital discharge (more than one month post-transplant), few do so early (Intensive Care Unit). The duration varies from 1-12 months post-transplant. The interventions were based on aerobic training and peripheral muscle strength. Some of them included breathing exercises and chest expansions. The most used outcome variable was submaximal exercise capacity measured with the 6-minute walk test. Conclusions Training the respiratory muscles of the adult transplant patient favors the improvement of exercise capacity and quality of life. Aerobic training, as well as strength training of the rest of the peripheral muscles, contribute to the improvement of respiratory muscles.
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Affiliation(s)
- Laura Muelas-Gómez
- Unidad de Rehabilitación Respiratoria, Servicio de Rehabilitación y Medicina Física, Hospital Universitario Puerta de Hierro Majadahonda, Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, España
| | - Lara Martínez-Gimeno
- Fundación San Juan de Dios, Departamento de Ciencias de la Salud, Escuela de Enfermería y Fisioterapia San Juan de Dios, Universidad Pontificia Comillas, Madrid, España
| | - Cristina Escudero-Gómez
- Servicio de Biblioteca, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - María Ángeles Atin Arratibel
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Maria Angels Cebrià i Iranzo
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia. Servicio de Medicina Física y Rehabilitación, Hospital La Fe de Valencia. Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Montserrat Solís-Muñoz
- Unidad de Investigación, Desarrollo e Innovación en Cuidados de Salud, Hospital Universitario Puerta de Hierro Majadahonda, Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, España
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Design of Lung Transplant Go (LTGO): A randomized controlled trial evaluating the efficacy of a telerehabilitation behavioral exercise intervention to improve physical activity, physical function, and blood pressure control after lung transplantation. Contemp Clin Trials Commun 2023; 33:101097. [PMID: 36911577 PMCID: PMC9999171 DOI: 10.1016/j.conctc.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/22/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Background Lung transplantation is an established treatment option for persons with advanced lung disease. After transplantation, lung function typically returns to near normal levels, however exercise capacity remains low due to chronic deconditioning, limited physical function, and inactive lifestyles which undermine the intended benefits of the highly selective, resource-intensive transplant procedure. Pulmonary rehabilitation is recommended to improve fitness and activity tolerance, however due to multiple barriers, lung transplant recipients either never participate, or fail to complete, pulmonary rehabilitation programs. Purpose To describe the design of Lung Transplant Go (LTGO), a trial modified for the remote environment based on recommendations to preserve trial integrity during COVID. The aims are to evaluate a behavioral exercise intervention to improve physical function, physical activity, and blood pressure control in lung transplant recipients conducted safely and effectively using a telerehabilitation (telerehab) platform, and to explore the role of potential mediators and moderators of the relationship between LTGO and outcomes. Methods Single-site, 2-group randomized controlled trial with lung transplant recipients randomized 1:1 to either the LTGO intervention (a 2-phased, supervised, telerehab behavioral exercise program), or to enhanced usual care (activity tracking and monthly newsletters). All study activities, including intervention delivery, recruitment, consenting, assessment, and data collection, will be performed remotely. Conclusion If efficacious, this fully scalable and replicable telerehab intervention could be efficiently translated to reach large numbers of lung recipients to improve and sustain self-management of exercise habits by overcoming barriers to participation in existing, in-person pulmonary rehabilitation programs.
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Chen Y, Li D, Liu Z, Liu Y, Fan H, Hou S. Research progress of portable extracorporeal membrane oxygenation. Expert Rev Med Devices 2023; 20:221-232. [PMID: 36846940 DOI: 10.1080/17434440.2023.2185136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is primarily used for the supportive treatment of patients suffering from severe cardiopulmonary failure. With the continued development of ECMO technology, the relevant scenarios also extend pre-hospital and inter-hospital. In order to meet the needs of emergency treatment in communities, disaster sites and battlefields, inter-hospital transfer and evacuation; miniaturized and portable ECMO has become a current research hotspot. AREA COVERED The paper first introduces the principle, composition and common modes of ECMO and summarizes the research status of portable ECMO, Novalung and wearable ECMO, analyzes the characteristics and shortcomings of existing equipment. finally, we discussed the focus and development trend of portable ECMO technology. EXPERT OPINION Currently, portable ECMO has many applications in interhospital transport and there are various studies on portable and wearable ECMO devices, but the development of portable ECMO still faces many challenges. In the future, research related to integrated components, rich sensor arrays, Intelligent ECMO system and lightweight technology can make future portable ECMO more suitable for pre-hospital emergency and interhospital transport.
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Affiliation(s)
- Yuansen Chen
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Duo Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Ziquan Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yanqing Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Shike Hou
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
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Lung Transplant Rehabilitation-A Review. Life (Basel) 2023; 13:life13020506. [PMID: 36836863 PMCID: PMC9962622 DOI: 10.3390/life13020506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Both lung transplant recipients and candidates are characterised by reduced training capacity and low average quality of life (QoL). This review investigates the impact of training on exercise ability and QoL in patients before and after lung transplant. METHODS Searches were conducted from the beginning to 7 March 2022 using the terms "exercise," "rehabilitation," "lung transplant," "exercise ability," "survival," "quality of life" and "telerehabilitation" in six databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL, Nursing and Allied Health, and Scopus. The inclusion criteria were studies evaluating the effects of an exercise training programme concurrent with lung transplantation as well as patients and candidates (>18 years old) through any lung diseases. The term "lung transplant rehabilitation" was used to refer to all carefully thought-out physical activities with the ultimate or intermediate objective of improving or maintaining physical health. RESULTS Out of 1422 articles, 10 clinical- and 3 telerehabilitation studies, candidates (n = 420) and recipients (n = 116) were related to the criteria and included in this review. The main outcome significantly improved in all studies. The 6-min walk distance, maximum exercise capacity, peak oxygen uptake, or endurance for constant load rate cycling improved measuring physical activity [aerobic exercises, breathing training, and aerobic and inspiratory muscle training sessions (IMT)]. Overall scores for dyspnoea improved after exercise training. Furthermore, health-related quality of life (HRQOL) also improved after aerobic exercise training, which was performed unsupervised or accompanied by breathing sessions. Aerobic training alone rather than combined with inspiratory muscle- (IMT) or breathing training enhanced exercise capacity. CONCLUSION In conclusion, rehabilitation programmes seem to be beneficial to patients both preceding and following lung transplantation. More studies are required to determine the best training settings in terms of time scale, frequency, and work intensity in terms of improving exercise ability, dyspnoea, and HRQOL.
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Early Change in Lower Limb Strength and Function in Lung Transplant Patients After Center-Based and Telerehabilitation. J Cardiopulm Rehabil Prev 2023; 43:55-60. [PMID: 35961370 DOI: 10.1097/hcr.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this study was to examine the change and relationship among quadriceps torque (QT) and physical function in adult lung transplant (LTx) patients undergoing rehabilitation. METHODS A prospective study assessed 6-min walk test (6MWT) distance, QT, and Short Physical Performance Battery (SPPB) at the start of pre-habilitation and 10-12 wk post-LTx. Functional outcomes were examined for within-group differences for participants who completed center-based rehabilitation between September 2019 and March 2020 and participants who completed telerehabilitation ("telerehab") between March 2020 and June 2021 during COVID-19. Relationships between QT, SPPB, and 6MWT were examined pre- and post-LTx. RESULTS A total of 49 LTx recipients were included (30 men, 61 [56-67] yr, 26 center-based rehab, and 23 telerehab). The 6MWT increased (median 75 m: 95% CI, 35 - 117, P < .0001), and the telerehab group showed an LTx decrease in QT (-9.6 Nm: 95% CI, -29 to -2.3, P = .02) and an increased gait speed (0.21 m/sec: 95% CI, 0.11 - 0.47, P < .0001). Pre-LTx QT showed a moderate correlation to pre-LTx SPPB ( r = 0.41, P = .004) and weak correlations to gait speed and 6MWT ( r ranging from 0.21 to 0.35, P < .05). Post-LTx QT showed moderate correlations to post-LTx SPPB ( r = 0.43, P = .002), gait speed ( r = 0.54, P < .001), five-time sit-to-stand ( r =-0.57, P < .0001), and 6MWT ( r = 0.62, P < .0001). CONCLUSIONS Early post-LTx 6MWT and gait speed increased with no improvement in QT or other SPPB components. Correlations between QT and measures of exercise capacity and lower limb function were stronger post-LTx. Serial measurements may further inform functional trajectories and rehabilitation models.
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Hume E, Muse H, Wallace K, Wilkinson M, Heslop Marshall K, Nair A, Clark S, Vogiatzis I. Feasibility and acceptability of a physical activity behavioural modification tele-coaching intervention in lung transplant recipients. Chron Respir Dis 2022; 19:14799731221116588. [PMID: 36306548 PMCID: PMC9619269 DOI: 10.1177/14799731221116588] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite improvements in pulmonary function following lung transplantation (LTx), physical activity levels remain significantly lower than the general population. To date, there is little research investigating interventions to improve daily physical activity in LTx recipients. This study assessed the feasibility and acceptability of a novel, 12-weeks physical activity tele-coaching (TC) intervention in LTx recipients. METHODS Lung transplant recipients within 2 months of hospital discharge were recruited and randomised (1:1) to TC or usual care (UC). TC consists of a pedometer and smartphone app, allowing transmission of activity data to a platform that provides feedback, activity goals, education, and contact with the researcher as required. Recruitment and retention, occurrence of adverse events, intervention acceptability and usage were used to assess feasibility. RESULTS Key criteria for progressing to a larger study were met. Of the 15 patients eligible, 14 were recruited and randomised to TC or UC and 12 completed (67% male; mean ± SD age; 58 ± 7 years; COPD n = 4, ILD n = 6, CF n = 1, PH n = 1): TC (n = 7) and UC (n = 5). TC was well accepted by patients, with 86% indicating that they enjoyed taking part. Usage of the pedometer was excellent, with all patients wearing it for over 90% of days and rating the pedometer and telephone contact as the most vital aspects. There were no adverse events related to the intervention. After 12 weeks, only TC displayed improvements in accelerometry steps/day (by 3475 ± 3422; p = .036) and movement intensity (by 153 ± 166 VMU; p = .019), whereas both TC and UC groups exhibited clinically important changes in physical SF-36 scores (by 11 ± 14 and 7 ± 9 points, respectively). CONCLUSION TC appears to be a feasible, safe, and well-accepted intervention in LTx.
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Affiliation(s)
- Emily Hume
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK,Emily HumeDepartment of Sport, Exercise and Rehabilitation, Faculty of Health and Life sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne NE1 8ST, UK.
| | - Hazel Muse
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie Wallace
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mick Wilkinson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Arun Nair
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Clark
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Abstract
Rationale: Sarcopenia is associated with disability and death. The optimal definition and clinical relevance of sarcopenia in lung transplantation remain unknown. Objectives: To assess the construct and predictive validity of sarcopenia definitions in lung transplant candidates. Methods: In a multicenter prospective cohort of 424 lung transplant candidates, we evaluated limited (muscle mass only) and expanded (muscle mass and quality) sarcopenia definitions from the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and a cohort-specific distribution-based lowest quartile definition. We assessed construct validity using associations with conceptually related factors. We evaluated the relationship between sarcopenia and frailty using generalized additive models. We also evaluated associations between sarcopenia definitions and key pretransplant outcomes, including disability (quantified by the Lung Transplant Valued Life Activities scale [range, 0-3; higher scores = worse disability; minimally important difference, 0.3]) and waitlist delisting/death, by multivariate linear and Cox regression, respectively. Results: Sarcopenia prevalence ranged from 6% to13% by definition used. The limited EWGSOP2 definition demonstrated the highest construct validity, followed by the expanded EWGSOP2 definition and both limited and expanded FNIH and lowest quartile definitions. Sarcopenia exhibited a linear association with the risk of frailty. The EWGSOP2 and expanded lowest quartile definitions were associated with disability, ranging from 0.20 to 0.25 higher Lung Transplant Valued Life Activities scores. Sarcopenia was associated with increased risk of waitlist delisting or death by the limited and expanded lowest quartile definitions (hazard ratio [HR], 3.8; 95% confidence interval [CI], 1.4-9.9 and HR, 3.5; 95% CI, 1.1-11.0, respectively) and the EWGSOP2 limited definition (HR, 2.8; 95% CI, 0.9-8.6) but not with the three other candidate definitions. Conclusions: The prevalence and validity of sarcopenia vary by definition; the EWGSOP2 limited definition exhibited the broadest validity in lung transplant candidates. The linear relationship between low muscle mass and frailty highlights sarcopenia's contribution to frailty and also questions the clinical utility of a sarcopenia cut-point in advanced lung disease. The associations between sarcopenia and important pretransplant outcomes support further investigation into using body composition for candidate risk stratification.
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Yamaga T, Yamamoto S, Sakai Y, Ichiyama T. Effects of inspiratory muscle training after lung transplantation in children. BMJ Case Rep 2021; 14:14/7/e241114. [PMID: 34290002 DOI: 10.1136/bcr-2020-241114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pulmonary rehabilitation is a cornerstone of management for patients after lung transplantation (LT), but the benefits of inspiratory muscle training (IMT) after LT in children are unclear. Therefore, we examined whether IMT can improve respiratory function and dyspnoea in a paediatric patient after LT.The patient was a 13-year-old boy who underwent double LT. However, mild physical activity such as walking triggered dyspnoea for the patient. The patient underwent IMT with the intensity of approximately 30% of his maximal inspiratory pressure (MIP) for 2 months.The patient's MIP was increased by approximately 60% after 2 months, and his forced vital capacity as a percent of the predicted normal value increased from 74.6% to 83.4%, with improvement of dyspnoea.IMT may help improve dyspnoea after LT in children with respiratory muscle weakness and a decline in respiratory function.
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Affiliation(s)
- Takayoshi Yamaga
- Occupational Therapy, Health Science University, Minamitsuru-gun, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Yasunari Sakai
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Takashi Ichiyama
- First Department of Internal Medicine, Shinshu University School of Medicin, Matsumoto, Nagano, Japan
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Soetanto V, Grewal US, Mehta AC, Shah P, Varma M, Garg D, Majumdar T, Dangayach NS, Grewal HS. Early postoperative complications in lung transplant recipients. Indian J Thorac Cardiovasc Surg 2021; 38:260-270. [PMID: 34121821 PMCID: PMC8187456 DOI: 10.1007/s12055-021-01178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/28/2022] Open
Abstract
Lung transplantation has become an established therapy for end-stage lung diseases. Early postoperative complications can impact immediate, mid-term, and long-term outcomes. Appropriate management, prevention, and early detection of these early postoperative complications can improve the overall transplant course. In this review, we highlight the incidence, detection, and management of these early postoperative complications in lung transplant recipients.
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Affiliation(s)
- Vanessa Soetanto
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Udhayvir Singh Grewal
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH USA
| | - Parth Shah
- Department of Medicine, Trumbull Regional Medical Center, Northeast Ohio Medical University, Warren, OH USA
| | - Manu Varma
- Division of Pediatric Cardiology, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Delyse Garg
- Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ USA
| | - Tilottama Majumdar
- Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ USA
| | - Neha S Dangayach
- Department of Neurosurgery, Division of NeuroCritical Care, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Harpreet Singh Grewal
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine Lung Transplantation, NewYork-Presbyterian/Columbia University Medical Center, New York, NY USA
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Cappelle M, Masschelein E, Vos R, Van Remoortel H, Smets S, Vanbekbergen J, Verreydt J, Troosters T, Goetschalckx K, Gosselink R, Monbaliu D. High-Intensity Training for 6 Months Safely, but Only Temporarily, Improves Exercise Capacity in Selected Solid Organ Transplant Recipients. Transplant Proc 2021; 53:1836-1845. [PMID: 34049699 DOI: 10.1016/j.transproceed.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Organ transplantation is a life-saving intervention that improves quality of life of patients with irreversible organ failure. Although exercise training immediately after transplantation has been suggested to be beneficial, such interventions remain rare in stable transplant recipients, whereas effects of high-intensity training (HIT) are even less frequently investigated. Moreover, sustainability of such interventions has not yet been reported. We investigated the effects of a 6-month, cycling-based HIT program on physical performance in long-term stable solid organ transplant (SOT) recipients, with follow-up evaluation after 6 months. METHODS Forty-two adult, stable, and selected SOT recipients participated in a 6-month individualized home- and group-based HIT program. Exercise capacity (VO2max), maximal power (Wmax), and body mass index were measured before, at the end, and 6 months after completion of the intervention. RESULTS The study comprised 12 heart, 7 lung, 8 liver, and 15 kidney recipients (mean age, 41.4 ± 11.1 years; median time posttransplant, 3.4 [1.7-8.0] years). For 6 months, VO2max increased in the heart, lung, and kidney groups, Wmax increased in the heart group, and body mass index decreased in the liver group. Six months after the HIT program, the achieved gain in exercise capacity had disappeared in all groups. CONCLUSION Despite voluntary participation selection bias, our observations indicate that HIT is safe and may result in a beneficial effect on physical performance in selected, stable SOT recipients. However, there was no sustained beneficial effect once training stopped. Larger scale and longer term studies are still required to investigate longevity of improvement and overall beneficial effects on clinical outcomes.
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Affiliation(s)
- Marie Cappelle
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Evi Masschelein
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department CHROMETA, BREATHE, KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Hans Van Remoortel
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Sven Smets
- Department of Nephrology, Sint Trudo Hospital, Sint-Truiden, Belgium
| | - Jonas Vanbekbergen
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Joris Verreydt
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
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13
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Condensed Outpatient Rehabilitation Early After Lung Transplantation: A Retrospective Analysis of 6-Minute Walk Distance and Its Predictors. Cardiopulm Phys Ther J 2021. [DOI: 10.1097/cpt.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Orizondo RA, Omecinski KS, May AG, Dhamotharan V, Frankowski BJ, Burgreen GW, Ye SH, Kocyildirim E, Sanchez PG, D’Cunha J, Wagner WR, Federspiel WJ. Month-long Respiratory Support by a Wearable Pumping Artificial Lung in an Ovine Model. Transplantation 2021; 105:999-1007. [PMID: 33031226 PMCID: PMC8024407 DOI: 10.1097/tp.0000000000003481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A wearable artificial lung could improve lung transplantation outcomes by easing implementation of physical rehabilitation during long-term pretransplant respiratory support. The Modular Extracorporeal Lung Assist System (ModELAS) is a compact pumping artificial lung currently under development. This study evaluated the long-term in vivo performance of the ModELAS during venovenous support in awake sheep. Feedback from early trials and computational fluid dynamic analysis guided device design optimization along the way. METHODS The ModELAS was connected to healthy sheep via a dual-lumen cannula in the jugular vein. Sheep were housed in a fixed-tether pen while wearing the device in a holster during support. Targeted blood flow rate and support duration were 2-2.5 L/min and 28-30 days, respectively. Anticoagulation was maintained via systemic heparin. Device pumping and gas exchange performance and hematologic indicators of sheep physiology were measured throughout support. RESULTS Computational fluid dynamic-guided design modifications successfully decreased pump thrombogenicity from initial designs. For the optimized design, 4 of 5 trials advancing past early perioperative and cannula-related complications lasted the full month of support. Blood flow rate and CO2 removal in these trials were 2.1 ± 0.3 L/min and 139 ± 15 mL/min, respectively, and were stable during support. One trial ended after 22 days of support due to intradevice thrombosis. Support was well tolerated by the sheep with no signs of hemolysis or device-related organ impairment. CONCLUSIONS These results demonstrate the ability of the ModELAS to provide safe month-long support without consistent deterioration of pumping or gas exchange capabilities.
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Affiliation(s)
- Ryan A. Orizondo
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Medicine, University of Pittsburgh
- Department of Bioengineering, University of Pittsburgh
| | - Katelin S. Omecinski
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Bioengineering, University of Pittsburgh
| | - Alexandra G. May
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Chemical and Petroleum Engineering, University of Pittsburgh
| | - Vishaal Dhamotharan
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Bioengineering, University of Pittsburgh
| | | | - Greg W. Burgreen
- Computational Fluid Dynamics Group, Center for Advanced Vehicular Systems, Mississippi State University
| | - Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Surgery, University of Pittsburgh
| | - Ergin Kocyildirim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Cardiothoracic Surgery, Children’s Hospital of Pittsburgh
| | - Pablo G. Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center
| | - Jonathan D’Cunha
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Bioengineering, University of Pittsburgh
- Department of Chemical and Petroleum Engineering, University of Pittsburgh
- Department of Surgery, University of Pittsburgh
| | - William J. Federspiel
- McGowan Institute for Regenerative Medicine, University of Pittsburgh
- Department of Bioengineering, University of Pittsburgh
- Department of Chemical and Petroleum Engineering, University of Pittsburgh
- Department of Critical Care Medicine, University of Pittsburgh Medical Center
- Clinical and Translational Science Institute, University of Pittsburgh
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15
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Choi EJ, Kim W, Jeon JY, Ko EJ, Yu J, Choi SH, Lee SH, Sung IY. Intensive pulmonary rehabilitation in a pediatric lung transplantation patient: A case report. Medicine (Baltimore) 2021; 100:e25523. [PMID: 33907101 PMCID: PMC8084064 DOI: 10.1097/md.0000000000025523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The pediatric lung transplant is a very important treatment for patients with end-stage lung diseae, and pulmonary rehabilitation (PR) is also an important factor in determining the prognosis. However, there is no much literature available on pulmonary rehabilitation in pediatric patients' post lung transplant. Through this case report, we would like to present our intensive PR program for pediatric patients' post-lung transplant. PATIENT CONCERNS The 10-year-old boy's breathing before receiving a lung transplant continued to deteriorate and he eventually became dependent on a wheelchair. DIAGNOSIS He was diagnosed with infantile acute lymphoblastic leukemia at 6 months of age. At the age of one year, he underwent allogeneic bone marrow transplantation, but was diagnosed with post-transplantation bronchiolitis obliterans (PTBO) two months later. He had a lung transplant at the age of 10. INTERVENTIONS He was hospitalized and received an initial assessment. This assessment included functional, cognitive, and psychological evaluations. He additionally completed PR exercises twice daily for two weeks. After discharge, he continued to participate in an outpatient-based PR program for three months. During the outpatient phase, PR exercises were performed once weekly, in addition to home-based cognitive training. OUTCOMES Our intensive post-lung PR program improved our patient's exercise capacity, lung function, and quality of life. As a comprehensive rehabilitation service, our program also included a cognitive training component. CONCLUSION We describe an intensive PR program tailored to pediatric patients' post-lung transplant. The program was feasible and resulted in improvements in functional exercise capacity, lung function, and quality of life. Future research into our method is necessary for continued improvement of this novel program.
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Affiliation(s)
- Eun Jung Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
- Department of Rehabilitation Medicine, Seongnam Citizens Medical Center, Seongnam
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - In Young Sung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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16
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Abstract
The rehabilitation needs of individuals undergoing thoracic surgery are changing, especially as surgical management is increasingly being offered to patients who are at risk of developing functional limitations during and after hospital discharge. In the past rehabilitative management of these patients was frequently limited to specific respiratory physiotherapy interventions in the immediate postoperative setting with the aim to prevent postoperative pulmonary complications. In the past two decades, this focus has shifted toward pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. While there is increased interest in (p)rehabilitation interventions the majority of thoracic surgery patients are however currently on their own with respect to progression of their exercise and physical activity regimens after they have been discharged from hospital. There are also no formal guidelines supporting the referral of these patients to outpatient rehabilitation programs. The current evidence regarding rehabilitation interventions initiated before, during, and after the hospitalization period will be briefly reviewed with special focus on patients undergoing surgery for lung cancer treatment and patients undergoing lung transplantation. More research will be necessary in the coming years to modify or change clinical rehabilitation practice beyond the acute admission phase in patients undergoing thoracic surgery. Tele rehabilitation or web-based activity counseling programs might also be interesting emerging alternatives in the (long-term) postoperative rehabilitative treatment of these patients.
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Affiliation(s)
- Daniel Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
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17
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Hume E, Ward L, Wilkinson M, Manifield J, Clark S, Vogiatzis I. Exercise training for lung transplant candidates and recipients: a systematic review. Eur Respir Rev 2020; 29:29/158/200053. [PMID: 33115788 PMCID: PMC9488968 DOI: 10.1183/16000617.0053-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise training on exercise capacity, QoL and clinical outcomes in pre- and post-operative lung transplant patients. A systematic literature search of PubMed, Nursing and Allied Health, Cochrane (CENTRAL), Scopus and CINAHL databases was conducted from inception until February, 2020. The inclusion criteria were assessment of the impact of exercise training before or after lung transplantation on exercise capacity, QoL or clinical outcomes. 21 studies met the inclusion criteria, comprising 1488 lung transplant candidates and 1108 recipients. Studies consisted of five RCTs, two quasi-experimental and 14 single-arm cohort or pilot studies. Exercise training improved or at least maintained exercise capacity and QoL before and after lung transplantation. The impact on clinical outcomes was less clear but suggested a survival benefit. The quality of evidence ranged from fair to excellent. Exercise training appears to be beneficial for patients before and after lung transplantation; however, the evidence for direct causation is limited by the lack of controlled trials. Well-designed RCTs are needed, as well as further research into the effect of exercise training on important post-transplant clinical outcomes, such as time to discharge, rejection, infection, survival and re-hospitalisation. Both inpatient and outpatient exercise training appears beneficial for improving exercise capacity and quality of life in lung transplant candidates and recipients. Further research investigating the effect on post-surgery clinical outcomes is required.https://bit.ly/2XD6J6S
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Affiliation(s)
- Emily Hume
- Dept of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Lesley Ward
- Dept of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Mick Wilkinson
- Dept of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - James Manifield
- Dept of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Stephen Clark
- Dept of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Dept of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
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18
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Abstract
PURPOSE Pulmonary rehabilitation (PR) is advocated in the pre- and post-lung transplantation (LTx) periods. However, there is limited literature on the benefit of PR post-LTx. The aim of this study was to investigate the efficacy of an outpatient, multidisciplinary, comprehensive PR program in bilateral LTx recipients in the early period after LTx. METHOD Twenty-three LTx recipients were referred to the PR center. Change in incremental and endurance shuttle walk tests, hand and quadriceps strength, respiratory muscle strength (maximum inspiratory/expiratory pressure), dyspnea (Medical Research Council score), quality of life (St George's Respiratory Questionnaire, Chronic Respiratory Questionnaire), and psychological status (Hospital Anxiety Depression Scale) were compared pre- and post-PR. RESULTS Seventeen of 23 (74%) recipients completed PR, comprising 15 male and 2 female patients whose median age was 51 yr. The initiation of the program was 75 ± 15 d after LTx. The incremental shuttle walk test distance was predicted as 23% before PR and it increased to 36% after PR (P < .001); the endurance shuttle walk test distance also increased (P < .01). Significant improvement was seen in upper and lower extremity strength, and St George's Respiratory Questionnaire and Chronic Respiratory Questionnaire scores and Hospital Anxiety Depression Scale scores reflected less anxiety and depressive symptoms. Furthermore, body mass and fat-free mass indices, maximum inspiratory pressure, and maximum expiratory pressure improved significantly. There was no significant change in forced expiratory volume in the first second of expiration, forced vital capacity, or Medical Research Council scores. CONCLUSION This study demonstrated that patients who attended PR within 3 mo of bilateral LTx showed improvements in exercise capacity, respiratory muscle strength, quality of life, body composition, and psychological status.
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19
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Tarrant BJ, Robinson R, Le Maitre C, Poulsen M, Corbett M, Snell G, Thompson BR, Button BM, Holland AE. The Utility of the Sit-to-Stand Test for Inpatients in the Acute Hospital Setting After Lung Transplantation. Phys Ther 2020; 100:1217-1228. [PMID: 32280975 DOI: 10.1093/ptj/pzaa057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Measurement of physical function is important to guide physical therapy for patients post-lung transplantation (LTx). The Sit-to-Stand (STS) test has proven utility in chronic disease, but psychometric properties post-LTx are unknown. The study aimed to assess reliability, validity, responsiveness, and feasibility of the 60-second STS post-LTx. METHODS This was a measurement study in 62 inpatients post-LTx (31 acute postoperative; 31 medical readmissions). Interrater reliability was assessed with 2 STS tests undertaken by different assessors at baseline. Known group validity was assessed by comparing STS repetitions in postoperative and medical groups. Content validity was assessed using comparisons to knee extensor and grip strength, measured with hand-held dynamometry. Criterion validity was assessed by comparison of STS repetitions and 6-minute walk distance postoperatively. Responsiveness was assessed using effect sizes over inpatient admission. RESULTS Median (interquartile range) age was 62 (56-67) years; time post-LTx was 5 (5-7) days postoperative and 696 (244-1849) days for medical readmissions. Interrater reliability was excellent (intraclass correlation coefficient type 2,1 = 0.96), with a mean learning effect of 2 repetitions. Repetitions were greater for medical at baseline (mean 18 vs 8). More STS repetitions were associated with greater knee extensor strength (postoperative r = 0.57; medical r = 0.47) and 6-minute walk distance (postoperative r = 0.68). Effect sizes were 0.94 and 0.09, with a floor effect of 23% and 3% at baseline (postoperative/medical) improving to 10% at discharge. Patients incapable of attempting a STS test were excluded, reducing generalizability to critical care. Physical rehabilitation was not standardized, possibly reducing responsiveness. CONCLUSIONS The 60-second STS demonstrated excellent interrater reliability and moderate validity and was responsive to change postoperatively. IMPACT The 60-second STS represents a safe, feasible functional performance tool for inpatients post-LTx. Two tests should be completed at each time point.
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Affiliation(s)
- Benjamin J Tarrant
- Physiotherapy Department, The Alfred, Alfred Health, Philip Block, Level 4, 55 Commercial Road, Melbourne, Victoria, Australia 3004, and School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria Australia
| | | | | | | | | | - Greg Snell
- Lung Transplant Services, The Alfred, Alfred Health and Allergy, Immunology, and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- Physiology Services, The Alfred, Alfred Health and School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Brenda M Button
- Physiotherapy Department, The Alfred, Alfred Health and Monash University
| | - Anne E Holland
- Physiotherapy Department, The Alfred, Alfred Health, Monash University and La Trobe University
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20
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Naranjo-Orellana J, Santalla A. Long-Term Combined Training in Idiopathic Pulmonary Fibrosis: A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145091. [PMID: 32679675 PMCID: PMC7400065 DOI: 10.3390/ijerph17145091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/29/2023]
Abstract
A supervised combined training program was applied to a sedentary 56-year-old man with idiopathic pulmonary fibrosis (IPF) along three years, until lung transplantation. It included: (a) aerobic continuous (CT) and interval training (IT), (b) high load resistance training (RT) and (c) inspiratory muscle training (IMT). IT and IMT were applied for two years, while CT and RT could be maintained until transplantation using supplemental oxygen. Maximal inspiratory pressure (MIP) kept above 180 cm H2O and forced vital capacity (FVC) remained stable until lung transplantation. Peak oxygen uptake VO2 increased during 1.5 years before its decline, staying above the poor prognosis level two years. Finally, the patient maintained his walking capacity and independence for 2 years, before the decline due to the disease. After receiving a two-lung transplant, the patient remained intubated for 12 h, left the intensive care unit after 3.5 days and was discharged after 18 days (average values: 48 h, 7–10 days and 25–35 days, respectively). These results show that systematic and supervised combined training can be safety applied in an IPF patient to maintain functionality and quality of life. In addition, we show that RT can be maintained for as long as necessary without complications.
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Affiliation(s)
- José Naranjo-Orellana
- Department of Sport and Computing, Pablo de Olavide University, 41013 Sevilla, Spain;
- Correspondence:
| | - Alfredo Santalla
- Department of Sport and Computing, Pablo de Olavide University, 41013 Sevilla, Spain;
- Instituto de Investigación Hospital 12 de Octubre (i+12), 28041 Madrid, Spain
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22
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Wietlisbach M, Benden C, Koutsokera A, Jahn K, Soccal PM, Radtke T. Perceptions towards physical activity in adult lung transplant recipients with cystic fibrosis. PLoS One 2020; 15:e0229296. [PMID: 32084221 PMCID: PMC7034849 DOI: 10.1371/journal.pone.0229296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
Background Barriers and motives towards physical activity (PA) in lung transplant (LTx) recipients with cystic fibrosis (CF) are largely unknown. We aimed to explore perceptions towards PA in LTx recipients with CF to better understand individuals’ needs and preferences. Methods Participants completed an online survey at two Swiss LTx and one follow-up shared care centre between June and December 2018. Results One hundred and eleven individuals completed the survey (87.4% response rate). Overall, survey participants perceive PA as important for their daily life and health. Perceived motives of PA were improving muscle strength, endurance and quality of life (QoL), to feel better, fun, to achieve personal goals and having more energy for everyday life. Fatigue was the most common perceived barrier to PA and associated with poorer QoL (r = -0.43, p<0.001) and health status (r = -0.31, p = 0.001). Participants with lung allograft dysfunction (LAD, n = 20) reported lower habitual PA (p = 0.009) and health status (p = 0.011), and rated shortness of breath, bad weather and concerns regarding lung rejection higher than those without LAD (all p<0.05). When we asked how an optimal training programme should look like, the majority would prefer individual, non-supervised (60%), outdoor (77%), endurance training (90%), once or twice a week (47%) for 40–60 minutes (48%). Only a minority of patients (14%) would be willing to use exercise applications for their home-based training. Conclusions LTx recipients with CF value PA as important for their health. People with CF should be encouraged individually by their multidisciplinary transplant team to implement PA in their daily life, potential barriers should be identified and addressed. Overall, knowledge on perceived barriers and motives for PA should be considered in the development of future patient-centred PA programmes.
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Affiliation(s)
- Martina Wietlisbach
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Angela Koutsokera
- Division of Pulmonology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kathleen Jahn
- Clinic of Pulmonary Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
| | - Paola M. Soccal
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- * E-mail:
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Abstract
Recent studies show improved outcomes in ambulated lung failure patients. Ambulation still remains a challenge in these patients. This necessitates development of more compact and less cumbersome respiratory support specifically designed to be wearable. The Paracorporeal Ambulatory Assist Lung (PAAL) is being designed for providing ambulatory support in lung failure patients during bridge to transplant or recovery. We previously published in vitro and acute in vivo results of the PAAL. This study further evaluates the PAAL for 5 days. Five-day in vivo studies with the PAAL were conducted in 50-60 kg sheep after heparinization (activated clotting time range: 190-250 s) and cannulation with a 27 Fr. Avalon Elite dual-lumen cannula. The animals were able to move freely in a stanchion while device flow, resistance, and hemodynamics were recorded hourly. Oxygenation and hemolysis were measured daily. Platelet activation, blood chemistry, and comprehensive blood counts are reported for preoperatively, on POD 0, and POD 5. Three animals survived for 5 days. No study termination resulted from device failure. One animal was terminated on POD 0 and one animal was terminated at POD 3. The device was operated between 1.93 and 2.15 L/min. Blood left the device 100% oxygenated. Plasma-free hemoglobin ranged 10.8-14.5 mg/dl. CD62-P expression was under 10%. Minimal thrombus was seen in devices at explant. Chronic use of the PAAL in awake sheep is promising based on our study. There were no device-related complications over the study course. This study represents the next step in our pathway to eventual clinical translation.
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Cho YH, Do KH, Chae EJ, Choi SH, Jo KW, Lee SO, Hong SB. Association of Chest CT-Based Quantitative Measures of Muscle and Fat with Post-Lung Transplant Survival and Morbidity: A Single Institutional Retrospective Cohort Study in Korean Population. Korean J Radiol 2019; 20:522-530. [PMID: 30799584 PMCID: PMC6389815 DOI: 10.3348/kjr.2018.0241] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/11/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Abnormal body composition is an important modifiable risk factor in lung transplantation. Therefore, precise quantification of different body components, including muscle and fat, may play an important role in optimizing outcomes in lung transplant patients. The purpose of the study was to investigate the prognostic significance of muscle and subcutaneous fat mass measured on chest CT with regard to lung transplantation survival and other post-transplant outcomes. MATERIALS AND METHODS The study population included 45 consecutive adult lung transplant recipients (mean age of 47.9 ± 12.1 years; 31 males and 14 females) between 2011 and 2017. Preoperative cross-sectional areas of muscle and subcutaneous fat were semi-automatically measured on axial CT images at the level of the 12th thoracic vertebra (T12). Additional normalized indexed parameters, adjusted for either height or weight, were obtained. Associations of quantitative parameters with survival and various other post-transplant outcomes were evaluated. RESULTS Of the 45 patients included in the present study, 10 mortalities were observed during the follow-up period. Patients with relative sarcopenia (RS) classified based on height-adjusted muscle area with a cut-off value of 28.07 cm²/m² demonstrated worse postoperative survival (log-rank test, p = 0.007; hazard ratio [HR], 6.39:1) despite being adjusted for age, sex, and body mass index (HR, 8.58:1; p = 0.022). Weight-adjusted parameters of muscle area were negatively correlated with duration of ventilator support (R = -0.54, p < 0.001) and intensive care unit (ICU) stay (R = -0.33, p = 0.021). CONCLUSION Patients with RS demonstrate worse survival after lung transplantation that those without RS. Additionally, quantitative parameters of muscles measured at the T12 level on chest CT were associated with the duration of post-lung transplant ventilator support and duration of stay in the ICU.
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Affiliation(s)
- Young Hoon Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hyun Do
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Wook Jo
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Oh Lee
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Bum Hong
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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PEHLİVAN ESRA, Kalafat S, Balcı A, Kılıç L. Akciğer Nakil Adaylarında Egzersiz Kapasitesinin Periferik Kas Kuvveti Ve Solunum Fonksiyonları İle İlişkisi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.538403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kayawake H, Chen-Yoshikawa TF, Hamaji M, Nakajima D, Ohsumi A, Aoyama A, Date H. Acquired recipient pulmonary function is better than lost donor pulmonary function in living-donor lobar lung transplantation. J Thorac Cardiovasc Surg 2019; 158:1710-1716.e2. [DOI: 10.1016/j.jtcvs.2019.06.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Abstract
Acute and chronic respiratory failure are a significant source of pediatric morbidity and mortality. Current respiratory support options used to bridge children to lung recovery or transplantation typically render them bedridden and can worsen long-term patient outcomes. The Pittsburgh Pediatric Ambulatory Lung (P-PAL) is a wearable pediatric blood pump and oxygenator (0.3 m surface area) integrated into a single compact unit that enables patient ambulation. The P-PAL is intended for long-term use and designed to provide up to 90% of respiratory support in children weighing 5-25 kg. Computational fluid dynamics and numerical gas exchange modeling were used to design the P-PAL and predict its performance. A P-PAL prototype was then used to obtain pressure versus flow curves at various impeller rotation rates using a blood analog fluid. In vitro oxygen exchange rates were obtained in blood in accordance with ISO standard 7199. The normalized index of hemolysis (NIH) was measured over a 6 hour period at blood flow rates of 1 and 2.5 L/min. The P-PAL provided blood flows of 1-2.5 L/min against the pressure drop associated with its intended-use pediatric cannulas. The oxygen exchange rate reached a maximum of 108 ml/min at a blood flow rate of 2.5 L/min and met our respiratory support design target. Device-induced hemolysis was low with NIH values of 0.022-0.027 g/100 L in the intended blood flow rate range. In conclusion, the current P-PAL design met our pumping, oxygenation, and hemolysis specifications and has the potential to improve treatment for pediatric respiratory failure.
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Shiner CT, Woodbridge G, Skalicky DA, Faux SG. Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes. PM R 2019; 11:849-857. [DOI: 10.1002/pmrj.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/22/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Christine T. Shiner
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
- St Vincent's Clinical SchoolFaculty of Medicine, University of New South Wales Sydney NSW Australia
| | - Genevieve Woodbridge
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
| | - David A. Skalicky
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
- St Vincent's Clinical SchoolFaculty of Medicine, University of New South Wales Sydney NSW Australia
| | - Steven G. Faux
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
- St Vincent's Clinical SchoolFaculty of Medicine, University of New South Wales Sydney NSW Australia
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Cebrià I Iranzo MÀ, Vos R, Verleden GM, Gosselink R, Langer D. Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case-Control Study. Arch Bronconeumol 2018; 55:239-245. [PMID: 30595421 DOI: 10.1016/j.arbres.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case-control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS. METHODS Twenty-four LTx recipients with BOS (BOS=Cases) and 24 without BOS (NON-BOS=Controls) were selected and individually matched according to age, gender, diagnosis and LTx characteristics. Measurements of 6-minute walking distance (6MWD), symptoms of dyspnea (BORG CR-10 scale), and comprehensive pulmonary function testing were performed before LTx and at annual follow-up assessments after LTx. RESULTS Peak FEV1 after LTx was similar in both groups [FEV1 (% predicted) 101±25 vs. 101±31, p=0.96] and BOS diagnosis in cases was established 3.6±2.5 years after LTx. At the final follow-up assessment (6.5±3.2 years after LTx) FEV1 (% predicted) was 86±34 in NON-BOS vs. 44±17 in BOS (p<0.001). Evolution of 6MWD was different between groups (group by time interaction: p=0.002). Borg dyspnea scores were also significantly different between groups at the final evaluation (NON-BOS 3.3±1.7 vs. BOS 5.0±2.2; p=0.024). CONCLUSIONS We observed gradual reductions in functional exercise capacity and increasing symptoms of dyspnea in patients who developed BOS after LTx. As such, prospective studies seem warranted to explore whether rehabilitative interventions might be useful to improve symptoms and slow down deterioration of exercise capacity in these patients from the onset of BOS.
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Affiliation(s)
- Maria À Cebrià I Iranzo
- Department of Physiotherapy, University of Valencia and Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Robin Vos
- Respiratory Division, Lung Transplantation Unit, University Hospitals Leuven and Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Geert M Verleden
- Respiratory Division, Lung Transplantation Unit, University Hospitals Leuven and Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Rik Gosselink
- Respiratory Division, Respiratory Rehabilitation Unit, University Hospitals Leuven and Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Daniel Langer
- Respiratory Division, Respiratory Rehabilitation Unit, University Hospitals Leuven and Department of Rehabilitation Sciences, KU Leuven, Belgium.
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Sher Y, Maldonado JR. Medical Course and Complications After Lung Transplantation. PSYCHOSOCIAL CARE OF END-STAGE ORGAN DISEASE AND TRANSPLANT PATIENTS 2018. [PMCID: PMC7122723 DOI: 10.1007/978-3-319-94914-7_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung transplant prolongs life and improves quality of life in patients with end-stage lung disease. However, survival of lung transplant recipients is shorter compared to patients with other solid organ transplants, due to many unique features of the lung allograft. Patients can develop a multitude of noninfectious (e.g., primary graft dysfunction, pulmonary embolism, rejection, acute and chronic, renal insufficiency, malignancies) and infectious (i.e., bacterial, fungal, and viral) complications and require complex multidisciplinary care. This chapter discusses medical course and complications that patients might experience after lung transplantation.
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Acute and 6-Month Outcomes in Recipients of Lung Transplantation Following Lower Extremity Strength Training: Pilot Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sivam S, Dentice R, Reddy N, Moriarty C, Yozghatlian V, Mellis C, Torzillo P, Glanville A, Gattas D, Bye P. Use of extracorporeal membrane oxygenation in cystic fibrosis in an Australian cystic fibrosis centre. Intern Med J 2018; 48:340-343. [PMID: 29512325 DOI: 10.1111/imj.13728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 11/26/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) support is used in selected patients with cystic fibrosis (CF) as a bridge to transplantation. Our aim was to describe briefly treatment and outcomes of six CF patients who received ECMO. One patient received a lung transplant and another recovered from acute respiratory failure. Four died despite ECMO support. Lack of timely availability of suitable donor lungs and patient selection are contributing factors.
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Affiliation(s)
- Sheila Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Dentice
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nazmeen Reddy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Carmel Moriarty
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Veronica Yozghatlian
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Craig Mellis
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Torzillo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Intensive Care Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Allan Glanville
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - David Gattas
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Intensive Care Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter Bye
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Song JH, Park JE, Lee SC, Kim S, Lee DH, Kim EK, Kim SY, Shin JC, Lee JG, Paik HC, Park MS. Feasibility of Immediate in-Intensive Care Unit Pulmonary Rehabilitation after Lung Transplantation: A Single Center Experience. Acute Crit Care 2018; 33:146-153. [PMID: 31723878 PMCID: PMC6786695 DOI: 10.4266/acc.2018.00129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
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.
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Affiliation(s)
- Joo Han Song
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Eun Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sarang Kim
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyung Lee
- Division of Nursing, Pediatric Intensive Care Unit, Severance Hospital, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Nursing, Neurointensive Care Unit, Severance Hospital, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Knols RH, Fischer N, Kohlbrenner D, Manettas A, de Bruin ED. Replicability of Physical Exercise Interventions in Lung Transplant Recipients; A Systematic Review. Front Physiol 2018; 9:946. [PMID: 30079028 PMCID: PMC6062962 DOI: 10.3389/fphys.2018.00946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: This systematic review aimed to assess the replicability of physical exercise interventions in lung transplantation patients. For replicability we focused on (1) the description of training principles, (2) the description of FITT components and adherence to the interventions, (3) the amount of detailed information given on the physical exercise intervention, and (4) reporting the methodological quality of the included works. Methods: Relevant databases (Medline-Ovid, EMBASE, CINAHL, PsychInfo, Cochrane Library) were searched. Author dyads selected and systematically analyzed the included studies independent from each other. A purpose developed checklist was used to assess the details of the exercise interventions and their methodological quality. Results: From the seven included manuscripts, three described resistance training, one endurance, and three combined training approaches. All manuscripts reported specificity and initial values, six manuscripts mention progression and overload. The exercise principle reversibility was reported once and diminishing returns was not reported at all. All studies reported the type of exercise, three studies reported intensity and one study reported time for training. Not any study completely reported frequency or described adherence to the intervention. Lack of detailed reporting was identified as the cause for murky description of the interventions. The highest score for intervention description was 5 of possible 12 items. Conclusions: Replicability of many exercise interventions in LTX is not warranted due too poor descriptions of important items related to training. In particular there were insufficiently detailed reporting of training principles and FITT components in programs developed for LTX. Future interventions that aim to train LTX patients should spent effort in writing reports in which the intervention is detailed to such an extent that full replicability in clinical settings can be guaranteed.
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Affiliation(s)
- Ruud H Knols
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Fischer
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Dario Kohlbrenner
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios Manettas
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Abstract
Mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) are the only viable treatment options for lung failure patients at the end-stage, including acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD). These treatments, however, are associated with high morbidity and mortality because of long wait times for lung transplant. Contemporary clinical literature has shown ambulation improves post-transplant outcomes in lung failure patients. Given this, we are developing the Pittsburgh Ambulatory Assist Lung (PAAL), a truly wearable artificial lung that allows for ambulation. In this study, we targeted 180 ml/min oxygenation and determined the form factor for a hollow fiber membrane (HFM) bundle for the PAAL. Based on a previously published mass transfer correlation, we modeled oxygenation efficiency as a function of fiber bundle diameter. Three benchmark fiber bundles were fabricated to validate the model through in vitro blood gas exchange at blood flow rates from 1 to 4 L/min according to ASTM standards. We used the model to determine a final design, which was characterized in vitro through a gas exchange as well as a hemolysis study at 3.5 L/min. The percent difference between model predictions and experiment for the benchmark bundles ranged from 3% to 17.5% at the flow rates tested. Using the model, we predicted a 1.75 in diameter bundle with 0.65 m surface area would produce 180 ml/min at 3.5 L/min blood flow rate. The oxygenation efficiency was 278 ml/min/m and the Normalized Index of Hemolysis (NIH) was less than 0.05 g/100 L. Future work involves integrating this bundle into the PAAL for which an experimental prototype is under development in our laboratory.
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Walsh JR, Hopkins PMA. Sarcopenia in lung transplant candidates: A novel biomarker to estimate skeletal muscle mass. Clin Transplant 2018; 32:e13200. [PMID: 29500845 DOI: 10.1111/ctr.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James R Walsh
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Rehabilitation Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Peter M A Hopkins
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Abstract
BACKGROUND Lung transplantation (LTx) is offered to older and more complex patients who may be at higher risk of skeletal muscle dysfunction, but the clinical implications of this remain uncertain. The study aims were to characterize deficits in skeletal muscle mass, strength and physical performance, and examine the associations of these deficits with clinical outcomes. METHODS Fifty LTx candidates (58% men; age, 59 ± 9 years) were prospectively evaluated for skeletal muscle deficits: muscle mass using bioelectrical impedance, quadriceps, respiratory muscle and handgrip strength, and physical performance with the Short Physical Performance Battery. Comparisons between number of muscle deficits (low muscle mass, quadriceps strength and physical performance) and 6-minute walk distance (6MWD), London Chest Activity of Daily Living Questionnaire, and quality of life were assessed using one-way analysis of variance. Associations with pretransplant and posttransplant delisting/mortality, hospital duration, and 3-month posttransplant 6MWD were evaluated using Fisher exact test and Spearman correlation. RESULTS Deficits in quadriceps strength (n = 27) and physical performance (n = 24) were more common than muscle mass (n = 8). LTx candidates with 2 or 3 muscle deficits (42%) compared with those without any deficits (26%) had worse 6MWD = -109 m (95% confidence interval [CI], -175 to -43), London Chest Activity of Daily Living Questionnaire = 18 (95% CI, 7-30), and St. George's Activity Domain = 12 (95% CI, 2-21). Number of muscle deficits was associated with posttransplant hospital stay (r = 0.34, P = 0.04), but not with delisting/mortality or posttransplant 6MWD. CONCLUSIONS Deficits in quadriceps muscle strength and physical performance are common in LTx candidates and further research is needed to assess whether modifying muscle function pretransplant can lead to improved clinical outcomes.
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Pehlivan E, Balcı A, Kılıç L, Kadakal F. Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey. EXP CLIN TRANSPLANT 2017; 16:455-460. [PMID: 28969527 DOI: 10.6002/ect.2017.0042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing. In our study, we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function, exercise capacity, and quality of life in patients who are candidates for lung transplant. MATERIALS AND METHODS This prospective study included 39 consecutive patients who were candidates for lung transplant. All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks. RESULTS Our patient group included 25 male and 14 female patients with a mean age of 36 years (range, 15 -68 y). Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation, significant improvements were observed in the Modified Medical Research Council dyspnea scores (P = .001) and 6-minute walk distance (P = .001). We also observed statistically significant improvements in the Short-Form 36 Quality of Life Questionnaire's physical function (P = .01) and emotional role (P = .02) subparameters. We also found a significant improvement in the Beck Depression Inventory score (P = .004). There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance, Short-Form 36, and Modified Medical Research Council dyspnea scores. CONCLUSIONS Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity, reduces the sensation of dyspnea and muscle strength loss, and has a positive effect on the psychologic state of patients who are candidates for lung transplant.
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Affiliation(s)
- Esra Pehlivan
- From the Pulmonary Rehabilitation Center, Medical Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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The Emerging Importance of Skeletal Muscle Function in Assessing Candidates for Transplantation. Transplantation 2017; 101:1967-1968. [DOI: 10.1097/tp.0000000000001784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Madhani SP, Frankowski BJ, Burgreen GW, Antaki JF, Kormos R, D'Cunha J, Federspiel WJ. In vitro and in vivo evaluation of a novel integrated wearable artificial lung. J Heart Lung Transplant 2017; 36:806-811. [PMID: 28359655 DOI: 10.1016/j.healun.2017.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/19/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Conventional extracorporeal membrane oxygenation (ECMO) is cumbersome and is associated with high morbidity and mortality. We are currently developing the Pittsburgh Ambulatory Assist Lung (PAAL), which is designed to allow for ambulation of lung failure patients during bridge to transplant or recovery. In this study, we investigated the in vitro and acute in vivo performance of the PAAL. METHODS The PAAL features a 1.75-inch-diameter, cylindrical, hollow-fiber membrane (HFM) bundle of stacked sheets, with a surface area of 0.65 m2 integrated with a centrifugal pump. The PAAL was tested on the bench for hydrodynamic performance, gas exchange and hemolysis. It was then tested in 40- to 60-kg adult sheep (n = 4) for 6 hours. The animals were cannulated with an Avalon Elite 27Fr dual-lumen catheter (DLC) inserted through the right external jugular into the superior vena cava (SVC), right atrium (RA) and inferior vena cava (IVC). RESULTS The PAAL pumped >250 mm Hg at 3.5 liters/min at a rotation speed of 2,100 rpm. Oxygenation performance met the target of 180 ml/min at 3.5 liters/min of blood flow in vitro, resulting in a gas-exchange efficiency of 278 ml/min/m2. The normalized index of hemolysis (NIH) for the PAAL and cannula was 0.054 g per 100 liters (n = 2) at 3.5 liters/min, as compared with 0.020 g per 100 liters (n = 2) for controls (DLC cannula and a Centrimag pump). Plasma-free hemoglobin (pfHb) was <20 mg/dl for all animals. Blood left the device 100% oxygenated in vivo and oxygenation reached 181 ml/min at 3.8 liters/min. CONCLUSION The PAAL met in vitro and acute in vivo performance targets. Five-day chronic sheep studies are planned for the near future.
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Affiliation(s)
- Shalv P Madhani
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian J Frankowski
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Greg W Burgreen
- Computational Fluid Dynamics Group, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, Mississippi, USA
| | - Jim F Antaki
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Robert Kormos
- Department of Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA
| | - Jonathan D'Cunha
- Department of Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA
| | - William J Federspiel
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Sharma NS, Hartwig MG, Hayes D. Extracorporeal membrane oxygenation in the pre and post lung transplant period. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:74. [PMID: 28275619 DOI: 10.21037/atm.2017.02.09] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Evolution in technology has resulted in rapid increase in utilization of extracorporeal membrane oxygenation (ECMO) as a bridge to recovery and/or transplantation. Although there is limited evidence for the use of ECMO, recent improvements in ECMO technology, personnel training, ambulatory practices on ECMO and lung protective strategies have resulted in improved outcomes in patients bridged to lung transplantation. This review provides an insight into the current outcomes and best practices for utilization of ECMO in the pre- and post-lung transplantation period.
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Affiliation(s)
- Nirmal S Sharma
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham AL, USA
| | - Mathew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC, USA
| | - Don Hayes
- Departments of Pediatrics, Internal Medicine, and Surgery, The Ohio State University, OH, USA
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Hermens JA, Braithwaite SA, Platenkamp M, Wijnandts PR, Van de Graaf EA, van der Kaaij NP, De Jong M, Heijnen G, Janssen J, Kesecioglu J, Donker DW. Awake ECMO on the move to lung transplantation: serial monitoring of physical condition. Intensive Care Med 2017; 43:707-708. [PMID: 28116453 DOI: 10.1007/s00134-016-4667-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 12/21/2022]
Affiliation(s)
- J A Hermens
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - S A Braithwaite
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Platenkamp
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P R Wijnandts
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E A Van de Graaf
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M De Jong
- Heartbeat Dutch Perfusion Service, Eemnes, The Netherlands
| | - G Heijnen
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Janssen
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - D W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Choi J, Hergenroeder AL, Burke L, Dabbs AD, Morrell M, Saptono A, Parmanto B. Delivering an in-Home Exercise Program via Telerehabilitation: A Pilot Study of Lung Transplant Go (LTGO). Int J Telerehabil 2016; 8:15-26. [PMID: 28775798 PMCID: PMC5536726 DOI: 10.5195/ijt.2016.6201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We evaluated the feasibility, safety, system usability, and intervention acceptability of Lung Transplant Go (LTGO), an 8-week in-home exercise intervention for lung transplant recipients using a telerehabilitation platform, and described changes in physical function and physical activity from baseline to post-intervention. The intervention was delivered to lung transplant recipients in their home via the Versatile and Integrated System for TeleRehabilitation (VISYTER). The intervention focused on aerobic and strengthening exercises tailored to baseline physical function. Participants improved walk distance (6-minute walk distance), balance (Berg Balance Scale), lower body strength (30-second chair stand test) and steps walked (SenseWear Armband®). No adverse events were reported. Participants rated the program highly positively in regard to the technology and intervention. The telerehabilitation exercise program was feasible, safe, and acceptable. Our findings provide preliminary support for the LTGO intervention to improve physical function and promote physical activity in lung transplant recipients.
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Affiliation(s)
- Jiyeon Choi
- DEPARTMENT OF ACUTE & TERTIARY CARE, SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Andrea L Hergenroeder
- DEPARTMENT OF PHYSICAL THERAPY, SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Lora Burke
- DEPARTMENT OF HEALTH & COMMUNITY SYSTEMS, SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Annette Devito Dabbs
- DEPARTMENT OF ACUTE & TERTIARY CARE, SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Matthew Morrell
- DIVISION OF PULMONARY ALLERGY AND CRITICAL CARE MEDICINE, DEPARTMENT OF MEDICINE, UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE & SCHOOL OF NURSING, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Andi Saptono
- DEPARTMENT OF HEALTH INFORMATION MANAGEMENT, SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
| | - Bambang Parmanto
- DEPARTMENT OF HEALTH INFORMATION MANAGEMENT, SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PENNSYLVANIA, USA
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De Geest S, Burkhalter H, Berben L, Bogert LJ, Denhaerynck K, Glass TR, Goetzmann L, Kirsch M, Kiss A, Koller MT, Piot-Ziegler C, Schmidt-Trucksäss A. The Swiss Transplant Cohort Study's Framework for Assessing Lifelong Psychosocial Factors in Solid-Organ Transplants. Prog Transplant 2016; 23:235-46. [DOI: 10.7182/pit2013250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Understanding outcomes after transplant requires a biopsychosocial model that includes biomedical and psychosocial factors. The latter, to date, are assessed only in a limited way as part of transplant registries or cohort studies. The Swiss Transplant Cohort Study (STCS) is a nationwide open cohort study (starting May 2008) to systematically and prospectively assess psychosocial factors. This article describes the framework underpinning STCS's psychosocial assessment. Methods The STCS framework was adapted from the multidimensional conceptual perspective of Dew et al to describe transplant psychosocial domains and specific outcomes by adding a time perspective, a system perspective, and interaction among domains. Results We propose a multidimensional, multilevel biopsychosocial framework representing mutually influencing domains from before to after transplant, and exemplify each domain by factors included in STCS and their measurement. The transplant patient, centrally positioned, is described by clinical and sociodemographic characteristics (eg, socioeconomic status, educational, professional, and relationship status). The following psychosocial domains further describe the patient: (1) physical/functional (eg, perceived health status, sleep quality, daytime sleepiness), (2) psychological (eg, depression, stress), (3) behavioral (eg, medication adherence, smoking, drug use, physical activity, sun protection), (4) social (eg, work capacity/return to work), and (5) global quality of life. Factors associated with health care system level (eg, trust in transplant team) are also included in the model. Conclusion The STCS's psychosocial framework provides a basis for studying the interplay of biomedical, sociodemographic, psychosocial, behavioral, and health care system factors in view of transplant outcomes and therefore has the potential to guide biopsychosocial transplant research.
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Affiliation(s)
- Sabina De Geest
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Hanna Burkhalter
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Lut Berben
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Laura Jane Bogert
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Kris Denhaerynck
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Tracy R. Glass
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Lutz Goetzmann
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Monika Kirsch
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Alexander Kiss
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Michael T. Koller
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Chantal Piot-Ziegler
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Arno Schmidt-Trucksäss
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
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Provision of Physical Therapy at a Long-Term Acute Care Hospital for Patients Awaiting Lung Transplantation: A Case Report With 3 Participants. Cardiopulm Phys Ther J 2016. [DOI: 10.1097/cpt.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fuller LM, Button B, Tarrant B, Steward R, Bennett L, Snell G, Holland AE. Longer Versus Shorter Duration of Supervised Rehabilitation After Lung Transplantation: A Randomized Trial. Arch Phys Med Rehabil 2016; 98:220-226.e3. [PMID: 27697429 DOI: 10.1016/j.apmr.2016.09.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the effects of a supervised longer- (14wk) versus shorter-duration (7wk) rehabilitation program after lung transplantation (LTX). DESIGN Randomized controlled trial. SETTING Outpatient rehabilitation gym setting. PARTICIPANTS Post-LTX patients aged ≥18 years (N=66; 33 women; mean age, 51±13y) who had undergone either single LTX or bilateral LTX. INTERVENTION Outpatient rehabilitation program consisting of thrice-weekly sessions with cardiovascular training on bike ergometer and treadmill plus upper and lower limb strength training. MAIN OUTCOME MEASURES Measures were taken at baseline, 7 weeks, 14 weeks, and 6 months by assessors who were blinded to group allocation. Functional exercise capacity was measured by the 6-minute walk test (6MWT). Strength of quadriceps and hamstrings was measured on an isokinetic dynamometer and recorded as average peak torque of 6 repetitions for both muscles. Quality of life (QOL) was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS Of the participants, 86% had bilateral LTX and 41% had primary diagnosis of chronic obstructive pulmonary disease. The 6MWT increased in both groups with no significant difference between groups at any time point (mean 6mo 6MWD: short, 590±85m vs long, 568±127m; P=0.5). Similarly, at 6 months, there was no difference between groups in quadriceps average peak torque (mean, 115±38Nm vs 114±40Nm, respectively; P=.59), hamstring average peak torque (57±18Nm vs 52±19Nm, respectively; P=.36), or mental or physical health domains of quality of life. CONCLUSIONS Shorter duration (7wk) of rehabilitation achieves comparable outcomes with 14 weeks of supervised rehabilitation for functional exercise capacity, lower limb strength, and quality of life at 6 months after LTX.
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Affiliation(s)
- Louise M Fuller
- Physiotherapy Department, The Alfred, Melbourne, Australia; Allergy, Immunology and Respiratory Department, The Alfred, Melbourne, Australia; Institute of Breathing and Sleep, La Trobe University, Bundoora, Australia.
| | - Brenda Button
- Physiotherapy Department, The Alfred, Melbourne, Australia; Monash University, Clayton, Australia
| | - Ben Tarrant
- Physiotherapy Department, The Alfred, Melbourne, Australia
| | | | - Lisa Bennett
- Physiotherapy Department, The Alfred, Melbourne, Australia
| | - Greg Snell
- Allergy, Immunology and Respiratory Department, The Alfred, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, The Alfred, Melbourne, Australia; Institute of Breathing and Sleep, La Trobe University, Bundoora, Australia
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Wickerson L, Rozenberg D, Janaudis-Ferreira T, Deliva R, Lo V, Beauchamp G, Helm D, Gottesman C, Mendes P, Vieira L, Herridge M, Singer LG, Mathur S. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J Transplant 2016; 6:517-31. [PMID: 27683630 PMCID: PMC5036121 DOI: 10.5500/wjt.v6.i3.517] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/31/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription during an uncomplicated and complicated clinical course in the pre-transplant, early and late post-transplant periods. The target audience includes clinicians involved in pre- and post-transplant patient care and rehabilitation researchers.
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Boling B, Dennis DR, Tribble TA, Rajagopalan N, Hoopes CW. Safety of Nurse-Led Ambulation for Patients on Venovenous Extracorporeal Membrane Oxygenation. Prog Transplant 2016; 26:112-6. [PMID: 27207398 DOI: 10.1177/1526924816640646] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Venovenous extracorporeal membrane oxygenation (VV ECMO) is an effective therapy in patients with acute lung injury and end-stage lung disease. Although immobility increases the risk of complications, ambulation of patients on VV ECMO is not the standard of care in many institutions. Staff concerns for patient safety remain a barrier to ambulation. In this case series, we present our experience utilizing a nurse-driven ambulatory VV ECMO process to safely rehabilitate patients. METHODS We retrospectively reviewed all VV ECMO cases at our institution between January 1, 2011, and November 1, 2013. Inclusion criteria for this study required patients to be cannulated in the right internal jugular vein and ambulated while on VV ECMO. RESULTS During the period from January 1, 2011, to November 1, 2013, 18 patients (mean age 49 ± 15 years, 12 male) were ambulated while on ECMO. Eight received a transplant and survived to discharge. Of the remaining patients, 4 were successfully weaned from VV ECMO and 6 died following decisions by the family to withdraw care. The mean duration of VV ECMO support was 18 ± 16 days with the maximum duration being 61 days. All patients received physical therapy, range of motion at the bedside, and ambulated in the hospital. There were no patient falls, decannulations, or any other complications related to ambulation. CONCLUSION The adoption of a nurse-driven program to ambulate patients on VV ECMO is safe and may reduce other complications associated with immobility.
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Affiliation(s)
- Bryan Boling
- Cardiovascular Intensive Care Unit, University of Kentucky, KY, USA
| | | | | | - Navin Rajagopalan
- Division of Cardiovascular Medicine, University of Kentucky, KY, USA
| | - Charles W Hoopes
- Department of Surgery, Section of Thoracic Transplantation, University of Alabama, Birmingham, AL, USA
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