Exam 2 Flashcards
First Successful Lung Transplant
1983 due to cyclosporine
Lung Transplants Cost
$100-200K + Medications of $1200-2000/month
Indications for Lung Txp
- End stage pulmonary disease (life expectancy <2yrs, CF, IPF, PPH, COPD)
- Progressive disability
- Maximized pulmonary medications & interventions
- Good organ fxn other than lungs
- No serious co-morbidities
- Good exercise capacity (but not too good)
- No history of cancer
COPD Indications for Lung Txp - Bode Index
Bode Index 7-10 or at least 1 of the following:
Hospitalization for PCO2 > 50mmHg
Pulmonary HTN, Cor Pulmonale
FEV1 < 20% predicted and DLCO <20%
COPD Indications for Lung Txp
Emphysema Alpha 1 anti-trypsin Pulmonary Fibrosis Sarcoid CF PPH Inhalation/burn trauma NOT lung cancer
Contraindications for Lung Transplant
Cancer hx in last 2 years (except basal cell carcinoma)
Heart, liver, or kidney dysfunction that is advanced or untreatable (CAD that can’t be bypassed, severe LV function)
Non-curable Hep B, C or HIV
Poor adherence with medications, follow-up visits etc.
Untreatable psychiatric conditions that interfere with the ability to comply post-op care
Poor or absent social support
Relative Contraindications for Lung Transplant
Age >65 yrs old
Mechanical ventilation
Poor functional status (> or = 400m on 6MWT)
Colonization with virulent bacteria, fungi, etc.
BMI >30 kg/m2
Severe osteoporosis
Pediatrics Lung Transplant
Kids under the age of 12 can’t not receive adult lungs
Priority 1- Urgent need of lung txp
Priority 2-not as urgent
6MWT: Amb >1000ft prior to transplant was correlated with shorter ICU stay & fewer days of ventilation
Types of Lung Transplants
Single txp (5-9hrs surgery), Double txp (7-9 hrs)
Lateral thoracotomy (5th intercostal space) cut through lat dorsi & serratus anterior
Transverse thoracotomy or clam shell incision
Connections at:
Pulmonary artery & vein
Mainstem bronchus
Typical LOS is 7-14 days
Acute care s/p Lung Transplant
Chest PT, postural drainage every 4-6 hours
Out of bed activities as soon as stable
Evaluation and training of cough
Secretion clearance techniques- positioning, splinted coughing, incentive spirometry, stacked breathing, ACB, Huff cough
Monitoring Effectiveness of Transplant
Oxygen Saturation
Ability to clear secretions
functional mobility
Signs of rejection
Outpatient PT for Lung Transplant
Aerobic training with goal of 30 min most if not all days of the week
Strength Training- UE strength training after MD clearance (6-8 wks)
Education on breathing strategies
Chest PT, secretion removal as necessary
Musculoskeletal concerns during Outpatient PT
Positioning during surgery
Nerve damage to muscles cut into (Thoracodorsal Nerve, Long Thoracic Nerve, Spinal Accessory)
Splinting secondary to pain, fix posture
There maybe underlying shoulder abnormalities
Outpatient PT: Monitoring for Rejection
- Decrease in exercise tolerance
- Decrease in microspirometry
- Signs of heart failure - R sided heart failure
- Auscultation
- Pain
- Shortness of breath, desaturation
- Medication side effects (tremors, joint aches)
- Fever
- Flu-like symptoms
Why is there a significant decrease in peak exercise capacity even though there is an improvement in lung function after transplantation?
-Patient had premorbid disease and muscle changes
ie. COPD
Atrophy of Type 1 fibers, Increase muscle fatigue, lower lactic acid threshold
-Ventilatory Limitations
Doesn’t seem to play a large role
Large Ventilatory reserve
Breathing mechanics relatively unchanged in long term
There are peripheral changes that limit the pt’s exercise tolerance and cardiac reserve
