Lung transplants for children: Exploring the intricacies
Most adult transplant centers require patients to walk a set distance in under six minutes to remain a good candidate for lung transplant. The thought is that if patients cannot meet this minimal threshold, then their chances of being able to rehabilitate after transplant are diminished. In pediatrics, this is also important. But Dawn Freiberger, RN, MSN, Boston Children’s Hospital’s Lung Transplant coordinator, says there are other factors that have to be considered. “The walk test is just one piece of the pie,” says Freiberger. In 2013, Freiberger co-authored a study, Pretransplant six-minute walk test predicts peri- and post-operative outcomes after pediatric lung transplantation, which became the precursor to a multicenter study with the Children’s Hospital of Philadelphia and St. Louis Children’s Hospital. The new study looks at how a child’s pre-transplant physical condition affects post-transplant outcomes. “A lot of centers believe if you are not physically fit you have a lesser chance of survival,” she says. “But children are different than adults; they can be physically fit in other ways. Kids exercise without realizing they are exercising.” Freiberger and co-investigator Anne Gould, PT, of the Division of Pulmonary and Respiratory Diseases at Boston Children’s, are following 40 patients until they are one-year post transplant. “We are studying pre-transplant variables...
Conclusion: Early and frequent PT may be important for patients admitted to the intensive care unit while awaiting transplantation and can play an even greater role for the less than “ideal” transplant candidate. The PT interventions can be provided safely for this population in the hospital setting. A rehabilitation approach focused on maximizing a patient's functional capacity with strength and gait training activities may facilitate improved outcomes for lung transplant recipients deemed less than optimal candidates.
Purpose: Individuals who receive lung transplantation (LTx) have prolonged lower extremity weakness that limits exercise capacity and function. The purposes of this pilot study were to measure whether acute, intense, gym-based rehabilitation significantly increased walking distance and lower extremity strength after LTx and to identify whether gains were retained at 6-month follow-up. Methods: Nine men (mean age =57 years) completed 4 weeks of daily (5×/wk), gym-based acute care rehabilitation after LTx. Rehabilitation included stretching, aerobic conditioning, education, and either low- or high-volume strength ...
ConclusionsECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early use of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.
Doctors in Scotland believe a woman’s large tattoo on her leg may have been the cause of her unexplained inflammation and severe leg pain. The authors of a report on the woman’s case, published in BMJ Case Reports, say it is a reminder to physicians that they should be mindful of their patients’ tattoos if they encounter unusual and unexplained symptoms. The 31-year-old woman was suffering a condition called inflammatory myopathy, which affected her left leg and caused pain severe enough to disrupt her sleep. The woman had a double lung transplant in 2009, and was taking drugs to suppress her immune syst...
Conclusions: In intervention development directed at increasing the level of PA and reducing sedentary time in recipients of solid-organ transplantation, attention should be paid to physical limitations, fear of negative effects, low expectations and self-confidence, health and physical outcomes, and exercise self-efficacy. PMID: 29757444 [PubMed - as supplied by publisher]
Limited research has been produced to demonstrate the safety and efficacy of providing physical therapy interventions in advanced CHF (aCHF) patients on circulatory support. The efficacy of Phase 1 Cardiac Rehab is well studied post myocardial infarction and cardiac surgery. The purpose of this project was to assess the safety and efficacy of implementing Phase 1 cardiac rehabilitation in an in-patient gym setting; the population studied included individuals with aCHF awaiting further intervention, most receiving inotropic support and/or mechanical circulatory assistive devices.
During the past decade, it has become evident that, where feasible, physical therapy —and in particular ambulation—during long periods of extracorporeal membrane oxygenation (ECMO) helps to mitigate progressive deconditioning in otherwise bedbound, critically ill patients.1,2 Now considered a fairly routine approach for adult patients on ECMO support (in particular those awaitin g lung transplants), this strategy has enjoyed limited adoption in pediatric centers, not only because of technical circuit limitations but in part also because of perceived issues with childhood compliance.
Conclusions ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early utilization of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.
CONCLUSIONS: ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early utilization of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes. PMID: 29559375 [PubMed - as supplied by publisher]
Extracorporeal membrane oxygenation (ECMO) is a versatile mechanical circulatory support technique that may be used as salvage therapy for patients with refractory cardiorespiratory failure in the acute setting, or as a bridge to definitive management in the extended term. Ambulatory venovenous ECMO may help optimize the condition of patients with respiratory failure for lung transplantation by allowing physical therapy and preventing deconditioning.1 Experience with ambulatory venoarterial ECMO (VA-ECMO) as a bridging strategy for heart transplantation, however, is less common.