Lung transplantation and physical therapy in the intensive care

Abstract

Lung transplantation becomes a standard treatment of terminal pulmonary diseases in selected patients with no contraindication. Multidisciplinary approach is essential in the postoperative time in the intensive care unit. Physiotherapy plays an important role in patient’s management. If the immediate period is often simple, the physical therapist is early involved in both respiratory and muscular readaptation to compensate the consequences of lowered respiratory volumes. The objective is to reduce the rate of complications. Breathing exercises are based on volumetric incentive spirometry and expiratory flow modulation. Motor work aims to allow patient walking as soon as possible. In case of complications, the physical therapist works on patient’s positioning, passive and active mobilization, as well as standing. Regarding breathing, the goal is airway deconstruction and weaning from mechanical ventilation. A new technique called extracorporeal oxygenation membrane (ECMO)-based bridge is currently being developed before transplantation in situation of great emergency. In this setting, physiotherapy is essential to prepare the patient for the upcoming transplantation in improved conditions. Physiotherapy must be performed in a suitable environment by a multidisciplinary team.