Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, NC, USA.
Crit Care Med. 2011 Dec;39(12):2593-8. doi: 10.1097/CCM.0b013e3182282bbe.
Extracorporeal membrane oxygenation as a bridge to lung transplantation has traditionally been associated with substantial morbidity and mortality. A major contributor to these complications may be weakness and overall deconditioning secondary to pretransplant critical illness and immobility. In an attempt to address this issue, we developed a collaborative program to allow for active rehabilitation and physical therapy for patients requiring life support with extracorporeal membrane oxygenation before lung transplantation.
An interdisciplinary team responded to an acute need to develop a mechanism for active rehabilitation and physical therapy for patients awaiting lung transplantation while being managed with extracorporeal membrane oxygenation. We describe a series of three patients who benefited from this new approach.
A quaternary care pediatric intensive care unit in a children's hospital set within an 800-bed university academic hospital with an active lung transplantation program for adolescent and adult patients. PATIENTS, INTERVENTIONS, AND MAIN RESULTS: Three patients (ages 16, 20, and 24 yrs) with end-stage respiratory failure were rehabilitated while on extracorporeal membrane oxygenation awaiting lung transplantation. These patients were involved in active rehabilitation and physical therapy and, ultimately, were ambulatory on extracorporeal membrane oxygenation before successful transplantation. Following lung transplantation, the patients were liberated from mechanical ventilation, weaned to room air, transitioned out of the intensive care unit, and ambulatory less than 1 wk posttransplant.
A comprehensive, multidisciplinary system can be developed to safely allow for active rehabilitation, physical therapy, and ambulation of patients being managed with extracorporeal membrane oxygenation. Such programs may lead to a decreased threshold for the utilization of extracorporeal membrane oxygenation before transplant and have the potential to improve conditioning, decrease resource utilization, and lead to better outcomes in patients who require extracorporeal membrane oxygenation before lung transplantation.
体外膜氧合作为肺移植的桥梁，传统上与大量发病率和死亡率相关。这些并发症的一个主要原因可能是由于移植前的危重病和不动导致的虚弱和整体失健。为了解决这个问题，我们开发了一个协作计划，允许需要体外膜氧合支持的患者在肺移植前进行积极的康复和物理治疗。
一个跨学科的团队响应了一个迫切的需求，即为接受体外膜氧合治疗的等待肺移植的患者开发一种积极康复和物理治疗的机制。我们描述了三个从这种新方法中受益的患者系列。
一家位于 800 张病床的大学附属医院内的儿童医院中的四级护理儿科重症监护病房，该医院拥有一个针对青少年和成年患者的活跃肺移植计划。
患者、干预措施和主要结果：三名患有终末期呼吸衰竭的患者（年龄分别为 16、20 和 24 岁）在等待肺移植时通过体外膜氧合进行了康复。这些患者参与了积极的康复和物理治疗，最终在成功移植前能够在体外膜氧合下步行。肺移植后，患者脱离机械通气，脱机至室内空气，从重症监护病房转出，移植后不到 1 周即可行走。
可以开发一个全面的、多学科的系统，以安全地允许接受体外膜氧合治疗的患者进行积极的康复、物理治疗和行走。此类计划可能会降低移植前使用体外膜氧合的门槛，并有可能改善患者的调理状况，减少资源利用，并为需要体外膜氧合支持的患者带来更好的结果。
