In addition to the detail described above, some important points should be considered in the lung (and also hear transplant) patients. Have a look over them as under:

The intensive care area and ward management of the cardiopulmonary transplant patient is similar to that any patient having undergone cardiac or thoracic surgery. The major differences include drug therapy and intensive and comprehensive monitoring necessary because of the potential for rejection and infection. The degree and the duration of the protection isolation of the recipients vary considerably between centers. Some units protectively isolate recipients in laminar air flow rooms, while others only require thorough hand washing before contact with the patient.

The lungs of the hear lungs and lungs recipients are denervated distal to the tracheal or bronchial anastmosis. As a result the recipient ability to cough spontaneously in response to the secretions accumulating distal to anastmosis is impaired.

Post operative physiotherapy is started immediately (30 minutes to 1 hour) post extubation, which is 6-12 hours following transfer to intensive care unit from the theatre. There are occasions, however, when it may be necessary for the physiotherapist to b involved before extubation. This may be to facilitate the removal of secretions. More often the treatment involves the techniques of breathing control when a patient, weaning from ventilator, showing the signs of distress without obvious fatigue. Well supported positioning, utilization of the stimulation and reassurance of hands on instruction alternated with shoulder and soft tissue techniques can bring about the change in the respiratory pattern and rate, and positively affect the arterial blood gases and haemodynamic status. Initial treatment involves:

The active cycle of breathing techniques:
-Breathing control
-Thoracic expansion exercises
-Forced expiration technique
-Gravity assisted position as appropriate

Assisted limb work progressing to active, antigravity limb exercise over the first day and as required as appropriate.

For Hear lung and lungs patients’ gravity assisted positions for middle / lingual and basal segments are incorporated into their daily treatment in acute phase. As a result of denervation of lungs, it is essential to evaluate whether the huff is dry or moist. If it is moist indicating the secretions, appropriate techniques should be employed to clear the bronchial secretions.

Patients may sit out of bed as early as day 1 postoperatively. Patients usually start mobilizing from bed to chair on day 2 or 3. Very debilitated patients may commence the light upper limb programme as early as day 3.
Patient may be transferred to ward as early as day 3 or 4 postoperatively. Once free to mobilize from the bed area, patients are commences on stair climbing and bicycle ergometer gentle work.

Rehabilitation training to improve patient physical condition ( posture, strength, endurance), performing the full range of activities of daily living & appropriate exercise activities, promoting independence in maintaining and monitoring the physical condition. In patient attend the gymnasium 1-2 times daily. Out patients are encouraged to attend the gymnasium 3-5 times weekly. The most effective way of introducing the exercise programe gradually is according to the scale of perceived exertion such as Borg Scale. Activities are introduced at intensity such that patient’s subjective description of his level of his level of exertion is very light or light. The intensity is subsequently progressed to the level of exertion described as some what hard or very hard. Gymnasium exercises used in post transplant rehabilitation programme is as under:

Activity Purpose Time/ repetition

Treadmill Warm up 12 minutes

Bicycle ergometer Endurance/aerobic fitness 5-40minutes

Multigym Quadriceps strengthening 12-30 repetitions

Rowing machine Quadriceps/upper limb/upper trunk strengthening 12-30 repetitions

Weights Upper limbs and shoulder girdle strengthening 1-10 KG, 10-30 repetitions

Minitrampoline Glutei and lower limb strengthening 1-15 minutes

Wobble Boards Ankle/Knee stability 1-5 minutes