CNE Article: Pain After Lung Transplant: High-Frequency Chest Wall Oscillation vs Chest Physiotherapy

2013 ◽  
Vol 22 (2) ◽  
pp. 115-124 ◽  
Author(s):  
Angeli Esguerra-Gonzalez ◽  
Monina Ilagan-Honorio ◽  
Stephanie Fraschilla ◽  
Priscilla Kehoe ◽  
Ai Jin Lee ◽  
...  
Keyword(s):  
Chest Wall ◽  
High Frequency ◽  
Repeated Measures ◽  
Lung Transplant ◽  
Chest Physiotherapy ◽  
Transplant Recipients ◽  
Pain Scores ◽  
Significant Difference ◽  
Wall Oscillation ◽  
Lung Transplant Recipients

Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ2 and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115–125)

Effect of high-frequency chest wall oscillation versus chest physiotherapy on lung function after lung transplant

2014 ◽  
Vol 27 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Angeli Esguerra-Gonzales ◽  
Monina Ilagan-Honorio ◽  
Priscilla Kehoe ◽  
Stephanie Fraschilla ◽  
Ai Jin Lee ◽  
...  
Keyword(s):  
Lung Function ◽  
Chest Wall ◽  
High Frequency ◽  
Lung Transplant ◽  
Chest Physiotherapy ◽  
Wall Oscillation

432 Chest Wall Infections in Lung Transplant Recipients: Does Surgical Approach Matter?

2011 ◽  
Vol 30 (4) ◽  
pp. S147
Author(s):  
R.K. Shields ◽  
C.J. Clancy ◽  
L.R. Minces ◽  
A. Vadnerkar ◽  
R.C. Abdel Massih ◽  
...  
Keyword(s):  
Chest Wall ◽  
Surgical Approach ◽  
Lung Transplant ◽  
Transplant Recipients ◽  
Lung Transplant Recipients

Effect of Positioning on Oxygenation in Single-Lung Transplant Recipients

2002 ◽  
Vol 11 (1) ◽  
pp. 66-75 ◽  
Author(s):  
Elisabeth L. George ◽  
Leslie A. Hoffman ◽  
Arthur Boujoukos ◽  
Thomas G. Zullo
Keyword(s):  
Blood Flow ◽  
Postoperative Period ◽  
Repeated Measures ◽  
Lung Transplant ◽  
Transplant Recipients ◽  
Repeated Measures Design ◽  
Native Lung ◽  
Single Lung Transplant ◽  
Quasi Experimental ◽  
Lung Transplant Recipients

• Background Many benefits and adverse effects of positioning are related to changes in ventilation and perfusion. A number of unique factors related to the allograft make the effects of positioning difficult to determine in single-lung transplant recipients.• Objectives To determine the effect of 3 body positions (supine, lateral with allograft lung down, and lateral with native lung down) on oxygenation and blood flow in single-lung transplant recipients in the 24 hours immediately after surgery.• Methods A quasi-experimental repeated-measures design with stratified assignment to 1 of 3 different sequencing patterns for turning group was used to study 15 transplant recipients, 9 with emphysema and 6 with fibrosis. Oxygenation, ventilation, and blood flow measures (heart rate, blood pressure) were assessed after each turn. The effect of ischemic reperfusion injury was also explored.• Results The oxygenation, ventilation, and blood flow variables did not differ significantly across group, diagnosis, or time. Oxygenation variables measured when the allograft lung was dependent did not differ significantly from such measurements obtained when the native lung was dependent.• Conclusions No single position maximizes oxygenation in the immediate postoperative period in single-lung transplant recipients. Although a single standard protocol for positioning cannot be supported, the study does support the idea that transplant recipients can be safely turned in the immediate postoperative period without compromising oxygenation or hemodynamic status.

scholarly journals Effects of High-Frequency Chest Wall Oscillation on Pleural Pressure and Oscillated Flow

2008 ◽  
Vol 42 (6) ◽  
pp. 485-491 ◽  
Author(s):  
Tal Zucker ◽  
Neil M. Skjodt ◽  
Richard L. Jones
Keyword(s):  
Chest Wall ◽  
Lung Volume ◽  
Pulse Pressure ◽  
High Frequency ◽  
Esophageal Pressure ◽  
Wall Pressure ◽  
Pleural Pressure ◽  
Significant Difference ◽  
Esophageal Balloon ◽  
Wall Oscillation

Abstract The effectiveness of high-frequency chest wall oscillation (HF-CWO) is directly related to the level of oscillated flow (vosc) in the airways. We used the Vest™ system to investigate the effects of HFCWO on chest wall and pleural pressures and we correlated these pressures to the resultant vosc. We also compared the latest HFCWO device with it predecessor. Different combinations of vest inflation pressure (background pressure) and oscillation frequency were randomly applied to 10 healthy volunteers. Chest wall pressure was determined using an air-filled bag under the vest and pleural pressure was estimated using an esophageal balloon. Reverse plethysmography was used to measure vosc at the mouth and a spirometer was used to measure changes in end-expired lung volume. We found a significant correlation between chest wall and pleural pressure with approximately one-third of the chest wall pressure transmitted into the pleural space. Mean esophageal pressure remained negative at all background pressure/frequency combinations. There was a significant correlation (p<0.0001) between the esophageal pulse pressure and vosc, which was highest at 15Hz regardless of the background pressure. The end-expired lung volume correlated with mean chest wall pressure. There was no significant difference between the two Vest™ systems. Since vosc dictates the effectiveness of HFCWO and since vosc is dependent on esophageal pulse pressure, which in turn is dependent on chest wall pulse pressure, it follows that the effectiveness of HFCWO is influenced by the ability to generate an effective chest wall pulse pressure.

scholarly journals 89. Efficacy and Tolerability of Voriconazole (VOR) vs. Isavuconazole (ISA) Prophylaxis (px) in Preventing Invasive Fungal Infections (IFI) in Lung Transplant Recipients (LTR)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S6-S7 ◽  
Author(s):  
Palash Samanta ◽  
Rachel V Marini ◽  
Erin K McCreary ◽  
Ryan K Shields ◽  
Bonnie A Falcione ◽  
...  
Keyword(s):  
Chest Wall ◽  
Lung Transplant ◽  
Fungal Infections ◽  
Fungal Culture ◽  
Transplant Recipients ◽  
Research Support ◽  
Kaplan Meier ◽  
Grade 3 ◽  
Lung Transplant Recipients ◽  
Underlying Diseases

Abstract Background IFI is a significant complication following lung transplant (LT). VOR was universal antifungal px in our LT program from 2004 to October 2015, at which time px was changed to ISA. We compared the efficacy and tolerability of VOR vs. ISA px in LTR. Methods We reviewed all LTR from September 2013 to February 2018 who received VOR or ISA Px. The standard duration of px was 3 or 4 months following basiliximab and alemtuzumab induction, respectively. All patients were followed for ≥1 years post-Tx. IFI was defined by revised EORTC/MSG criteria. Results In total, 310 LTR were included, 149 and 161 of whom received ISA and VOR px, respectively. There was no difference in demographics, underlying diseases, single vs. double LT, or induction therapy (alemtuzumab vs. basiliximab) between the 2 groups. At 1-year after LT, 9% (14) and 8% (13) of patients in ISA and VOR groups developed IFI, respectively (P = 0.5). 5% (7) and 3% (5) of patients developed breakthrough (BT) IFI during ISA and VOR px, respectively (P = 0.6; Figure 1, P = 0.4, Kaplan-–Meier). ISA BT included pneumonia (PNA, 2), endobronchial IFI (2), mediastinitis (1), chest wall IFI (1), and candidemia (1). ISA BT patients were infected with Aspergillus fumigatus (3; 2 with ISA MIC = 0.5 µg/mL, 1 MIC = 1 µg/mL), black mould (1), and yeasts (3; 2 C. glabrata, 1 C. albicans). VOR BT IFI included PNA (2), endobronchial IFI (1), empyema (1), and chest wall IFI (1). VOR BT IFIs were due to A. ustus, A. niger, A. lentulus, black mould, and Rhizopus spp (1 each). All Aspergillus VOR BT isolates exhibited VOR MIC ≥2 µg/mL. Patients with IFI were more likely to have positive pre-LT respiratory fungal culture (P = 0.01) and grade ≥3 ischemic reperfusion injury (IRI) post-LT (P = 0.01). VOR and ISA were prematurely discontinued in 53% (85) and 14% (21) of patients due to adverse events, respectively (P < 0.0001). Hepatotoxicity was more common with VOR (22%, 35) than ISA (5%, 7) (P < 0.0001). IFI was an independent risk factor for death at 1 year (Figure 2, P < 0.0001, Kaplan–Meier). Conclusion ISA was as effective as VOR in preventing IFI in LTR, and significantly better tolerated. Pre-LT fungal culture positivity and grade ≥3 IRI post-LT were risk factors for the development of IFI. IFI within 1-year post-LT had a significant impact on mortality Disclosures Fernanda P. Silveira, MD, MS, FIDSA, Ansun: Grant/Research Support; Qiagen: Grant/Research Support; Shire: Grant/Research Support; Whiscon: Grant/Research Support.

Increasing the Quantity of Lungs for Transplantation Using High-Frequency Chest Wall Oscillation: A Proposal

2002 ◽  
Vol 12 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Jane M. Braverman
Keyword(s):  
Chest Wall ◽  
High Frequency ◽  
Critical Factor ◽  
Chest Physiotherapy ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Donor Lung ◽  
Direct Data ◽  
Wall Oscillation ◽  
Better Than

The use of chest physiotherapy in donor patient management occupies an established place in most lung procurement protocols. Although its merits remain controversial and uncorroborated by direct data, some studies support the efficacy of chest physiotherapy in a variety of pulmonary patient populations. Comparative studies have shown that an airway clearance technology utilizing high-frequency chest wall oscillation clears pulmonary secretions as well as or better than chest physiotherapy, but has few of its contraindications and disadvantages. The implementation of high-frequency chest wall oscillation as part of the donor lung procurement protocol may increase rates of successful lung recovery by providing effective clearance of obstructing pulmonary secretions containing destructive by-products of inflammation and entrapped pathogens. High-frequency chest wall oscillation may also improve arterial blood gas values, a critical factor in increasing lung procurement rates. Although speculative, the benefits of high-frequency chest wall oscillation on donor lungs might improve perfusion and oxygenation of other organs for possible transplantation.

scholarly journals Noninvasive monitoring of infection and rejection after lung transplantation

2015 ◽  
Vol 112 (43) ◽  
pp. 13336-13341 ◽  
Author(s):  
Iwijn De Vlaminck ◽  
Lance Martin ◽  
Michael Kertesz ◽  
Kapil Patel ◽  
Mark Kowarsky ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
High Frequency ◽  
Lung Transplant ◽  
Area Under The Curve ◽  
Human Herpesvirus ◽  
Clinical Results ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Clinical Complications ◽  
Lung Transplant Recipients

The survival rate following lung transplantation is among the lowest of all solid-organ transplants, and current diagnostic tests often fail to distinguish between infection and rejection, the two primary posttransplant clinical complications. We describe a diagnostic assay that simultaneously monitors for rejection and infection in lung transplant recipients by sequencing of cell-free DNA (cfDNA) in plasma. We determined that the levels of donor-derived cfDNA directly correlate with the results of invasive tests of rejection (area under the curve 0.9). We also analyzed the nonhuman cfDNA as a hypothesis-free approach to test for infections. Cytomegalovirus is most frequently assayed clinically, and the levels of CMV-derived sequences in cfDNA are consistent with clinical results. We furthermore show that hypothesis-free monitoring for pathogens using cfDNA reveals undiagnosed cases of infection, and that certain infectious pathogens such as human herpesvirus (HHV) 6, HHV-7, and adenovirus, which are not often tested clinically, occur with high frequency in this cohort.

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