ObjectiveTo explore the effect of continuous nursing on lung transplant patients at home based on humanistic care. MethodsAccording to hospitalization order, patients who received lung transplantation in our hospital from January 2016 to October 2020 were divided into a control group and a nursing group. The control group was treated with routine lung transplantation education and regular follow-up after discharge, and the nursing group received humanistic care during follow-up, health education at discharge, cultural exchange activities, and home care plans. After discharge, the self-management ability at home, medication adherence and satisfaction of home care between the two groups were campared. ResultsA total of 60 patients were included in the study. There were 23 patients in the control group, including 16 males and 7 females, with an average age of 58.70±11.00 years. There were 37 pateints in the nursing group, including 25 males and 12 females, with an average age of 57.90±13.20 years. The scores of self-management ability at home of the nursing group (self-concept 27.41±2.37 points vs. 21.78±3.54 points; self-care responsibility 20.73±1.63 points vs. 16.83±2.79 points; self-care skills 41.46±3.77 points vs. 28.26±4.11 points; health knowledge level 57.95±4.10 points vs. 44.87±5.79 points) were higher than those in the control group (all P＜0.05). The medication adherence (7.47±0.46 points vs. 6.87±0.28 points) and satisfaction of home care (23.80±1.20 points vs. 20.50±1.90 points) in the nursing group were higher than those in the control group (both P<0.05). ConclusionContinuous nursing based on humanistic care for lung transplant patients can effectively improve the self-management ability, medication adherence and nursing satisfaction of patients after discharge.
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic at the end of December 2019, more than 85% of the population in China has been infected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly affects the respiratory system, especially the lungs. The mortality rate of patients with severe infection is high. A percentage of 6% to 10% of patients will eventually develop into COVID-related acute respiratory distress syndrome (CARDS), which requires mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support. Some patients who survive acute lung injury will subsequently develop post COVID-19 pulmonary fibrosis (PCPF). Both fully treated CARDS and severe PCPF are suitable candidates for lung transplantation. Due to the special course, evaluation strategies are different from those used in patients with common end-stage lung disease. After lung transplantation in COVID-19 patients, special treatment is required, including standardized nucleic acid testing for the novel coronavirus, adjustment strategy of immunosuppressive drugs, and rational use of antiviral drugs, which is a big challenge for the postoperative management of lung transplantation. This consensus was evidence-based written and was reached by experts after multiple rounds of discussions, providing reference for assessment and postoperative management of patients with interstitial pneumonia after COVID-19 infection.
Lung transplantation has been the only valid method in treating end-stage lung diseases, airway complications are the main cause to the failure of surgery and common postoperative complications. With the development on patient selection, organ preservation, surgical technique, immunosuppressive therapy and postoperative surveillance, the successful ratio of surgery has become most satisfactory. However, airway complications are still common after lung transplantation. Among these, the airway anastomosis stenosis is more predominant than others. The living quality and long-dated survival rate are highly improved by paying enough attention to the formation,corresponding management for tracheal stenosis. The progress of the cause, prevention and treatment of airway anastomosis stenosis after lung transplantation is reviewed in this article.
Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.
ObjectiveTo analyze the benefits of lung transplantation in the treatment of interstitial lung disease (ILD) and investigate its prognostic factors.MethodsThe clinical data of patients diagnosed with ILD and meet the lung transplantation criteria were retrospectively analyzed from January 2012 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. A total of 111 patients, 88 males and 23 females, aged (58.3±11.4) years old, were divided into lung transplantation group and non-lung transplantation group. Clinical data and prognosis of the two groups were compared and the factors affecting the prognosis of lung transplantation were analyzed with relevant literatures. Results There were 56 patients in lung transplantation group and 55 patients in non-lung transplantation group. The mainly underlying disease of both groups were idiopathic pulmonary fibrosis (IPF). There was no significant difference in age, body mass index, arterial partial pressure of oxygen, percentage of forced vital capacity in the estimated value, percentage of diffusing capacity of the lung for carbon monoxide in the estimated value, six-minute walk distance between the two groups (P>0.05). The pulmonary arterial hypertension and arterial partial pressure of carbondioxide were higher in lung transplantation group than non-transplantation group (P<0.05). The 1-year survival rate in the lung transplantation group was significantly higher than that in the non-lung transplantation group: 77.4% vs. 32.7% (P<0.01). COX regression analysis showed that preoperative ventilator dependence, serum creatinine, bilirubin, pulmonary artery pressure, and procedures (single lung vs. double lung) had no significant effect on the prognosis of lung transplantation; age and preoperative diabetes mellitus were risk factors for the prognosis of lung transplantation.ConclusionsLung transplantation can significantly improve the prognosis of patients with ILD who are refractory to medicine therapy. IPF patients should be advised to consider lung transplantation as soon as possible. Age and preoperative diabetes mellitus are risk factors for the prognosis of lung transplantation.
Lung transplantation has developed in China for nearly half a century. The Wuxi lung transplant team completed our first lung transplantation on September 28, 2002. By the year of 2021, the total number of lung transplantation in China has been increased to 775, while 49 medical centers have been qualified to perform lung transplantation. During the past two decades, we vigorously promoted lung transplantation technique, cooperated and communicated with colleagues in relevant specialties. Thus, more and more patients with end-stage lung diseases could be evaluated and transplanted to save their lives, with the support of medical insurance and funds. The full-process monitoring and staged objective management, have been well established regarding to donor evaluation standards and acquisition procedures, the green channel for organ transportation, postoperative intensive care unit management, prevention of rejection and infection, as well as long-term follow-up of recipients. Based on the classical lung transplantation surgical techniques, technical breakthroughs have been made while the public’s acknowledgement of lung transplantation has been also enhanced. In the future, lung transplantation techniques will be increasingly challenged by new technologies and ethics, bringing diversified opportunities and challenges to the lung transplantation team collaboration.
From December 2022 to January 2023, 4 lung transplant recipients (3 males and 1 female, aged 52-60 years, all received transplantation less than 1 year) were hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Xi'an Jiaotong University due to COVID-19 after surgery. The clinical manifestations were mostly characterized by elevated body temperature accompanied by shortness of breath, and indicators such as heart rate, oxygen saturation, and oxygenation index could reflect the severity of the condition. The therapy was timely adjusted to immunosuppressive drugs, upgraded oxygen therapy, anti-bacterial and anti-fungal therapy, prone ventilation, general treatment, and anticoagulant therapy, depending on the situation. Finally, 3 patients were cured and discharged from hospital, and 1 died.
ObjectiveTo investigate the epidemiology, etiology and prognosis of pneumonia in lung transplantation recipients. MethodsWe retrospectively analyzed the follow-up data of 42 case times (40 patients) of allogenic lung transplantation between March 2005 and August 2014. There were 29 males and 11 females with a mean age of 52.4±13.8 years. There were 32 case times with double lung transplantation, and 10 case times with single lung transplantation. Two patients underwent lung transplantation twice at an interval of 6.5 years and 4.0 years, respectively. ResultsIn 42 case times of lung transplantation, 26 case times had forty-two episodes of pneumonia throughout the follow-up period of median 146 days (range 3 to 2 704 days). Microbiological etiology was established in 36 case times of pneumonia. Bacterial pneumonia (68.1%) was more frequent than fungal (10.6%) and viral pneumonia (8.5%). The cumulative risk of a pneumonia episode increased sharply in the first 30 days after transplantation. A percentage of 38.1% of total pneumonia episodes occurred within 30 days after transplantation, predominately due to Gram negative bacilli. While pneumonia of gram-negative bacilli occurred earliest with a median of 20 days (range 8-297 days). pneumonia caused by viruses (283 days, range 186-482 days) appeared significantly later than gram-negative bacilli, and unknown etiology (44.5 days, range 3-257 days) (P=0.001 and P=0.019, respectively). The survival rate in 1 year, 3 years, and 5 years was 66.1%, 56.3%, and 36.2%, respectively. pneumonia episode within 30 days after lung transplantation was associated remarkably with mortality risk (P=0.03) in lung transplantation recipients. The total blood loss during transplantation procedure and post-transplantation intubation time were associated significantly with early onset of pneumonia (≤30 days) by univariate analysis. ConclusionRecognition of epidemiology, etiology and chronology of post-transplantaion pneumonia has implications relevant for appropriate management and optimal antibiotic prescription in lung transplantation recipients.