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Lung transplantation is widely accepted as the only viable treatment option for patients with end-stage lung disease. However, the imbalance between the number of suitable donor lungs available and the number of possible candidates often results in intensive care unit (ICU) admission for the latter. In the ICU setting, critical care is essential to keep these patients alive and to successfully bridge to lung transplantation. Proper management in the ICU is also one of the key factors supporting long-term success following transplantation. Critical care includes the provision of respiratory support such as mechanical ventilation (MV) and extracorporeal life support (ECLS). Accordingly, a working knowledge of the common critical care issues related to these unique patients and the early recognition and management of problems that arise before and after transplantation in the ICU setting are crucial for long-term success. In this review, we discuss the management and selection of candidates for lung transplantation as well as existing respiratory support strategies that involve MV and ECLS in the ICU setting. [ABSTRACT FROM AUTHOR]

Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: This study aimed to introduce the authors' surgical technique of bilateral video-assisted thoracoscopic thymectomy (BVT) and to compare their early surgical results between BVT and transsternal extended thymectomy (T3-b thymectomy) for patients with myasthenia gravis (MG). Methods: The records of 114 patients who underwent either BVT ( n = 55) or T3-b thymectomy ( n = 59) for MG were reviewed retrospectively between January 2006 and November 2009. Results: No surgical mortality or major morbidity occurred in either group. There was no conversion to open thymectomy, and no statistical difference was found in operation time between the two groups (112.2 ± 26.2 min for BVT vs. 130.7 ± 27.3 min for T-3b; p = 0.908). The duration of the chest tube, the length of the intensive care unit (ICU) or hospital stay, and the duration of opioid use for pain control were shorter in BVT group. The estimated blood loss and the total amount of drainage were greater in the T3-b thymectomy group. The specimen weights retrieved by BVT (72.5 ± 61.6 g) were similar to those retrieved by T3-b thymectomy (74.1 ± 38.2 g, p = 0.63) in nonthymomatous MG. Conclusions: The BVT was a safe procedure with a surgical extent and amount similar to those of T-3b thymectomy and less invasive for patients with MG. Long-term follow-up assessment and more extensive data are mandatory to verify the early surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation. Methods: We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4). Results: The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4. Conclusions: Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation. [ABSTRACT FROM AUTHOR]