Patients awaken from surgery in the heart and vascular surgical intensive care unit (HVICU) at the Hospital of the University of Pennsylvania. They see many tubes attached to them and medical apparatus around the bed.
A breathing tube in the mouth and into the airway is connected to a ventilator. This assists patients with breathing during surgery and while waking up until they are able to do the work of breathing on their own. They are unable to talk while the tube is in place. The ICU staff and the transplant team are very good at communicating with patients and understanding their needs after surgery. Typically, the breathing tube is removed when patients are fully awake from the anesthesia and able to do the work of breathing on their own. This can take from two to three days after the surgery. Sometimes there are complications that require the patient to remain on the ventilator longer.
Soft restraints are placed on the wrists to keep patients from accidentally pulling on the tubes as they wake up. The restraints are removed once patients are awake and able to follow instructions.
Patients receive several medications to support their new lung in the first few days following transplant. These medications are delivered through an intravenous (IV) line and will slowly be changed to pill form once the patient is cleared to swallow food and liquids.
Catheters (tubes) are placed in the neck, arms and wrist to assist with monitoring pressure and blood flow through the heart, lungs and rest of the body. All of the tubes and catheters are removed as patients recover.
Chest tubes are placed around each transplanted lung. These tubes are placed during surgery and are intended to drain air and fluid from the area around the new lung(s) inside the chest, allowing the lung(s) to fully expand.
A bladder catheter is in place to drain urine. Early post-operatively, urine output is closely monitored to make sure that kidney function is intact. Once a patient is able to move independently, this tube is removed.
Patients who spend more than a couple hours a day in bed are at risk to develop blood clots in their legs. To prevent this, compression boots are applied to the lower legs. These devices gently inflate and deflate (like a blood pressure cuff) to promote good blood movement.
As soon as patients are able to participate in physical therapy, the pulmonary rehabilitation team begins to work with them. Typically, this work begins in the ICU and continues throughout the hospitalization and beyond.
Unless there are complications, most people are in the intensive care unit for three to five days. A decision to advance a patient to the lung transplant floor is based on the individual's condition.
Transplant patients have a private room while in the hospital to protect them from infection. Although family and friends may visit, they are asked to avoid visiting if they have a cold, fever, or feel sick. Anyone entering the room must first wash their hands.
Patients are encouraged to increase their physical activity after they move to the step-down unit. Their muscles may be weak and they need to begin exercising in small ways immediately following surgery. A physical therapist and respiratory therapist evaluate every patient’s exercise abilities and conduct physical therapy sessions daily. This is the beginning of the journey to recovery and the return to physical fitness.
Patients are assigned a primary nurse, who works with the lung transplant team to educate patients and their families about medications, lifestyle and activity. The patient’s primary care givers are asked to attend the teaching sessions with the lung transplant nurse coordinator.
Before discharge, a bronchoscopy is performed to make sure the surgical connection of the air tubes (bronchus) are healing well and free of infection.
An average length of stay in the hospital after transplant is 10 to 14 days.