The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

PULMONARY REHABILITATION IN PATIENTS WITH SEVERE END-STAGE LUNG DISEASE REQUIRING HIGH FLOW OXYGEN WITH EXERCISE PRIOR TO LUNG TRANSPLANTATION.



D. Biggar RN BC ANP, C. Hoerr BS RRT, D. Clinkscale MBA RRT, E. Trulock MD, GA Patterson MD, Respiratory Care Services Barnes-Jewish Hospital and the Washington University Lung Transplant Program, Washington University School of Medicine, St. Louis, MO

Background: Patients accepted for lung transplant at our institution are required to participate in pulmonary rehabilitation prior to transplantation. These patients have severe end-stage lung disease and many require high flow oxygen with exercise. The purpose of this study was to evaluate the six minute walk (6 MW) test distance at initial evaluation, at the evaluation, start of the rehabilitation program, and again prior to transplantation in a subgroup of patients requiring high flow oxygen during exercise endurance training and determine if use of high flow oxygen improved 6MW test distance outcomes.

Method: Retrospective review of the rehabilitation results of a series of 15 patients with complete data transplanted between March 20, 2002 and December 23, 2004.

PatientsPopulation: The study group consisted of 15 patients (8 males, 7 females) with a mean age of 47 who were evaluated and accepted for bilateral lung transplantation. All patients in this group subsequently underwent on to surgery. Diagnoses included: idiopathic pulmonary fibrosis (7), cystic fibrosis (4), COPD (1), bronchiectasis (1) and sarcoidosis (2). Diagnostic information gathered at initial evaluation is as follows:

FVC (Mean %) = 47 DLCO (Mean %) = 29
FEV1 (Mean %) = 38 RVEF (Mean %) = 37
TLC (Mean %) = 84 PAP (Mean mmHg) = 34
Mean age: 47 Gender: 8 males, 7 females
Mean eval Fev1 (%): 38% Mean eval DLCO (%): 29%
Mean eval FVC (%): 47% Mean eval RVEF: 37%
Mean evalTLC (%): 84 Mean eval pulmonary artery pressure: 34 mm/Hg

Interventions: All patients participated in pulmonary rehabilitation pre-transplant. Rehabilitation included supervised endurance exercise training either on a treadmill or cycle ergometer for 30 continuous minutes, 5 days/week. Treadmill speed or ergometer resistance was increased each session to patient's tolerance and/or to maintain heart rate at 70-85% of predicted maximum. Supplemental oxygen was administered as necessary to keep SpO2 > 90%. Oxygen usage during exercise: 8 required high flow cannula at mean flow of 8.5 liters; 7 required use of partial non-rebreather masks. . Mean time from initial evaluation to beginning the pulmonary rehabilitation program at our center was 43 weeks. Mean time in the pulmonary rehabilitation program prior to transplant was 14 weeks.

Results:
Mean 6 MW Distance (feet) *

Parameter p-value+
Evaluation (1) Start rehab (2) Pre-transplant(3) 1 vs.2 2 vs. 3 1 vs. 3
979 ± 383.9 879±376.2 735±401.7 0.040 0.186 0.002

Mean 6 MW Distance (feet) * p-value+
Eval (1) Start rehab (2) Pre-transplant(3) 1 vs.2 2 vs. 3 1 vs. 3
979 + 383.9 879+376.2 735+401.7 0.040 0.186 0.002

*Data are expressed as mean ± standard deviation.

+ Related two-group comparisons were performed with paired, two-tailed "t" tests for means of normally distributed continuous variables.

Conclusions: Despite severe end-stage lung disease this group of ese patients were was able to tolerate endurance exercise training for 30 minutes up until transplantation. 6MW declined in these patients despite high flow oxygen during exercise. There was a statistically significant decline (p< 0.05) in 6 MW from the time of initial evaluation to the start of pulmonary rehabilitation. A and continuing decrease in 6MW was seen from the start of rehabilitation tup until o right before transplantation, despite the use of high flow oxygen during exercise. However, this decrease was not statistically significant. There was no significant change in 6 MW from the start of pulmonary rehab to right before transplantation. A combination of physical reconditioning and high flow oxygen suggests that progressive deterioration of endurance can be slowed in this patient population.

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