Pre-transplantation phase

Transplant surgeons, thoracic surgeons, ICU physicians, transplant nutritionists, physical therapists, psychologists, and a specialized ECMO nursing team formed a multidisciplinary team at our transplant center. Lung transplant experts assessed the pulmonary function of patients. Nutritionists formulated personalized nutritional support plans. To enhance patient recovery, physical therapists provided personalized rehabilitation programs, and psychologists assisted the patients in managing negative psychological states during their hospital stay.

The indications for ECMO were difficulties in managing hypoxemia, hypercapnia, and right heart failure after active treatment for potential lung transplant recipients.[6] The ECMO mode was selected in accordance with the standard protocol for administering ECMO during the perioperative period of LTx. After respiratory and circulatory functions gradually stabilized, ECMO was weaned postoperatively. The weaning strategy of ECMO depends on its modes. For veno-venous ECMO (V-V ECMO) mode, the blood flow was gradually reduced to 2.5–3.0 L/min, and then the ventilation volume was decreased. Under the same mechanical ventilation conditions, V-V ECMO can be discontinued if significant improvements are found in imaging studies, with no carbon dioxide retention and adequate oxygenation maintained. However, for the veno-arterial ECMO (V-A ECMO) mode, it is important to evaluate the recovery of lung and heart function. Common indicators for heart function recovery include maintenance of hemodynamic stability with low-dose vasopressors, a self-pulse pressure difference ≥20 mmHg, and improved bedside ultrasound indicators such as cardiac output, ventricular size, aortic velocity-time integral, and ejection fraction.

The patients who receive ULTx usually have more severe conditions than those who receive regular transplants.[7] We developed a personalized pulmonary rehabilitation protocol tailored to the specific situation of each patient. To improve nutritional status, nutritional support was initiated before LTx. Within 24 h after admission, nurses conducted a comprehensive nutritional assessment using the Nutritional Risk Screening 2002 (NRS 2002) and weight measurements, followed by weekly monitoring. An NRS 2002 score of ≥3 indicated a higher risk of malnutrition. Nutritionists were consulted to develop a dietary plan that met the patient’s energy needs, with a protein intake of 1.2–2.0 g/(kg·d). We conducted real-time monitoring of nutrition-related indicators and recorded detailed daily nutrition. Given that patients needed mechanical ventilation waiting for transplantation, we adopted a strategy that comprised passive and active training. Passive training included limb relaxation and bed-bike training. Simultaneously, we managed patients’ physical condition in real time to prevent deterioration by changing physiological and psychological states. Therefore, the patients could receive surgical treatment in the best physical and mental state, reducing the occurrence of postoperative complications.