Fisioterapia

Pulmonary Rehabilitation for Patients Who Undergo Lung-Volume-Reduction Surgery or Lung Transplantation
Carolyn L Rochester MD

Introduction Rationale for Pulmonary Rehabilitation Prior to Lung Volume Reduction Surgery or Lung Transplantation Benefits of Pulmonary Rehabilitation Prior to LVRS or Lung Transplantation Clinical Benefits of Pulmonary Rehabilitation Versus LVRS PulmonaryRehabilitation Following LVRS or Lung Transplantation Program Content of Pulmonary Rehabilitation for LVRS or Lung Transplantation Summary Patients preparing for or recovering from lung-volume-reduction surgery (LVRS) or lung transplantation represent a selected group of patients with advanced chronic respiratory disease. Such patients typically have severe ventilatory limitation and disability and are athigh risk of preoperative and postoperative complications. Pulmonary rehabilitation is an ideal setting in which to: address the patient’s questions and knowledge-deficits regarding his or her disease and its treatment; ensure that the patient understands the nature, potential benefits, risks, and expected outcomes of the surgery relative to medical therapies, and; prepare physically andemotionally for the surgery. Pulmonary rehabilitation also may improve survival to and/or outcomes of LVRS and transplantation, at least in part by stabilizing and improving the patient’s exercise tolerance and muscle function. Further work is needed to determine whether pulmonary rehabilitation can augment the benefits and outcomes of LVRS or lung transplantation, reduce postoperative complications, orimprove patient survival to or following the surgery. Key words: lung-volume-reduction surgery, LVRS, lung transplantation, chronic respiratory disease, pulmonary rehabilitation. [Respir Care 2008;53(9):1196 –1202. © 2008 Daedalus Enterprises]

Introduction Pulmonary rehabilitation is now recognized widely as an important component of care of patients with chronic

obstructive pulmonary disease(COPD),1-3 because it improves dyspnea, exercise tolerance, and quality of life. Patients preparing for or recovering from lung-volumereduction surgery (LVRS) or lung transplantation repre-

Carolyn L Rochester MD is affiliated with the Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, Connecticut. Dr Rochester presented a version of this paper at the 23rdAnnual New Horizons Symposium at the 53rd International Respiratory Congress of the American Association for Respiratory Care, held December 1-4, 2007, in Orlando, Florida.

The author reports no conflict of interest related to the content of this paper. Correspondence: Carolyn L Rochester MD, Section of Pulmonary and Critical Care, Yale University School of Medicine, 333 Cedar Street, BuildingLCI-105, New Haven CT 06520. E-mail: carolyn.rochester@ yale.edu.

1196

RESPIRATORY CARE • SEPTEMBER 2008 VOL 53 NO 9

PULMONARY REHABILITATION

FOR

PATIENTS WHO UNDERGO LVRS

OR

LUNG TRANSPLANTATION

Fig. 1. Schema summarizing the rationale for and benefits of pulmonary rehabilitation for patients who undergo lung volume reduction surgery or lung transplantation.

sent a highlyselected group of patients with advanced emphysema and other forms of severe chronic respiratory disease, such as pulmonary fibrosis, pulmonary artery hypertension, and cystic fibrosis (CF). Among all persons with chronic lung disease these patients tend to have the greatest degree of ventilatory limitation and disability, and are at high risk of preoperative and postoperative complications.Efforts to physically and emotionally prepare the patient for surgery may reduce the risk of complications and improve patient-centered outcomes. Postoperative rehabilitation also may hasten recovery. Preoperative and postoperative pulmonary rehabilitation is an ideal means by which these goals can be realized. Pulmonary rehabilitation is routinely provided to such patients and is recommended as a...