Nutritional Supplementation And Neuromuscular Electrical Stimulation In Lung Transplant Patients

Purpose Intensive rehabilitation is recognized as an essential component to successful outcomes for recovery after a major cardio-thoracic surgery. We developed a multi-modal rehabilitation program that combines a physical therapy protocol with neuromuscular electric stimulation and nutrition supplementation to achieve improved functional outcomes for patients requiring lung transplantation. Methods Patients are randomized to the treatment arm or usual care 72 hours after transplant. Both groups undergo a global assessment of functional capabilities prior to transplant and at 72 hours post-transplantation. Patients in the treatment arm received additional physical therapy plus therapy with an electrical device and nutrition supplementation with essential amino acids. All patients received computed tomography to measure change in lower extremity skeletal muscle area. Muscle cross sectional area was measured at 1/3rd of the distance from the femoral tuberosity to the knee articulation. Results Preliminary results for six patients are presented in Figure 1. All patients had decreases in muscle cross-sectional area at 14 days post transplant. Compared to the standard of care group, the treatment group decreased average time of intubation (1.00±0.0 vs 2.33±1.4 days), average ICU length of stay (6.33±4.2 vs 8.33±7.5 days), and average hospital length of stay (17.00±2.6 vs 23.30±9.0 days). Conclusion We intend to use the data obtained from this pilot study to develop a larger, randomized interventional trial evaluating the effects of an intense multimodal rehabilitation program in improving long-term patient outcomes (including patient and graft survival) in cardiothoracic transplant recipients and as well as hospital length of stay and rate of early re-admission.