Reviewed By Pulmonary Rehabilitation Assembly
Submitted by
Rebecca H. Crouch, PT, DPT, MS, CCS, FAACVPR
Director of Pulmonary Rehabilitation
Duke University Medical Center
Durham, NC
Brian Tiep, MD
Medical Director, Pulmonary Rehabilitation
City of Hope National Medical Center
Duarte, CA
Submit your comments to the author(s).
History
A 56-year-old man with severe COPD is listed for lung transplantation. He is a disabled brick mason who lives alone. He is hypercapnic and oxygen dependent: 3 L/min via nasal cannula at rest, 4 L/min with exercise and 2 L/min during sleep with bilevel PAP. He recently stopped smoking via ALA “Freedom From Smoking” administered by a pulmonary rehabilitation instructor. He has hypertension that is controlled with medication. His goals are to return to community activities, resume household chores and to become oxygen independent. The patient’s greatest physical difficulties are walking inclines, functioning in hot weather, showering and vacuuming. The patient reports intermittent cervical stiffness with his worse pain level at 5/10. Medications include diltiazem, aspirin, inhaled formoterol, furosemide, inhaled levalbuterol, inhaled mometasone, omeprazole, lisinopril and inhaled tiotropium.
This patient underwent preoperative pulmonary rehabilitation (12/20/07 – 02/05/08). Bilateral lung transplant was performed on 7/5/08. Postoperative pulmonary rehabilitation started 17 days after surgery (07/22/08 – 09/15/08).
Physical Exam
Lab
Preoperative Data
Prerehabilitation (Pretransplant)
Arterial Blood Gas: (12/06/07)
FIO2 | 30% |
pH | 7.38 |
PCO2 | 72 mm Hg |
PO2 | 53 mm Hg |
Base Excess | 14 mM/L |
Bicarbonate | 43 mM/L |
CO2 Total | 45 mM/L |
Hemoglobin | 14.2 g/dl |
%O2 Hemoglobin | 87.7 % |
%CO Hemoglobin | 1.8 % |
Pulmonary Function Tests (PFT): (12/06/07)
Reference | Best | Predicted | ||
FVC | Liters | 5.13 | 2.27 | 44 % |
FEV1 | Liters | 4.02 | 0.48 | 12 % |
FEV/FVC | % | 78 | 21 | |
FEF 25-75% | L/sec | 3.74 | 0.13 | 4 % |
PEF | L/sec | 9.23 | 2.09 | 23 % |
MVV | L/min | 152 | 14 | 9 % |
6-Minute Walk Test: (12/20/07)
Prewalk | Postwalk | |
Heart Rate | 118 bpm | 136 bpm |
Blood Pressure | 116/86 mm Hg | 186/90 mm Hg |
Oxygen Saturation | 98% | 93% |
Oxygen | 2 lpm | 4 lpm |
Rate of Perceived Exertion: |
||
Breathing | 0/10 | 8/10 |
Effort |
0/10 | 6/10 |
Distance (feet) | 1300 | |
Number of rest stops | 0 | |
Ambulatory assistive device |
4-wheeled rolling walker |
Postrehabilitation (Pretransplant)
Following 25 Sessions of Pulmonary Rehabilitation
6-Minute Walk Test: (2/05/08)
Prewalk | Postwalk | |
Heart Rate | 115 bpm | 141 bpm |
Oxygen Saturation | 98% | 94% |
Oxygen | 4 lpm | 8 lpm |
Rate of Perceived Exertion: |
||
Breathing | 0/10 | 8/10 |
Effort |
0/10 | 8/10 |
Distance (feet) | 1400 | |
Number of rest stops | 0 | |
Ambulatory assistive device |
4-wheeled rolling walker |
Postoperative Data
Arterial Blood Gas: 25 days after surgery (7/30/08)
Patient Temperature | 37.0 |
FIO2 | 21% |
pH, Blood | 7.36 |
PCO2 | 56 mm Hg |
PO2 | 64 mm Hg |
Base Excess | 5 mM/L |
Bicarbonate | 32 mM/L |
PCO2 Total | 33 mM/L |
Hemoglobin | 12.7 g/dl |
%O2 Hemoglobin | 92.5 % |
%CO Hemoglobin | 1.4 % |
Pulmonary Function Tests (PFT): 46 days after surgery (8/20/08)
Reference | Best | % Predicted | ||
FVC | Liters | 5.11 | 3.29 | 64 |
FEV1 | Liters | 4.00 | 2.76 | 69 |
FEV/FVC | % | 78 | 84 | |
FEF 25-75% | L/sec | 3.70 | 3.44 | 93 |
PEF | L/sec | 9.20 | 7.90 | 86 |
MVV | L/min | 151 | 111 | 74 |
Pulmonary Function Tests (PFT): 1 year after surgery (7/06/09)
Reference | Best | % Predicted | ||
FVC | Liters | 5.11 | 4.27 | 83 |
FEV1 | Liters | 4.00 | 3.48 | 87 |
FEV/FVC | % | 78 | 82 | |
FEF 25-75% | L/sec | 3.70 | 4.14 | 112 |
PEF | L/sec | 9.20 | 9.04 | 98 |
MVV | L/min | 151 | 142 | 94 |
Prerehabilitation (Posttransplant)
6-Minute Walk Test: (7/22/08)
Prewalk | Postwalk | |
Heart Rate | 100 bpm | 118 bpm |
Oxygen Saturation | 98% | 98% |
Oxygen | 0 | 0 |
Rate of Perceived Exertion: |
||
Breathing | 0/10 | 0/10 |
Effort |
0/10 | 3/10 |
Distance (feet) | 1500 | |
Number of rest stops | 0 | |
Ambulatory assistive device |
4-wheeled walker |
Following 23 Pulmonary Rehabilitation Sessions
Postrehabilitation (Posttransplant)
6-Minute Walk Test: (9/15/08)
Prewalk | Postwalk | |
Heart Rate | 108 bpm | 118 bpm |
Oxygen Saturation | 98% | 97% |
Oxygen | 0 | 0 |
Rate of Perceived Exertion: |
||
Breathing | 0/10 | 5/10 |
Effort |
0/10 | 6/10 |
Distance (feet) | 1600 | |
Number of rest stops | 0 | |
Ambulatory assistive device |
none |
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