Pulmonary rehabilitation in the surgical patient. Lung transplantation and lung volume reduction surgery.

Prior to lung transplantation or lung volume reduction surgery, patients complete a comprehensive pulmonary rehabilitation program. The program aids physicians in the selection of appropriate surgical candidates and prepares patients physically and psychologically for the stress of surgery. Because lung transplantation often involves relocation and prolonged waiting, stress levels can be particularly high. Rehabilitation continues through the perioperative and postoperative period to facilitate recovery and bring patients to the highest possible level of function. Studies of lung transplant recipients suggest that most patients who survive to hospital discharge enjoy a significant improvement in pulmonary function and many resume work and household responsibilities. Initial experiences with lung volume reduction surgery also suggest that many patients experience improved dyspnea symptoms and functional status after the procedure. As lung transplantation and lung volume reduction surgery emerge as viable therapeutic options for many patients with end-stage lung disease, comprehensive pulmonary rehabilitation programs are essential to address the complex medical, surgical, and psychological issues that surround these procedures and to produce optimal therapeutic outcomes.