title: Do Chest Expansion Exercises Aid Re-shaping the Diaphragm Within the First 72 Hours Following Lung Transplantation in a Usual Interstitial Pneumonia Patient?
abstract: OBJECTIVE
  Usual interstitial pneumonia is a chronic pulmonary disease, and it is characterized by progressive and rapid lung fibrosis and typically affects patients older than 50 years. This study sought to discuss the use of chest expansion exercises during the immediate post-operative phase in a lung transplantation recipient.
  
  
  METHODS
  This was a non-experimental case report study. A 58-year-old man who was affected by usual interstitial pneumonia with severe respiratory insufficiency requiring continuous oxygen therapy underwent double lung transplantation. Pre-operative x-ray showed elevation of the diaphragm. Rehabilitation treatment started within the first 24 h. Pain intensity was assessed using a numeric rating scale, and pulmonary function was evaluated based on variation in tidal volume. Each treatment lasted about 1 h, and the sessions were initially carried out twice daily, increasing over the intensive care unit stay to three or four times daily.
  
  
  RESULTS
  At 72 h, the tidal volume increased to 850-900 mL (approximately 400 mL more than baseline) during the chest expansion exercises. The diaphragm began to gradually lower. Chest x-ray examination on post-operative day 6 showed further reshaping of the diaphragm.
  
  
  CONCLUSIONS
  Chest expansion exercises seem to be suitable in order to re-establish lung volume and diaphragmatic function as early as within the first 72 h after bilateral lung transplantation.
authors.affiliation: Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Polastri
authors.affiliation: Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Venturini
authors.affiliation: Department of Cardiac-Thoracic and Vascular Diseases, University Hospital S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Pastore
authors.affiliation: Heart and Lung Transplantation Programme, University Hospital S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dell'Amore
mesh_terms: D003964:Diaphragm; D005500:Follow-Up Studies; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D012138:Respiratory Therapy / Q000379:methods*; D013990:Tidal Volume / Q000502:physiology*; D013997:Time Factors; D014109:Total Lung Capacity / Q000502:physiology; D016896:Treatment Outcome
keywords: diaphragm; idiopathic pulmonary fibrosis; lung transplantation; respiratory therapy