Initial Rehabilitation and Physical Therapy Management in the ICU Following an Orthotopic Heart Transplant: A Case Report

Introduction: Many articles in the literature discuss physical therapy management for patients who have undergone Orthotopic Heart Transplants (OHT) 3 to 12 months after the procedure. However, relatively few articles address the immediate rehab which takes place in the ICU the first two weeks following transplant. The purpose of this report is to provide a case example of the physical therapy management of a patient following an OHT in the ICU setting. Case Description: A 45-year-old male with a 14-year history of non-ischemic cardiomyopathy was hospitalized for thirty days for management of cardiogenic shock. After failed attempts to manage the condition the patient underwent an OHT. Starting on post-op day one the patient received physical therapy in the ICU for a total of two weeks. Interventions: Treatment sessions were performed 5 days/week for 30-40 minutes. There was an emphasis on improving the performance of functional movements such as bed mobility, transfers, and ambulation. ClinicalOutcomes: Outcome measures were based on the level of assist required for functional tasks. The Inpatient Basic Mobility Screen & Gait and Mobility Assessment were the two functional scales utilized for the patient during the plan of care. Discussion: Patients with end-stage heart failure (HF) present with dysfunctions in several body systems. It can be difficult to assess the chronic effects of HF and the transient effects of bed rest and inactivity on overall performance. However, evidence supports that early mobilization is safe and effective for the patient population and leads to greater mobility. Maintaining sternal precautions, reviewing daily labs, assessing EKGs, and minimizing the potential risk of infection are all vitally important with each patient encounter.