he Implications of Cytomegalovirus Infection and ICU Acquired Weakness Following a Bilateral Lung Transplant: A Case Report

Background: Long term survival post lung transplantation continues to be threatened by a number of prognostic factors including the development of post-operative bacterial and viral infections, chronic lung allograft dysfunction (CLAD), renal insufficiency and intensive care unit acquired weakness (ICUAW). The purpose of this case report is to highlight the barriers associated with the physical therapy management of a patient with complications following a bilateral lung transplant. Case Description: A 59-year-old male underwent a bilateral lung transplant due to hypersensitivity pneumonitis and was discharged home. Approximately 10 months following discharge, the patient was readmitted for dehydration and tested positive for cytomegalovirus (CMV) viremia. The patient then developed several medical complications during his admission requiring medical management in the ICU. Outcomes: Outcome measures were based on the level of assistance required to complete functional activities. The AM-PAC "6-Clicks" Inpatient Basic Mobility Screen and the ICU Mobility Scale were utilized for this patient. Discussion: This patient’s ICU stay was met with multiple adverse challenges that he eventually succumbed to including respiratory failure secondary to infection, lung transplant rejection, bacteremia, acute kidney injury, anemia secondary to sepsis, severe protein calorie malnutrition and ECMO cannula malposition. It is important to note that the physical therapy management of patients with multi-organ involvement can be met with unforeseen circumstances but that should not deter therapists from promoting mobilization within the ICU.