Patients having lung transplants could make a quicker and better recovery, thanks to new research that may pick up early injury to the transplanted organs.
Researchers at Royal Papworth Hospital NHS Foundation Trust are looking at using ultrasound scans – which can be performed at a patient’s bedside – to improve monitoring during the 72 hours immediately after a transplant. This is a critical time for the development of primary graft dysfunction (PGD), a type of severe lung injury that can affect up to a quarter of lung transplant patients and is a common cause of death in the early post-operative period.
Ultrasound scans may pick up PGD earlier than the chest x-rays currently in use to monitor a patient’s progress.
Unlike an x-ray, a lung ultrasound does not involve radiation, takes about five minutes and means the patient doesn’t have to be woken up and repositioned during the vulnerable post-operative period when they find breathing difficult or are in pain.
Ellen O’Brien, a Critical Care Scientist at Royal Papworth and lead investigator in the study
Although ultrasound is currently used to monitor other serious lung conditions it has not yet been tried in transplant patients. It may also yield further information during this crucial time: “For example, we may be able to predict whether a patient will need additional help with their breathing immediately after surgery or pick up other conditions that need treatment earlier,” says Ellen.
To date, some 40 patients – having one or both lungs transplanted – have been entered into the study. An ultrasound scan is done at the patient’s bedside on arriving in Critical Care from the operating theatre and then repeated at 24, 48 and 72 hours as part of their routine monitoring.
The study compares these scans with chest x-rays taken as close in time as possible to the ultrasound. The two sets of data are analysed by experts and compared statistically to see if there is a relationship. “We’re trying to correlate the two methods and see if there is a pattern between the ultrasound scans and subsequent development of PGD,” adds Ellen. The study results are expected shortly.
Patients aged from early twenties to early sixties with a range of serious lung conditions, such as cystic fibrosis, have been included. “It’s exciting to be involved,” says Ellen and continues: “As scientists, we need to keep up to date with evidence-based research which is so vital for patient-centred care.
“If we prove that ultrasound monitoring is effective, we could have a big impact on these patients and how we manage them at the bedside in critical care.
“Hopefully we’ll be able to intervene at an earlier point before PGD progresses and streamline their care without having to wait for other test results or scans,” she adds.
The study is supported by the Royal Papworth Charity Innovation Fund which helped with some of the research costs and has enabled Ellen to present her work at international conferences.
Ellen was inspired to become a Clinical Scientist after applying for the Scientist Training Programme – or STP – specialising in Critical Care following an undergraduate degree in Medical Physiology.
I feel a big responsibility to publicise the role of healthcare scientists in the NHS; we account for 5% of the overall healthcare workforce yet are involved in 80% of all patient diagnoses and pathways working with, and developing, leading edge technology.
Ellen O'Brien
“It’s certainly given me the research bug and inspired me to make my clinical practice the best it can possibly be.”
Ellen admits that research has challenges: “You always want more time, and the chance to try things differently. But this is how you learn the right skills to become an efficient researcher, working within the demands of NHS. We can’t underestimate the importance of continuing research because we might improve patients’ lives.”