Introduction: We present two rare cases of successful lung transplantation (LT) in recipients with COVID-19-related ARDS. The recipients developed long-term intensive care unit-acquired weakness (ICU-AW), which detrimentally impacted early mobilization and functional improvement. Although few reports have described ICU-AW in LT recipients for COVID-19, it is a recognized complication in critically ill patients. In these cases, successful LT significantly improved the unfavorable prognosis and extended survival. Both cases demonstrated recovery from ICU-AW and were subsequently discharged from the hospital. Herein, we call for placing a strong emphasis on ICU-AW in LT recipients, which is a critical aspect of management.
Case 1: The first patient, was positive for COVID-19 PCR and his condition was getting worse. On day 15, with decreased oxygenation and unconsciousness, he was urgently intubated and transferred to ICU. The next day, he went into cardiac arrest, was given CPR, and received a V-A ECMO. Four months later, the patient was transferred to our hospital. At admission, the patient's MRC score was only 18, indicating ICU-AW. CT scan showed significant fibrosis in both lungs. After evaluation, indications for LT were determined, and he was placed on waiting list. The patient underwent bilateral LT. Following surgery, ECMO removal occurred on day 1, and successful weaning off the ventilator was achieved by day 5. Bronchoscopy was periodically employed to maintain airway clearance. An invasive ventilation bridge with high-flow respiratory humidifier oxygen therapy was utilized, complemented by intensified respiratory function exercises. Activities such as getting out of bed were carefully and intermittently performed. The patient's daily nutrition and caloric supply were meticulously maintained. The patient was transferred to the ward on day 125 after LT. Following rehabilitation, the recipient fully recovered and was ultimately discharged from the hospital 144 days after transplantation.
Case 2: The second patient, initially presented with fever, chills, cough, and sputum production, testing positive for COVID-19 PCR. The patient was transferred to the ICU due to worsening condition, followed by endotracheal intubation and VV-ECMO. Chest CT revealed double lung diffuse exudation and fibrosis and LT was recommended after evaluation. The patient underwent successful bilateral LT. ECMO and tracheal tube was removed on day 1 and day 8, respectively. After awake, muscle strength of the patient was significantly decreased and the MRC score was 24. The patient developed ICU-AW. Subsequently, he received pulmonary rehabilitation, limb function exercises, and joint motion training, such as cough exercises, ball blowing exercises, bed sitting exercises, walking, bed bicycle and elastic band exercises. After rehabilitation exercises, ICU-AW improved. The patient was transferred out of ICU on day 22 after LT. His upper and lower limb strength improved. The patient was discharged home for rehabilitation at the 57th postoperative day without oxygen inhalation.