What to expect

After surgery, all patients are transferred to the Intensive Care Unit (ICU). The ICU is a specialised area of the hospital where we care for patients with severe life threatening illness or after major surgery such as a lung transplant. The ICU team, led by the ICU consultant, will work closely with the medical and surgical transplant teams to ensure you receive the best possible care. In the ICU, you will have your own dedicated nurse at all times to care for you. It is the safest place for you to recover from your surgery.

The ICU environment can feel overwhelming for patients and their families. You will have lots of tubes in place and you will be attached to a machine that constantly monitors your heart rate, blood pressure and oxygen levels. You will receive multiple medications and may be attached to machines to support your breathing, your kidneys or your heart. These monitors and machines may alarm frequently but please do not be frightened. The alarms don't mean something is necessarily wrong, but instead notify the nurse of any changes. The ICU nurse is specially trained to use the equipment and to respond to any concerns.

You may be in the ICU for weeks or even months depending on how your body copes with your new lung(s). This part of the journey can be very tough for patients and their families. The bedside nurse can regularly provide updates to your family, or arrange for your family to meet with the ICU consultant. It is important to us that both you and your family are kept updated on your progress.

It is very important that you receive proper nutrition after your transplant to help with wound healing and rebuilding muscle strength. You will not be able to eat immediately after surgery because the breathing tube will make it difficult to swallow. To make sure you get enough nutrition, we will place a small feeding tube into your nose. It will stay in place until you are able to eat and drink enough to meet your nutritional needs on your own.

Once the breathing tube is removed, the speech and language therapist will assess your swallow often by passing a tiny camera through your nose into your throat. This camera allows them to see if your swallow has recovered enough for you to start eating and drinking safely. Some patients can begin to eat and drink normally in the first week after transplant. For others it may take longer. It is important to wait until your swallow is strong enough because when your swallow is weak, food and drink can get into your lungs and cause pneumonia.

Sometimes the speech and language therapist recommend you start slowly, taking ice chips or small sips of water. As your swallow improves they may allow softer foods, or thickened drinks. In other cases, they may recommend that you do not have anything to eat and drink until your swallow is stronger. This can be very difficult as you will likely feel thirsty but remember this is to protect your new lungs. You’ll still be getting all the nutrition you need from the feeding tube. The nurse and speech and language therapist will use swabs to moisten your mouth as much as possible to improve your comfort.

Regardless of whether you are eating and drinking normally, or relying on the feeding tube, the dietitian will monitor your nutritional intake closely to make sure you are getting all of the nutrients you need to support your recovery.

It is important that you are comfortable after your surgery and able to breathe, cough and move with as little discomfort as possible. Our aim is to try and wake you and have you moving around as early as possible. This helps to lower your chances of getting a clot to your legs and lungs. It will also help you clear your mucus, which will prevent infection.

To help minimise your pain, you will receive multiple pain relief medications. These can be given to you through your feeding tube, by mouth or through a drip. You may also receive pain relief through a nerve block or epidural. For this, an intensive care doctor or anaesthetist will insert a small tube into your chest wall or back, to block the nerves that sense pain in the areas around your wound. Previous patients have told us that the pain was not as bad as they had expected. You may also feel nauseated or constipated. We can give you medications to treat these symptoms. Good pain control is important for your recovery. We want to make sure you're as comfortable as possible.

It is common to become confused and agitated in ICU after your transplant. You may also experience hallucinations (seeing, hearing or feeling things that appear to be real but only exist in your mind). Please do not be afraid to tell your nurse or doctors if you are having hallucinations. This can be upsetting and frightening for you and your family. It may help to know that this is a normal response to major surgery and lots of new medications. The symptoms usually resolve as your health improves. There are many people available to help you, including the psychologist, psychiatry team and the ICU team. They will reassure you, answer any questions and can prescribe medications to help, if necessary.

The ICU can be noisy and some patients may find it difficult to get good sleep because of the lights and sounds of the monitors and machines. Important medications may also need to be administered during the night, which can disturb your sleep. The lack of sleep, mixed with the different medications you will be taking, can contribute to confusion, agitation or even hallucinations. This is normal, and your nurse knows to look out for it. Let your nurse know if you are uncomfortable. They can give you further medication to help you manage.

There are periods in the ICU every day when the lights are dimmed and noise and interruptions are kept to a minimum. This is a good time to get some rest.

Helping you heal involves caring for all of your needs, including your spiritual, religious and cultural ones. There is a Christian pastoral care team on site that visits the ward regularly. We also work with leaders of other faiths. Please let us know if you would like to meet with a spiritual advisor at any point during your hospital stay.