After your surgery, you will spend a short time in the Recovery Room before being transferred to the Thoracic Intermediate Care Unit (TICU) on 11B. Some patients may require additional monitoring that can only be provided in the Surgical Intensive Care Unit (SICU). This decision is made at the discretion of your surgeon, and usually you will know if you are going to be cared for in the SICU before you go in for your surgery. Sometimes, however, space considerations or other circumstances beyond our control warrant a different bed assignment.
You will stay in the recovery room for 1-2 hours until you are ready to be transferred to the TICU or SICU. In the recovery room you will have a chest x-ray and the nurse will take your vital signs every 15 minutes. You can expect the following lines and tubes to be in place:
The TICU is a 20-bed unit with 4 additional beds specially constructed for lung transplant patients (male-female mixed) that provides 24-hour monitored care with one nurse for every two patients. Your stay in the TICU will last about two to three days. This is a busy and critical time in your recovery from surgery. Many factors contribute to a successful recovery. For instance, it is essential for you to actively participate with chest physical therapy and ambulation, as this promotes recovery and prevents complications.
You will begin deep breathing and coughing exercises on the evening of your surgery. These exercises will help clear the secretions from your lungs and prevent pneumonia.
You may be worried about pain control during coughing, but you will have an epidural catheter placed in your spine which delivers medicine to control your pain. This line is placed by the anesthesiologist while you are asleep and it delivers pain medication directly to the site of your surgery. Most patients find their pain control to be excellent.
You will be getting out of bed and walking on the morning after surgery. There are several exceptions to this rule, which will be discussed with you if you fall into an "exception" category. We use a specially adapted walker that provides extra support and oxygen. Walking will help your breathing and keep your strength up following surgery. The nurse or therapist will accompany you when you walk.
For the first few days after your surgery you will need extra oxygen, but as your lung heals you will find you need it less and less. Several days after surgery the chest tube will be removed.
You will begin shoulder exercises as soon as you can tolerate them. These exercises are important, because without them your shoulder may stiffen up.
The therapist will also begin chest physiotherapy, which involves tapping on your back to loosen the secretions in your lung. Your lung always produces secretions after surgery. It is part of the healing process. The percussion techniques used during chest physiotherapy will make it easier for you to cough up the secretions. Some patients worry that coughing will break open the incision, but this will not happen and it is important to keep coughing.
While you have the chest tubes in place, daily chest x-rays will be taken. The chest films are used to help decide when to take the tubes out. The timing of removal of these tubes varies greatly from person to person. Don't be discouraged if your roommate's tubes are removed before yours.
Try to catch naps whenever possible. Rest is important to the healing process. Nourishment is also vital to healing. Although you may not be hungry, try to eat something at each meal.
Because various aspects of your nursing care must be administered 24 hours a day, you may notice while you are in the TICU that your normal sleep routine is disrupted. Although you may feel tired, you may be awoken at night for chest physical therapy, and vital signs are taken periodically throughout the night. As you continue to improve after surgery, your need for aggressive care at night will decrease and your opportunity to sleep for longer periods of time will increase.
When you are ready to leave the TICU, you will be transferred to a general surgical bed on 11B, 11C, or 11D.
You will be discharged the day after your chest tubes are removed. The usual length of stay is 5-7 days, but length of stay varies depending on the extent of your surgery. Your follow-up visit will be 10-14 days after discharge.
When you are ready to leave the hospital, you will be given a follow-up appointment with the surgeon, and will receive written discharge instructions and prescriptions from your nurse.