High flow nasal cannula in patients awaiting lung transplantation with acute respiratory failure exacerbations resulting from interstitial lung disease. Series of cases

Mechanical ventilation (MV) in patients with exacerbation of interstitial lung disease (ILD) drastically decreases chances of lung transplantation (LT). Avoiding MV and improving muscle state among ILD patients optimizes pre LT conditions. The use of high flow nasal cannula (HFNC) in four patients during exacerbations and their pre LT pulmonary rehabilitation (PR) i s presented. The tables represent the most important characteristics and data of the patients, pre and post use of HFNC. PR pre LT: cycle ergometry aerobic training, with continuum variable method (50-70% intensity) and / or intermittent (100% intensity) using HFNC, subsequently initiating walking with supplemental oxygen. All four patients were successfully transplanted. The use of HFNC allowed us to avoid MV during the most critical stages of the illness and prevented common episodes associated to MV. We believe that PR contributed to the successful outcome of the LT.