Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis. Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI， WanFangData， VIP， CBM， PubMed， Web of Science， Embase， Elsevier ScienceDirect and CINAHL databases. The search was conducted from the time of database construction to November 2023. Literature screening， quality assessment， and data extraction were performed independently by 2 investigators， and Meta-analysis was performed using Stata 17.0 software. Results 10 cohort studies， including 1 999 patients， were finally included， and 13 influencing factors were extracted， including advanced age （OR=1.05）， female （OR=2.50）， BMI （OR=0.38）， diagnosis of primary pulmonary disease （OR=2.90）， 6MWD （OR=0.34）， and lung allocation score （OR=0.69）， FVC （OR=0.60）， pre-transplant frailty （OR=0.81）， hypoproteinemia （OR=4.12）， hemoglobin （OR=0.50）， anemia （OR=4.37）， length of ICU stay （OR=1.24）， and total length of stay （OR=1.05）. Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients， with an incidence of frailty in 24% before transplantation and 50% in post-transplantation. Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients， with a pre-transplant frailty incidence of 30%. Conclusion There are many factors involved in the incidence of frailty in lung transplant patients， and nursing staff should dynamically evaluate the frailty of lung transplant patients， and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Objective To retrieve，evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation，and to provide a reference for clinical practice. Methods UpToDate，BMJ Best Practice，Registered Nurses’ Association of Ontario，National Guideline Clearinghouse，National Institute for Health and Care Excellence，Yimaitong，Joanna Briggs Institute Library，Cochrane Library，CINAHL，PubMed，SinoMed，CNKI，Wanfang Database，Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature，including clinical guidelines，expert consensuses，evidence summaries，systematic reviews，and well-designed original studies. The time limit for retrieval was until June 2023. The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of JBI Evidence-Based Health Care Center. Results 14 pieces of the literature were included，including 2 clinical guidelines，4 expert consensuses，5 systematic reviews，2 cohort studies and 1 case series. Totally 33 pieces of evidence were summarized，covering 7 aspects：adaptation conditions for the implementation of awake ECMO，team composition，comprehensive assessment，pre-mobilization preparation，mobilization content，prevention and control of adverse events，and effect evaluation. Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation. It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients，apply the best evidence to standardize the early mobilization process，and formulate an individualized mobilization program.

Objective To form the expert consensus on postoperative pulmonary rehabilitation nursing for lung transplant patients，standardize the nursing care of pulmonary rehabilitation after lung transplantation in medical institutions，and promote the early postoperative rehabilitation of lung transplant patients. Methods The clinical guideline，expert consensus，systematic review，evidence summary and original research on postoperative pulmonary rehabilitation of lung transplant patients were comprehensively searched in domestic and foreign databases. The time limit for retrieval was from the establishment of databases until February 2023. The draft of the Consensus was formed based on clinical practice experience. From April to June 2023，17 experts were invited to conduct 2 rounds of expert consultation，in order to revise and improve the content of the first draft，and then conduct expert demonstration，and finally form the final draft of the consensus. Results Totally 16 experts responded，and the expert positive coefficient was 94.12%. The effective recovery rates of the 2 rounds of expert consultation were both 100%；the expert authority coefficients were both 0.941；the judgment coefficients were both 0.963；and the familiarity degree were both 0.900. The Kendall coefficients of the 2 rounds of expert consultation were 0.133 and 0.123，respectively，which were statistically significant. The consensus includes 13 themes，involving the formation and management of a pulmonary rehabilitation team, fluid management, mechanical ventilation,sequential assisted ventilation,respiratory function exercise,airway clearance，pain management,exercise management,nutritional support，immunosuppressive management,prevention and control of pulmonary complications,psychological support,and follow-up management. Conclusion The consensus is highly scientific，and can provide references and bases for clinical nursing staff to carry out pulmonary rehabilitation for lung transplant patients.

Objective To construct a postoperative matching exercise training program for lung transplant patients and to evaluate the clinical application effect. Methods A non-concurrent controlled study was used. By convenience sampling method，patients undergoing lung transplantation in a tertiary A hospital in Hangzhou from December 2021 to March 2022 were included in a trial group with 35 cases，while the patients from April to November 2021 were recruited in a control group with 34 cases. Baseline data was consistent between the 2 groups. On the basis of the intervention program in the control group，the trial group received the matching exercise training program which was constructed based on the evidence and Delphi expert consultation method. It was divided into 4 stages according to the BODE index，including primary exercise，advanced exercise，intensive exercise and stable exercise，covering exercise mode，time，and intensity，etc. The control group received a routine pulmonary rehabilitation training program. The 6MWT distance standard time，deep inhalation volume standard time，hospitalization time，FEV1%，BMI，MBI and the incidence of adverse events during exercise training of 2 groups were compared. Results The standard time of the 6MWT distance and the deep inhalation volume in the trial group were lower than it in the control group（P<0.05）. The FEV1% and MBI at discharge in the trial group were lower than those in the control group（P<0.05）. There was no significant difference in length of stay，BMI and incidence of adverse events between the 2 groups（P>0.05）. Conclusion The matching exercise training program is accurate，safe and feasible，and it can promote the rapid postoperative rehabilitation of lung transplant patients.

To summarize the nursing experience of a child with pulmonary rejection after hematopoietic stem cell transplantation who underwent double lung transplantation and was complicated with bronchiolitis obliterans after lung transplantation and underwent second lung transplantation. The key points of nursing included：the implementation of step-wise lateral position and prone position alternate non-invasive mechanical ventilation to improve lung function；sequential airway clearance was used to control pulmonary infection；precise volume management to prevent pulmonary edema；to strengthen the observation and medication management，prevent hospital infection and rejection；to provide goal-oriented personalized nutritional support to improve nutritional status；psychological nursing measures were implemented to improve the treatment confidence and compliance of children；health education and follow-up management should be strengthened to improve the long-term quality of life. After active treatment and careful nursing，the child recovered and was discharged 26 days after surgery.

Rehabilitation care of 6 children after sequential double lung transplantation was summarized. Key points：to establish a pediatric lung transplant rehabilitation team，to implement precise liquid volume management to prevent pulmonary edema，to implement infection prevention strategies to reduce the risk of infection，to strengthen disease monitoring and drug management to prevent acute rejection and drug-related adverse reactions，to guide children to implement respiratory training through fun games，to promote non-invasive ventilation smoothly through adding childlike elements，to promote early activities through peer encouragement，to strengthen discharge education and follow-up to improve the quality of life of children after discharge. After the personalized and precise rehabilitation nursing，all the children were discharged successfully.

Objective To construct a pulmonary rehabilitation program for patients with double lung transplantation and to evaluate its application effect.Methods 46 patients admitted to our hospital for double lung transplantation from January 2020 to March 2021 were selected as the research subjects. Using random number table method,they were divided into a control group and an experimental group with 23 cases each. The experimental group received the intervention of the lung rehabilitation program for patients with double lung transplantation on the basis of the control program. The pulmonary rehabilitation team led by respiratory therapy specialist nurses guided the whole process,including preoperative pre-rehabilitation training and adaptive training,early postoperative activities,and respiratory muscles training,sequential oxygen therapy,airway clearance,active breathing and circulation techniques,etc. The control group received conventional treatment,health education and pulmonary rehabilitation guidance. The postoperative ECMO assisting time,mechanical ventilation time,hospital stay,oxygenation index,6-minute walk test,incidence of adverse events,and compliance with postoperative pulmonary rehabilitation were compared between the 2 groups.Results The length of hospital stay in the experimental group was lower than that in the control group. The oxygenation index,6-minute walk test distance,and compliance with postoperative pulmonary rehabilitation were better than those in the control group（P<0.05）. There was no statistical difference in the ECMO assisting time,mechanical ventilation time and the incidence of adverse events in the 2 groups（P>0.05）.Conclusion The pulmonary rehabilitation program for patients with double lung transplantation is safe and effective. It can shorten the length of ICU hospitalization,improve exercise capacity,and promote early recovery of transplanted lung function.

To summarize the nursing experience of a patient complicated with idiopathic hyperammonemia after double lung transplantation. Nursing points include the early warning of idiopathic hyperammonemia after lung transplantation;care of comprehensive ammonia lowering therapy，including intermittent hemodialysis and continuous kidney replacement therapy，drug ammonia lowering therapy，dynamic nutrition support care;special management of immunosuppressive drugs;continuous individualized training of transplanted lung function;care of cognitive impairment caused by cerebral cortex damage. After the active treatment，the patient was transferred，and the blood ammonia concentration returned to normal. The patient was discharged smoothly.

The nursing experience of pre-rehabilitation for 25 lung transplant patients was summarized. Key points include as following. Pre-rehabilitation mainly includes psychological support,nutritional support and physical exercise,providing family-centered active psychological intervention,goal-oriented nutrition management program and precise graded exercise program,respectively. Pre-rehabilitation also provides simultaneous adaptive training on contextualized lung rehabilitation,including breathing mode,prone ventilation,and adaptive training for rehabilitation equipment. Under the active intervention of pre-rehabilitation,the condition of 25 patients did not deteriorate during the waiting for organs,and some of the patients improved their body condition. All patients received an uneventful lung transplantation successfully.

Objective To retrieve,evaluate and summarize the best evidence of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation（ECMO）,and to provide a reference for clinical practice. Methods The BMJ Best Practice,UpToDate,Registered Nurses’ Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,CNKI,Wanfang Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including guidelines,consensuses,evidence summaries,systematic reviews,and well-designed original studies. The time limit for the retrieval is from the inception of databases until August 2021. Results 11 pieces of the literature were retrieved,including 5 consensuses,2 system reviews,1 randomized controlled trial,1 quasi-experimental study,1 cohort study and 1 cross-section survey. Totally 30 pieces of evidence were summarized,including team composition and ability requirements,transport preparation,monitoring during transport,prevention and control of adverse events and management of handover. Conclusion It is suggested to build a professional ECMO intra-hospital transport team based on the actual hospital situation,to apply the best evidence to standardize the intra-hospital transport process of patients on ECMO,and to establish an adverse event prevention and control system and information communication mechanism to ensure patient safety.

To summarize the nursing care of acute antibody-mediated rejection in a child with blood incompatibility after non-living donor liver transplantation. Nursing points：strictly monitor changes in the condition,promptly initiate response plans,and monitor liver function throughout the whole process;perform various monitoring during plasma exchange,including monitoring of adverse reactions,filter anticoagulation and coagulation functions,titration sedation management and pipeline safety management;precise immunosuppressive drug treatment;provide reasonable nutritional support during gastrointestinal bleeding;strictly implement nosocomial infection prevention and control measures. After active treatment,the child survived the acute rejection safely and eventually recovered and was discharged.

To summarize the nursing experience of 6 severe burn patients with extracorporeal membrane oxygenation（ECMO） and continuous renal replacement therapy（CRRT）. Nursing points：the whole process pressure monitoring;the development of individualized liquid management plan to ensure adequate capacity;the precise anticoagulation management to prevent blood clotting in filter and the special attention to wound drainage;the establishment of a full-time team for infection control to strictly prevent infection;under the premise of protecting the burned skin. During the treatment of ECMO combined with CRRT,no one was found with any complications such as tube shedding,tube bleeding,nozzle skin infection,abnormal shutdown of ECMO and CRRT,or bleeding.

Objective To construct a nurse-led diagnostic blood loss management plan,so as to reduce the diagnostic blood loss in patients with extremely severe burns. Methods A multidisciplinary team was established to form a nurse-led diagnostic blood loss management scheme which was conducted to intervene in a batch of 15 patients with extremely severe burns admitted on June 14,2020,and we evaluated the effect of the intervention.Results The predicted diagnostic blood loss before intervention was（37.45±8.17） ml,and the actual diagnostic blood loss after intervention was（18.16±6.35） ml,with statistical differences（t=102.215,P<0.001）. Conclusion The nurse-led diagnostic blood loss management scheme can effectively reduce the amount of diagnostic blood loss in patients with extremely severe burns.

To summarize the nursing care of a patient with coronary heart disease complicated by hepatic artery pseudoaneurysm after hepatopancreatduodenectomy. Nursing points include：to strengthen the observation and nursing care of the disease,to be alert to the occurrence of acute coronary syndrome,to pay attention to early warning sentinel bleeding,to implement nursing care during conservative treatment of hepatic artery pseudoaneurysm,and the prevention and nursing care of complications after interventional treatment. After careful treatment and nursing care,the patient recovered after 78 days of hospitalization.

To summarize the nursing care of a patient after combined liver and lung transplantation. Key points of nursing care:through target-based fluid management,restrictive rehydration strategies were adopted to maintain negative volume balance;progressive and individualized rehabilitation training were taken to promote early rehabilitation;closely monitored the function of transplanted liver and lung;precise anti-rejection medicine nursing care;multi-mode combined analgesia to control pain;closely monitored complications and provided patients with humanistic care and psychological support. The patient was discharged from the hospital 26 days after surgery and recovered well