Mount Sinai Documents Postoperative Nursing Care Following Its Pioneering Tracheal Transplant
Airway management and securement, graft assessment, stoma and wound care, nutrition, medication administration, patient education, and emotional support lessons will guide nursing management of future tracheal transplant recipients
A multidisciplinary team of nurses at The Mount Sinai Hospital has documented the postoperative nursing care they provided in connection with the world’s first human tracheal transplant. Their findings, published in Critical Care Nurse, will guide the meticulous nursing management of future tracheal transplant recipients.
In early 2021, a team of Mount Sinai surgeons performed the single-stage long-segment tracheal transplant—an achievement that has the potential to save the lives of thousands of patients around the world who have tracheal birth defects, untreatable airway diseases, burns, tumors, or severe tracheal damage from intubation, including those who had been hospitalized with COVID-19 and placed on a ventilator. Until then, no long-term treatments existed for these patients with long-segment tracheal damage, and thousands of adults and children died each year as a result.
A multidisciplinary team of nurses played a critical role in the recovery of the tracheal transplant recipient, a 56-year-old woman who received a graft from a deceased donor. The purpose of the article is to review her post-transplant treatment.
“High-quality nursing care in addition to family support and a patient-centered multidisciplinary team approach played a pivotal role in the successful outcome of the first single-stage long-segment tracheal transplant,” said Ella Illuzzi, NP, nurse practitioner in the transplant intensive care unit (ICU) at The Mount Sinai Hospital and first author of the paper. “Our hope is that the work we’ve done will guide the diligent nursing care of future tracheal transplant recipients. It is an honor to be a part of this historic moment in organ transplantation, giving our brave patient a second chance at life."
The recipient had severe tracheal damage, specifically tracheal stenosis, due to repeated intubation after an asthma attack. Several failed surgical attempts to reconstruct her trachea led to even further damage. She breathed through a tracheostomy—a surgically created hole in her neck—and was at high risk of suffocation and death because of the progression of her airway disease and likelihood of her trachea collapsing.
The team of nurses provided clinical support such as evaluating graft function, monitoring for infection and rejection, administering immunosuppressive medication, and educating the patient. They also rendered emotional support to the patient’s family. Specific to tracheal transplantation, the nurses were additionally responsible for airway management and securement as well as tracheal stoma and wound care. Given the novelty of tracheal transplantation, nurses need relevant education and specialty training that is evidence-based and applicable to their patient population.
“Much of our success in this innovative transplant program is attributed to the multidisciplinary approach in caring for our patient,” said Celia Wells, PhD, RN, Senior Director of Nursing, Critical Care, at The Mount Sinai Hospital and corresponding author on the paper. “Teamwork and effective communication among nurses, nurse practitioners, physician assistants, intensivists, surgeons, respiratory therapists, physical therapists, and ancillary staff ensured the patient received exceptional care through the assessment, evaluation, and planning of patient care activities. It’s important for nurses to document the care they provide by sharing lessons learned. Our hope is that by sharing our best practices, future tracheal transplant recipients will receive the same level of care we provided.”
“A first-in-human surgical procedure brings with it many unknowns,” said Eric Genden, MD, Dr.Isidore Friesner Professor and Chair of Otolaryngology – Head and Neck Surgery for Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai. “When the surgery was done, the real challenge of managing the patient began. The nurses in the operating room, the intensive care unit, and the patient floor were simply amazing, and it is the reason why this patient did so well. Our nursing team responded to the challenge in an exemplary way; their professionalism and care were outstanding and I could not be more proud to work with this group of nurses.”
Ten months after receiving the transplant, the patient was home, doing well, and breathing
on her own.
Launching a Center of Excellence for Head and Neck Cancer
To provide safe and efficient care, nurses must be educated on all facets of post-transplant management, which requires a multidisciplinary team. Recently, Mount Sinai launched the Center of Excellence for Head and Neck Cancer, where a multidisciplinary team of experts work to advance the highest possible clinical care for patients with head and neck cancers, including cancers of the larynx, tongue, palate, sinuses, and thyroid. The Center of Excellence for Head and Neck Cancer is co-led by Dr. Genden, Marshall Posner, MD, Director of Head and Neck Medical Oncology at Mount Sinai Health System, and Richard Bakst, MD, MD, Co-Chief of the Head and Neck Institute at the Mount Sinai Health System.
Dr. Genden was the first to perform transoral robotic surgery (TORS) for oropharyngeal cancers in New York in 2009 and the first to perform the world’s first tracheal transplant in 2021. Dr. Posner is an expert in clinical and translational research in head and neck cancers, HIV, and immunity, as well as virally caused head and neck cancers. He has, in collaboration with Dr. Genden, Dr. Bakst, and other members of the Center of Excellence, established a broad clinical research program in de-escalation of treatment for human papilloma virus-related head and neck cancer. A board certified radiation oncologist whose clinical practice focuses on the personalized treatment of patients with head and neck cancer, Dr. Bakst aims to implement radiation therapy only when necessary. He specializes in the use of proton therapy at the New York Proton Center, the only one in the state, to target radiation to at-risk areas while minimizing radiation exposure to nearby normal tissues, reducing side effects.
“With the center of excellence, every patient is getting a personalized multidisciplinary assessment of their needs and their treatment plan,” said Dr. Posner. “We put together a program where we use surgery to eliminate radiation for half of our patients, and we reduce radiation in the other half as well as reduce the amount of chemotherapy for patients with the worst prognosis. This is cutting edge and is not done in most places.”
“Our center of excellence is part of The Tisch Cancer Institute, so we benefit from the Institute’s expertise in both clinical trials and basic science research,” said Dr. Bakst. “We specialize in the management and the subsequent recovery from treatment for head and neck cancer patients.”
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.