Date of birth * dd-mm-yyyy

Height * cm

Weight * kg

Lung Diagnosis Code Allergic bronchopulmonary aspergillosisAlpha-1-antitrypsin deficiencyAlveolar proteinosisAmyloidosisARDS/pneumoniaBOOPBronchiectasisBronchoalveolar carcinoma (BAC)Bronchopulmonary dysplasiaCarcinoid tumorletsChronic pneumonitis of infancyCommon variable immune deficiencyCongenital malformationConstrictive bronchiolitisCOPD/emphysemaCREST - pulmonary hypertensionCREST - restrictiveCystic fibrosisEhlers-Danlos syndromeEisenmenger's syndrome: atrial septal defect (asd)Eisenmenger's syndrome: multi congenital anomaliesEisenmenger's syndrome: other specifyEisenmenger's syndrome: persistent ductus arteriosus (pda)Eisenmenger's syndrome: vsdEosinophilic granulomaFibrocavitary lung diseaseFibrosing mediastinitisGranulomatous lung diseaseHermansky Pudlak syndromeHypersensitivity pneumonitisHypogammaglobulinemiaIdiopathic pulmonary fibrosis / usual interstitial pneumonitisIdiopathic pulmonary hemosiderosisInhalation burns/traumaKartagener's syndromeLung re-tx/gf: acute rejectionLung re-tx/gf: non-specificLung re-tx/gf: obliterative bronchiolitis-obstructiveLung re-tx/gf: obliterative bronchiolitis-restrictiveLung re-tx/gf: obstructiveLung re-tx/gf: other specifyLung re-tx/gf: primary graft failureLung re-tx/gf: restrictiveLymphangioleiomyomatosisLymphocytic interstitial pneumonitisMixed connective tissue diseaseObliterative bronchiolitis (non re-transplant)Obstructive lung diseaseOccupational lung disease other specifyParaneoplastic pemphigus associated Castleman's diseasePolymyositisPortopulmonary hypertensionPrimary ciliary dyskinesiaPrimary pulmonary hypertensionPulmonary fibrosis other specify causePulmonary hyalinizing granulomaPulmonary telengectasia - pulmonary hypertensionPulmonary telengectasia - restrictivePulmonary thromboembolic diseasePulmonary vascular diseasePulmonary veno-occlusive diseasePulmonic stenosisRheumatoid diseaseRight hypoplastic lungSarcoidosisSchwachman-diamond syndromeScleroderma - pulmonary hypertensionScleroderma - restrictiveSecondary pulmonary hypertensionSilicosisSjogren's syndromeSurfactant protein B deficiencyTeratomaThromboembolic pulmonary hypertensionTuberous sclerosisWegener's granuloma - bronchiectasisWegener's granuloma - restrictiveLupusGraft-vs-host-disease (gvhd)Post-COVID-19 ARDSPost-COVID-19 pulmonary fibrosis *

Assistance level No assistanceSome assistanceTotal assistance *

Diabetes Insulin dependentNo diabetesNon insulin dependentUnknown *

Assisted Ventilation Non-invasive BiPAP or pressure supportContinuous mechanicalNon-invasive CPAPIntermittent mechanical (no sedation)Not needed *

Supplemental Oxygen With exercise onlyAt nightNot neededAt rest *

Amount of oxygen * FIO2 in %Oxygen (l/min) *

FVC predicted * %

Pulmonary Artery Systolic Pressure * mmHg

Mean Pulmonary Artery Pressure * mmHg

Pulmonary Capillary Wedge Mean * mmHg

Current PCO2 * kPamm HG *

Highest PCO2 * kPamm HG *

Lowest PCO2 * kPamm HG *

Six minute walk distance * m

Serum Creatinine * µmol/lmg/dl *

Extracorporeal support interventional lung assist or ECCO2-RNot neededpulmonal-arterial and left-atrial System (PALA)veno-arterial or veno-venous arterial ECMOveno-venous ECMO with one cannulaveno-venous ECMO with two cannulas *