Standardized Rehabilitation for ICU Patients with Acute Respiratory Failure

ICU急性呼吸衰竭患者的标准化康复

• 批准号: 8247041
• 负责人: PETER E MORRIS
• 金额: $ 53.14万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-08 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8247041
• 关键词: Activities of Daily Living; Acute; Acute respiratory failure; Affect; Aging; Basic Science; Biological Markers; Budgets; Caring; Clinical; Clinical Trials Design; Consensus; Contracture; Critical Care; Critical Illness; Data; Discipline of Nursing; Dyspnea; Enrollment; Environment; Exercise; Exercise Physiology; Exhibits; Funding; Grant; Health; Heart failure; Hospital Costs; Hospitalization; Hospitals; Inflammation; Intensive Care Units; Joints; Length of Stay; Measures; Mechanical ventilation; Medicine; Mental Depression; Muscle Weakness; Outcome; Passive Range of Motion function; Patients; Performance; Physical therapy; Protocols documentation; Publishing; Quality of life; Recovery; Regimen; Rehabilitation therapy; Research; Research Personnel; Resistance; Safety; Societies; Testing; Time; Training; Work; aged; arm; cost; critical care nursing; experience; follow-up; functional outcomes; functional status; health economics; health related quality of life; improved; innovation; interest; multidisciplinary; novel; randomized trial; respiratory; strength training; treatment as usual; trend

DESCRIPTION (provided by applicant): Acute Respiratory Failure (ARF) requiring mechanical ventilation affects 1.1 million of the 4.4 million people admitted to US Intensive Care Units (ICU) every year. Patients with ARF experience deconditioning, muscle weakness, joint contractures, dyspnea, depression, and reduced health-related quality of life, all of which may contribute to prolonged hospitalization and increased costs. Patients with ARF average 15 hospital days with median costs of $30,000. Critical care rehabilitative therapy for patients with ARF is not uniform in its content, timing or the acceptance of its safety. Our published data indicate that Standardized Rehabilitation Therapy, initiated in the ICU, is feasible and safe. The pilot showed a trend in reduced hospital stay, but functional outcomes were not determined. Therefore, for the acceptance of Standardized Rehabilitation Therapy in US hospitals to advance, this study will demonstrate that Standardized Rehabilitation Therapy for patients with ARF reduces hospital stay through immediate improvement in functional capacity and functional performance. Mechanistically, it is understood that patients with ARF exhibit acute inflammation and since rehabilitation increases functional outcomes and lowers biomarkers of inflammation in heart failure and the frail aging, we will determine whether the anticipated improvements in ARF patient outcomes are associated with a reduction in biomarkers of inflammation. The proposed study will test the following hypotheses: 1) Standardized Rehabilitation Therapy will shorten hospital stay in patients with ARF; 2) Standardized Rehabilitation Therapy will improve objective functional measures and quality of life at 6 months post-enrollment; 3) Standardized Rehabilitation Therapy will reduce biomarkers of inflammation; 4) Standardized Rehabilitation Therapy will decrease hospital costs. We will conduct a two-arm, randomized trial in 326 patients with ARF to compare Standardized Rehabilitation Therapy, initiated in the ICU and administered throughout the hospitalization, vs. Usual Care (control). Standardized Rehabilitation Therapy will consist of: passive range of motion, physical therapy and progressive resistance exercise (strength training). Our unique environment provides a hospital-funded, experienced Mobility Team (7days/week) consisting of a critical care nurse, physical therapist and nursing assistant to administer this protocol. The proposed study is a natural extension of our prior work, is multidisciplinary (Exercise Physiology, Physical Therapy, Nursing, Medicine, Basic Science, Health Economics), is supported by extensive preliminary studies, is innovative, and is responsive to recent society consensus statements. PUBLIC HEALTH RELEVANCE: For patients with ARF, no national standard for the administration of in-hospital rehabilitation exists. Patients with ARF suffer for months after hospital discharge with weakness and decreased quality of life. This study will provide the information for US hospitals to prioritize and budget for the rehabilitation needs of patients with ARF by demonstrating that Standardized Rehabilitation Therapy, initiated in the ICU, reduces hospital stay with immediate and sustained improvement in function and quality of life for patients with ARF.

描述（由申请人提供）：需要机械通气的急性呼吸衰竭（ARF）每年在美国重症监护病房（ICU）接纳的440万人中，有110万。 ARF的患者经历了调节性，肌肉无力，关节染色，呼吸困难，抑郁症以及与健康相关的生活质量降低，所有这些都可能导致住院时间延长和成本增加。 ARF的患者平均15天，中位成本为30,000美元。针对ARF患者的重症监护康复治疗在其内容，时间安排或接受其安全性上并不统一。我们发布的数据表明，在ICU中启动的标准化康复疗法是可行且安全的。飞行员表现出减少住院时间的趋势，但尚未确定功能性结果。因此，为了在美国医院接受标准化的康复治疗以进步，这项研究将表明，通过立即提高功能能力和功能性能，为ARF患者提供标准化的康复疗法会减少住院。从机械上讲，据了解，ARF患者表现出急性炎症，并且由于康复会增加功能性预后，并降低心力衰竭炎症和衰老的生物标志物，因此我们将确定ARF患者预后的预期改善是否与炎症生物标志物的减少有关。拟议的研究将检验以下假设：1）ARF患者的标准化康复疗法将缩短住院时间； 2）标准化的康复疗法将改善注册后6个月时的客观功能措施和生活质量； 3）标准化的康复疗法将减少炎症的生物标志物； 4）标准化的康复疗法将降低医院费用。我们将对326名ARF患者进行两臂随机试验，以比较ICU启动并在整个住院期间进行管理的标准化康复疗法，与常规护理（对照）。标准化的康复疗法将包括：被动运动，物理疗法和进行性抗性运动（力量训练）。我们独特的环境提供了由医院资助的经验丰富的出行团队（每周7天），由重症监护护士，物理治疗师和护理助理组成，以管理该协议。拟议的研究是我们先前工作的自然扩展，是多学科（运动生理学，物理治疗，护理，医学，基础科学，健康经济学），得到了广泛的初步研究的支持，具有创新性，并且对最近的社会共识陈述做出了反应。公共卫生相关性：对于有ARF的患者，不存在管理院内康复的国家标准。 ARF患者出院后几个月以虚弱和生活质量降低。这项研究将通过证明在ICU中启动的标准化康复疗法，为ARF患者的康复需求提供优先级和预算的信息，以减少ARF患者的功能和生活质量的立即和持续改善的医院。