The Multimodal Rehabilitation of Older Ventilated Survivors Of Critical Illness

描述(由申请人提供)：危重疾病的老年机械通风幸存者身体虚弱，功能受损。这些缺陷是由于危重疾病本身、慢性并存、在急性ICU住院期间长时间卧床以及他们在长期急性护理设施中的持续护理造成的。这会导致炎症、骨质疏松症、营养不良、慢性贫血以及日益严重的疲劳、虚弱和残疾。由于这些老年患者的虚弱、多种合并症、慢性残疾、行动不便、认知功能障碍以及有限的资源，长期急性护理医院(LTACH)的身体康复往往是降级的，而不是高级的。这会导致任何功能或物理上的退化 在医疗中心取得的成果。我们建议进行一项试验性研究，为需要长期机械通气的危重疾病的老年幸存者进行为期8周的多模式康复计划(MRP)。这项初步研究测试了一项假设，即以功能活动、力量、耐力和动机为目标的MRP将通过增加力量和步行能力以及减少炎症，比通常的康复护理更多地改善这些患者的活动功能(步态和平衡)和基本日常生活能力(ADL)。我们的目标是表明，这些参加我们MRP计划的老年患者所取得的身体和功能上的进步将转化为临床上有意义的结果，包括增加步行能力、呼吸肌力、改善生活质量和更好的机械通气率。

DESCRIPTION (provided by applicant): Older, mechanically ventilated survivors of critical illness are frail and functionally impaired. These deficiencies are a result of critical illness itelf, chronic comorbidities, prolonged bed rest during their acute ICU stay, and their continued care at long term acute care facilities. This leads to inflammation, sarcopenia, malnutrition, chronic anemia and worsening fatigue, weakness and disability. Often, physical rehabilitation is de-escalated in the long term acute care hospital (LTACH) rather than advanced due to these older patients' frailty, multiple comorbidities, chronic disability, impaired mobility, cognitive dysfunction, as well as limited resources. This results in regression of any functional or physical gains achieved in the medical center. We propose a pilot study trialing an 8-week multimodal rehabilitation program (MRP) for older survivors of critical illness who require prolonged mechanical ventilation in a LTACH. This pilot study tests the hypothesis that an MRP that targets functional mobility, strength, endurance and motivation will improve mobility function (gait and balance), and basic activities of daily living (ADLs), by increasing strength and ambulatory capacity and reducing inflammation more than usual rehabilitation care in these patients. The goal is to show that the physical and functional gains made by these older patients enrolled in our MRP will translate into clinically meaningful outcomes, including increased ambulatory capacity, respiratory muscle strength, improved quality of life and better rates of weaning from mechanical ventilation.