The Multimodal Rehabilitation of Older Ventilated Survivors Of Critical Illness

描述（由申请人提供）：老年人，机械通气的危重病幸存者是虚弱和功能受损。这些缺陷是由于危重病、慢性合并症、急性ICU住院期间长时间卧床休息以及长期急性护理机构的持续护理造成的。这会导致炎症、肌肉减少症、营养不良、慢性贫血和疲劳、虚弱和残疾恶化。通常，由于这些老年患者的虚弱、多种合并症、慢性残疾、活动能力受损、认知功能障碍以及资源有限，在长期急性护理医院（LACH）中，身体康复是降级的，而不是高级的。这导致任何功能或物理的退化 在医疗中心取得的成就。我们提出了一项试点研究，试验8周的多模式康复计划（MRP）的老年危重病幸存者谁需要长时间的机械通气在LACH。这项初步研究测试了这样一种假设，即针对功能性移动性，力量，耐力和动机的MRP将通过增加力量和走动能力以及减少炎症来改善这些患者的移动功能（步态和平衡）和基本日常生活活动（ADL）。我们的目标是表明，这些老年患者在我们的MRP中所取得的身体和功能方面的进步将转化为具有临床意义的结果，包括提高走动能力、呼吸肌力量、改善生活质量和更好的机械通气脱机率。

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.