The Multimodal Rehabilitation of Older Ventilated Survivors Of Critical Illness

描述（由申请人提供）：老年，危重疾病的机械通气幸存者身体虚弱，功能受损。这些缺陷是由于危重疾病本身、慢性合并症、急性ICU住院期间长时间卧床休息以及他们在长期急性护理机构继续护理造成的。这会导致炎症、肌肉减少、营养不良、慢性贫血以及日益严重的疲劳、虚弱和残疾。通常，由于这些老年患者身体虚弱、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（LTACH），身体康复的升级程度较低，而不是很先进。这会导致任何功能或身体的退化

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.