Facilitating Functional Independence in Patients Requiring Prolonged Mechanical Ventilation

 描述（由申请人提供）：在从危重疾病中恢复后，许多患者通常会经历使人衰弱的肌肉萎缩和无力，这对他们的功能恢复产生不利影响。这些后果在需要长时间机械通气的患者中特别常见-这是一个慢性危重患者亚组，对他们来说，恢复特别具有挑战性。目前的康复策略，包括标准的物理治疗，不足以使大多数通气患者恢复到以前的功能水平。 独立因此，这些患者中的许多人需要长期安置在养老院。神经肌肉电刺激（NMES）是一种创新技术，可增强慢性疾病患者的肌肉大小、力量和运动能力。NMES耐受性良好，无不良反应。因为它需要最少的合作，并不负担心肺系统，NMES可能是理想的肌肉和促进功能独立的患者需要长期通气的恢复。因此，本提案的主要目标是测试NMES（结合标准化物理治疗计划）在促进需要长时间通气的患者独立功能活动方面的有效性。为了最大限度地减少与急性危重病相关的混杂因素，将在转移到长期急性护理医院（LTACH）进行延长康复和断奶后招募患者。患者将被随机分配接受双腿四头肌、胫骨前肌和腓肠肌的NMES或假NMES。NMES组和假NMES组都将接受标准化的物理治疗计划。将使用重症监护室（FSS-ICU）功能状态评分量化LTAH住院期间进行功能活动的独立性（主要结局）。还将在LACH出院后3个月和6个月评估NMES对患者报告结局（Barthel指数、SF-36、肺功能状态量表[PFSS]）和基于性能的测量（计时和持续[TUG]测试）的长期影响。NMES在通气患者中的作用机制在很大程度上尚不清楚。因此，将通过测量肌肉大小（使用超声检查）和肌肉功能（使用手持式测力计）研究对NMES的生理反应。从这项研究中获得的关于NMES（与标准化物理治疗计划相结合）疗效的信息可以为需要长期机械通气的患者提供促进功能独立的策略的范式转变。1

 DESCRIPTION (provided by applicant): After recovery from critical illness, many patients commonly experience debilitating muscle wasting and weakness, which adversely impacts their functional recovery. These consequences are particularly common in patients who required prolonged mechanical ventilation -- a subgroup of chronically critically ill patients for whom recovery is especially challenging. Current rehabilitation strategies, including standard physical therapy, are insufficient to restore most ventilated patients to their previous level of functional independence. As such, many of these patients require long-term placement in nursing homes. Neuromuscular electrical stimulation (NMES) is an innovative technique that augments muscle size, strength and exercise capacity in deconditioned patients with chronic diseases. NMES is well-tolerated without adverse effects. Because it requires minimal cooperation and does not burden the cardiopulmonary system, NMES may be ideal for reconditioning the muscles and facilitating the return of functional independence in patients requiring prolonged ventilation. Thus, the primary goal of this proposal is to test the effectiveness of NMES (in combination with a standardized physical therapy program) in facilitating independent functional activities in patients requiring prolonged ventilation. To minimize confounders related to acute critical illness patient will be recruited following transfer to a long-term acute care hospital (LTACH) for extended rehabilitation and weaning. Patients will be randomly assigned to receive NMES or sham- NMES of the quadriceps, tibialis anterior, and gastrocnemius muscles of both legs. Both NMES and sham- NMES groups will receive a standardized physical therapy program. Independence in performing functional activities during the LTACH stay (primary outcome) will be quantified using the Functional Status Score for the Intensive Care Unit (FSS-ICU). The long-term impact of NMES on patient-reported outcomes (Barthel index, SF-36, pulmonary functional status scale [PFSS]) and performance-based measurement (Timed-up and go [TUG] test) will also be assessed at three and six months after discharge from the LTACH. Mechanisms of action of NMES in ventilated patients are largely unknown. Accordingly, physiologic response to NMES will be investigated by measuring muscle size (using ultrasonography) and muscle function (using hand-held dynamometry). Information gained from this study about the efficacy of NMES (in combination with a standardized physical therapy program) could provide a paradigm shift in strategies employed at facilitating functional independence in patients requiring prolonged mechanical ventilation. 1