Inspiratory Muscle Training to Improve Total Joint Arthroplasty Outcomes

吸气肌训练可改善全关节置换术的效果

• 批准号: 10725952
• 负责人: Barbara K Smith
• 金额: $ 22.56万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725952
• 关键词: Academic Medical Centers; Acceleration; Acute; Address; Adult; Age; Anesthesia procedures; Attenuated; Biological; Breathing; Cardiac Surgery procedures; Caring; Chemosensitization; Clinical; Clinical Research; Consent; Controlled Study; Coughing; Data; Day Surgery; Destinations; Deterioration; Dyspnea; Elderly; Enrollment; Evidence based treatment; Exercise; Exploratory/Developmental Grant; Face; Fiber; Frequencies; Future; Generations; Health Services Accessibility; Hospitalization; Hospitals; Hour; Impairment; Individual; Inpatients; Inspiratory Capacity; Knowledge; Learning; Length of Stay; Lower Extremity; Lung; Lung diseases; Mechanical ventilation; Medical; Medical center; Methods; Morbidity - disease rate; Motor; Muscle; Muscle function; Operative Surgical Procedures; Outcome; Patients; Postoperative Complications; Postoperative Period; Preoperative Care; Preparation; Proteolysis; Public Health; Randomized; Readiness; Recovery; Rehabilitation therapy; Replacement Arthroplasty; Research; Resources; Respiratory Diaphragm; Respiratory Muscles; Respiratory physiology; Risk; Risk Factors; Schedule; Shortness of Breath; Smoker; Supervision; Testing; Time; Training; Vital capacity; Walking; clinical practice; comorbidity; follow-up; high reward; high risk; improved; neural; neuromuscular; neuromuscular function; neuromuscular plasticity; novel; patient population; postoperative recovery; prescription opioid; preservation; pressure; pulmonary function; recruit; respiratory; safety net; sex; socioeconomic disadvantage; standard of care; surgery outcome; ultrasound; ventilation

ABSTRACT Total joint arthroplasty (TJA) surgeries are among the most common elective surgeries in the US and projected to increase in frequency. Recent TJA clinical practices have effectively reduced post-operative hospital length of stay, yet despite improvements in the efficiency of TJA care, the effects of TJA surgical procedures on pulmonary and respiratory muscle function are less widely appreciated. Even during surgeries as short as TJA, the administration of anesthesia, neuromuscular inactivity, and mechanical ventilation acutely deteriorate pulmonary function and trigger rapid, significant proteolysis of the primary inspiratory muscle, the diaphragm. However, conventional TJA preoperative care does not conventionally address these issues. Older adults, smokers, and those with significant pre-existing lung disease, multiple medical comorbidities, or socioeconomic disadvantage face the greatest risk for declines in post-operative pulmonary and respiratory neuromuscular function. Most patients who utilize our urban safety-net academic medical center have at least one of these risk factors, which can interfere with acute rehabilitation, increase the risk for post-operative pulmonary complications, and extend hospital length of stay. Thus, we propose a clinical study of preoperative inspiratory muscle training (IMT) among individuals with increased risk for pulmonary post-operative complications. Preoperative IMT has been shown to counteract post-operative inspiratory weakness and reduce postoperative pulmonary complications following prolonged cardiac surgeries, but its potential benefits have not been investigated in shorter surgeries such as TJA, with expected brief post-operative hospitalizations. The central hypothesis of this project is that preoperative IMT is feasible and will improve respiratory strength, hasten the early postoperative respiratory recovery, and optimize functional mobility for hospital discharge. Adults scheduled for TJA with pre-existing respiratory muscle or lung impairment will be randomized to complete either: daily IMT in advance of surgery (dIMT), a single acute IMT session immediately before surgery (aIMT), or usual surgical standard of care (SOC). Follow-up testing on the day of surgery and during the acute post-operative hospitalization will identify the feasibility of IMT (Aim 1), distinguish IMT effects on inspiratory and cough strength, (Aim 2), and evaluate patient readiness for discharge (Aim 3). This high risk, proof-of-principle proposal will provide the first controlled evidence concerning disturbances in the regulatory functions of breathing following TJA. Our plan is that data generated from this study will form the basis for future mechanistic studies of IMT to restore breathing strength and further optimize early rehabilitation following TJA.

摘要 全关节置换术（TJA）手术是美国最常见的择期手术， 增加频率。最近的TJA临床实践有效地缩短了术后住院时间， 然而，尽管TJA护理的效率有所提高，但TJA手术对肺功能的影响仍然存在。 和呼吸肌功能的认识不那么广泛。即使在像TJA这样短的手术中， 麻醉、神经肌肉不活动和机械通气会使肺功能严重恶化。 功能和触发快速，显著的蛋白水解的初级吸气肌，隔膜。然而，在这方面， 传统的TJA术前护理通常不能解决这些问题。老年人，吸烟者， 有显著既往肺部疾病、多种医学合并症或社会经济劣势的患者 面临术后肺和呼吸神经肌肉功能下降的最大风险。最 使用我们的城市安全网学术医疗中心的患者至少有一个这些风险因素， 可能干扰急性康复，增加术后肺部并发症的风险，并延长 住院时间。因此，我们提出了一项临床研究，术前吸气肌训练（IMT）， 肺部术后并发症风险增加的个体。术前IMT已被证明 抵消术后吸气无力，减少术后肺部并发症 长期心脏手术，但其潜在的好处还没有在较短的手术，如 TJA，预期术后短暂住院。 该项目的中心假设是，术前IMT是可行的，并将改善呼吸 力量，加速术后早期呼吸恢复，并优化功能活动度， 出院预先存在呼吸肌或肺损伤的计划进行TJA的成人将 随机分配完成以下任一项：术前每日IMT（dIMT），即刻单次急性IMT治疗 术前（aIMT）或常规手术标准治疗（SOC）。手术当天的随访检测， 在急性术后住院期间将确定IMT的可行性（目标1），区分IMT效应 吸气和咳嗽强度（目标2），并评估患者出院准备情况（目标3）。这种高风险， 原则证明提案将提供有关监管干扰的第一个受控证据。 TJA后的呼吸功能。我们的计划是，这项研究产生的数据将成为未来的基础。 IMT恢复呼吸强度和进一步优化TJA后早期康复的机制研究。