Standardized Rehabilitation for ICU Patients with Acute Respiratory Failure

ICU急性呼吸衰竭患者的标准化康复

• 批准号: 7636485
• 负责人: PETER E MORRIS
• 金额: $ 56万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-08 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7636485
• 关键词: Activities of Daily Living; Acute; Acute respiratory failure; Affect; Age; Aging; Basic Science; Biological Markers; Budgets; Caring; Clinical; Clinical Trials Design; Consensus; Contracture; Critical Care; Critical Illness; Data; Discipline of Nursing; Dyspnea; Enrollment; Environment; Exercise; Exercise Physiology; Exhibits; Funding; Grant; Heart failure; Hospital Costs; Hospitalization; Hospitals; Inflammation; Intensive Care Units; Joints; Length of Stay; Measures; Mechanical ventilation; Medicine; Muscle Weakness; Nurses; Outcome; Passive Range of Motion function; Patients; Performance; Physical therapy; Protocols documentation; Publishing; Quality of life; Randomized Controlled Clinical Trials; Recovery; Rehabilitation therapy; Research; Research Personnel; Resistance; Safety; Societies; Testing; Time; Training; Treatment Protocols; Upper arm; Work; cost; critical care nursing; depression; experience; follow-up; functional outcomes; functional status; health economics; health related quality of life; improved; innovation; interest; multidisciplinary; novel; public health relevance; respiratory; strength training; treatment as usual; trend

DESCRIPTION (provided by applicant): Acute Respiratory Failure (ARF) requiring mechanical ventilation affects 1.1 million of the 4.4 million people admitted to US Intensive Care Units (ICU) every year. Patients with ARF experience deconditioning, muscle weakness, joint contractures, dyspnea, depression, and reduced health-related quality of life, all of which may contribute to prolonged hospitalization and increased costs. Patients with ARF average 15 hospital days with median costs of $30,000. Critical care rehabilitative therapy for patients with ARF is not uniform in its content, timing or the acceptance of its safety. Our published data indicate that Standardized Rehabilitation Therapy, initiated in the ICU, is feasible and safe. The pilot showed a trend in reduced hospital stay, but functional outcomes were not determined. Therefore, for the acceptance of Standardized Rehabilitation Therapy in US hospitals to advance, this study will demonstrate that Standardized Rehabilitation Therapy for patients with ARF reduces hospital stay through immediate improvement in functional capacity and functional performance. Mechanistically, it is understood that patients with ARF exhibit acute inflammation and since rehabilitation increases functional outcomes and lowers biomarkers of inflammation in heart failure and the frail aging, we will determine whether the anticipated improvements in ARF patient outcomes are associated with a reduction in biomarkers of inflammation. The proposed study will test the following hypotheses: 1) Standardized Rehabilitation Therapy will shorten hospital stay in patients with ARF; 2) Standardized Rehabilitation Therapy will improve objective functional measures and quality of life at 6 months post-enrollment; 3) Standardized Rehabilitation Therapy will reduce biomarkers of inflammation; 4) Standardized Rehabilitation Therapy will decrease hospital costs. We will conduct a two-arm, randomized trial in 326 patients with ARF to compare Standardized Rehabilitation Therapy, initiated in the ICU and administered throughout the hospitalization, vs. Usual Care (control). Standardized Rehabilitation Therapy will consist of: passive range of motion, physical therapy and progressive resistance exercise (strength training). Our unique environment provides a hospital-funded, experienced Mobility Team (7days/week) consisting of a critical care nurse, physical therapist and nursing assistant to administer this protocol. The proposed study is a natural extension of our prior work, is multidisciplinary (Exercise Physiology, Physical Therapy, Nursing, Medicine, Basic Science, Health Economics), is supported by extensive preliminary studies, is innovative, and is responsive to recent society consensus statements. PUBLIC HEALTH RELEVANCE: For patients with ARF, no national standard for the administration of in-hospital rehabilitation exists. Patients with ARF suffer for months after hospital discharge with weakness and decreased quality of life. This study will provide the information for US hospitals to prioritize and budget for the rehabilitation needs of patients with ARF by demonstrating that Standardized Rehabilitation Therapy, initiated in the ICU, reduces hospital stay with immediate and sustained improvement in function and quality of life for patients with ARF.

描述（由申请人提供）：在美国重症监护病房（ICU）每年收治的440万人中，需要机械通气的急性呼吸衰竭（ARF）影响了110万人。ARF患者会出现失调、肌无力、关节挛缩、呼吸困难、抑郁和健康相关生活质量下降，所有这些都可能导致住院时间延长和费用增加。ARF患者平均住院15天，平均费用为30，000美元。ARF患者的重症监护康复治疗在其内容、时间或对其安全性的认可方面并不统一。我们发表的数据表明，在ICU开始的标准化康复治疗是可行和安全的。飞行员显示出减少住院时间的趋势，但功能结果尚未确定。因此，为了促进美国医院对标准化康复治疗的接受，本研究将证明ARF患者的标准化康复治疗通过立即改善功能能力和功能表现来减少住院时间。从机制上讲，可以理解ARF患者表现出急性炎症，由于康复会增加功能结局并降低心力衰竭和虚弱衰老中的炎症生物标志物，我们将确定ARF患者结局的预期改善是否与炎症生物标志物的减少相关。拟议的研究将检验以下假设：1）标准化康复治疗将缩短ARF患者的住院时间; 2）标准化康复治疗将改善入组后6个月的客观功能指标和生活质量; 3）标准化康复治疗将减少炎症生物标志物; 4）标准化康复治疗将降低住院费用。我们将在326例ARF患者中进行一项双臂随机试验，以比较在ICU开始并在整个住院期间进行的标准化康复治疗与康复护理（对照）。标准化康复治疗将包括：被动活动范围，物理治疗和渐进式阻力运动（力量训练）。我们独特的环境提供了一个医院资助的，经验丰富的流动团队（7天/周），由一名重症监护护士，物理治疗师和护理助理组成，以管理此协议。拟议的研究是我们先前工作的自然延伸，是多学科的（运动生理学，物理治疗，护理，医学，基础科学，健康经济学），得到了广泛的初步研究的支持，是创新的，并响应最近的社会共识声明。公共卫生相关性：对于ARF患者，没有关于住院康复管理的国家标准。ARF患者在出院后数月内虚弱，生活质量下降。本研究将为美国医院提供信息，以优先考虑ARF患者的康复需求并制定预算，证明在ICU开始的标准化康复治疗可减少ARF患者的住院时间，并立即持续改善其功能和生活质量。